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GI Final > Drugs that affect Water Balance > Flashcards

Drugs that affect Water Balance Flashcards

1
Q

What are five classes of drugs that affect Chloride secretion?

A

CIC-2, GC-C, CFTR inhibitors, Somatostatin analogues, Bismuth Subsalicylate

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2
Q

What CIC-2 drug do you need to know?

A

Lubiprostone

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3
Q

What is the MOA for Lubiprostone?

A

Activates CIC2 which increases Cl secretion.

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4
Q

What is the therapeutic use for Lubiprostone?

A

Chronic constipation, Constipation - IBS

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5
Q

What are side effects of Lubiprostone?

A

Diarrhea, Nausea, HA, Increased fetal loss making it a Class C drug

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6
Q

What about Lubiprostone’s absorption?

A

Poorly absorbed so almost no systemic effects.

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7
Q

What GC-C drug do you need to know?

A

Linaclotide

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8
Q

What is the MOA for Linaclotide?

A

Activates guanylyl cyclase C which increases cGMP and activates CFTR and increases Cl- secretion which increases water in lumen.

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9
Q

What is the therapeutic use for Linaclotide?

A

Chronic constipation, Constipation-IBS

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10
Q

What are the side effects of Linaclotide?

A

Diarrhea, Increased maternal death which makes it a Class C drug, Inc. mortality in juvenile mice.

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11
Q

Who should you NOT give Linaclotide to?

A

DO NOT give to kids.

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12
Q

What about Linaclotide’s absorption?

A

Very little systemic absorption.

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13
Q

What CFTR inhibitor do you need to know?

A

Crofelemer

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14
Q

What is the MOA for Crofelemer?

A

Voltage dependent inhibition of CFTR and another Cl- channel which leads to decreased Cl- secretion and decreased Na+/H2O excretion and firm stools

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15
Q

What is the therapeutic use for Crofelemer?

A

Diarrhea due to HIV drug treatment.

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16
Q

What about the absorption of Crofelemer?

A

Very little systemic absorption.

17
Q

What Somatostatin Analogue do you need to know?

A

Octreotide

18
Q

What is the MOA of Octreotide?

A

Dec. fluid secretion. Low dose increases motility and high dose decreases motility.

19
Q

What is the therapeutic use for Octreotide?

A

Off label use of severe diarrhea due to Dumping syndrome, short bowel syndrome, Vagotomy and AIDs

20
Q

What side effects are associated with Octreotide?

A

Impaired pancreatic secretion (dec. fat absorption which leads to VitaADEK defeiciency). Decreased GI motility (dose dependent - nausea, pain, flatulence), Decreased Gallbladder contractility (gallstones - 50 percent and acute cholecystitis (rare)), Insulin/glucagon imbalance, hypothyroidism and bradycardia.

21
Q

What should you know about the synthetic somatostatin analogue (Octreotide)?

A

Longer half life (SS 1-5 hrs, Oct 6-12 hours)

22
Q

What is the MOA of Bismuth Subsalicylate?

A

Salicylate decreases PG and Cl- secretion in large intestine. Antimicrobial, binds enterotoxin.

23
Q

What is the therapeutic use of Bismuth Subsalicylate?

A

Prevention/treatment of Traveler’s diarrhea. Opiates are a better choice once diarrhea has started.

24
Q

What are the side effects of Bismuth Subsalicylate?

A

Black stool, Black tongue, High dose - salicylate toxicity like tinnitus, acid/base disturbances, etc.

25
Q

What six drugs are osmotic cathartics?

A

Lactulose, Magnesium, Hydroxide, Sodium phosphate, Polyethylene glycol, Electrolyte solution

26
Q

What is the MOA for Osmotic Cathartics?

A

Not absorbed which increases H2O in lumen by osmosis.

27
Q

What is the therapeutic use of Osmotic Cathartics?

A

Constipation - especially when enteric NS is disrupted.

28
Q

What are the side effects of Lactulose?

A

Dec. plasma [Ammonia] which leads to portal systemic encephalopathy. Its metabolized by microbiome which leads to severe cramps.

29
Q

What are the side effects of Osmotic Cathartics?

A

Most are safe in most patients.

30
Q

What are the side effects of Mg(OH)2?

A

Hypermagnesium in patient with kidney failure.

31
Q

What can happen if Osmotic laxatives are absorbed systemically?

A

All can cause intravascular volume depletion and electrolyte imbalance (inc. PO4, dec. Ca2+, inc. Na, dec. K)

32
Q

What are the Bile Acid Binding Resins?

A

Cholestyramine, Colestipol

33
Q

What is the MOA for Bile Acid Binding Resins?

A

BABR bind unabsorbed bile acides and dec. H2O secretion.

34
Q

What is the therapeutic use for BABRs?

A

Dec. reabsorption of bile sales which leads to secretory diarrhea in Crohn’s disease and resection of terminal ileum.

35
Q

What are the side effects of BABRs?

A

Frequent “untoward” GI effects like bloating, gas, constipation, fecal impaction. Impaired absorption of other drugs and ADEK.

GI Final (9 decks)

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