Elimination Flashcards
What is the main function of the small intestines? Large intestine?
SI: Absorption of nutrients
LI: Reabsorption of water
- Vit B + K synthesis
Describe the positive feedback of HCl.
Gastrin secreted by G-cells….
> > Production of HCl acid (by parietal cells)»_space; Proton pump releases HCl (mediated by H, K, ATPase)
> > Histamine»_space; binds to H2 receptors (stim. by parietal cells)»_space; Increases HCl production
Foveolar or Goblet cells secrete ______.
Mucous, HCO3
Anatacid
Neutralizes existing avid by increasing stomach pH without decreasing HCl production.
- Sx relief only
- Unscheduled
**2 hours post/pre other PO meds
What 2 drug classes does Magnesium hydroxide (Milk of Magnesia) belong to?
- Antacid
S/e: diarrhea - Saline/Osmotic laxative
- Best for pre-procedure
- 1-3 hours (fast onset)
Bismuth Subsalicylate
(Pepto-Bismol)
- 3 drug classes
- Antacid
- Anti-infective
- Anti-diarrheal
How do PPIs differ from H2-receptors?
PPI has higher efficacy + longer t1/2.
Ranitdine (Zantac)
Selectively inhibits H2-receptor to decrease HCl production (H2-receptor blocker)
*Doesn’t cross BBB = no drowsiness
Complications of diarrhea
- Electrolyte imbalance
- Dehydration
- Malabsorption
Opioids
- S/e
- Contraindications?
Antidiarrheal
S/e: CNS depression
Contraindication: pregnancy, drug abuse
Lomotil (dyphenosylate)
Atropine (Antidiarrheal)
Low dose: OTC
High dose: Rx
Imodium (Loperamide HCl)
- Meperidine + atropine
Atropine (Antidiarrheal)
Metamucil
Bulk forming laxative
- Must take w/ water
- Onset: 1-2 days
Lactulose
Saline + Osmotic laxative
- Best for pre-procedure
- Fast onset: 1-3 hrs
- Contraindication: lactose intolerance
GoLytely
Saline + Osmotic laxative
- Best for pre-procedure
- Fast onset: 1-3 hrs
Ducolax; Senna; Castor oil
Stimulant laxative
**Not first choice for constipation + pre-surgery
S/e: N+V, cramping
Colace (Docusate sodium)
When is it mainly used?
Softener (laxative)
- *Mainly used for post-MI + surgery
- Decreases straining
Mineral oil; Glycerine
Laxatives
- Lubrication
- Supplementary tx
Cathartics Enema
A pre-procedural bowel preparation that expands the bowel for fast evacuation
- Have pt lie on their LS
Gasex
Tx: bloating
Gravol (dimenhydrinate + cholortheophyline) Ginger gravol (OD s/e??)
H1 antagonist
Ginger gravol OD:
- Bleeding
- CNS depression
Tx for motion/morning sickness; Nausea
Reduces vestibular excitation.
- H1 antagonists
- Antimuscarinic anticolinergics
Tx for drug-induced pain; Chemo/visceral pain
5HT3 (serotonin) antagonists
Tx for GI pain
Phenothiazines (D2-receptor antagonism) - stimulates GI motility
Tx for Chemo/Chronic disease
Cannabinoids (CB 1, CB 2 agonism) - binds to receptor that stimulates GABA
Dramamine (Meclizine)
H1 antagonist
Diclectin (doxylamine + pyridoxine hydrochloride)
H1 antagonist
**For pregnant women
Scopolamine (Hyoscine)
Antimuscarinic anticholinergic
- Has some affinity to H1-receptors
Ondansetron (Zofran)
- What is its drug schedule?
5HT3 antagonism
- Rx only!
Metoclopramide
(Maxeran, Reglan)
- s/e?
- Drug schedule?
Phenothiazines (D2-receptor antagonism)
s/e: sedation
- Rx only
Prochlorperzine (Stemetil)
- s/e?
- Drug schedule?
Phenothiazines (D2-receptor antagonism)
s/e: sedation
- Rx only
Dronabinol (Marinol); Cesamet/Nabilone;
Cannabis
Cannaboids
Traveler’s Diarrhea
- Tx and PK?
Diarrheal condition usually caused by bacteria.
Tx: Ciprofloxacin
- 70% bioavailability
- Directly binds to bacteria in GI
- t1/2 = 4 hours
C. difficle
- Type of infection?
- Clinical presentations?
- Tx?
Destroys intestinal lining by releasing Toxin A (enterotoxin) and Toxin B (cytotoxin).
- HAI (esp. in elderly)
Presentations:
- *Bloody diarrhea w/ pus
- Fever
- Ab. pain
Tx:
1st line: FLAGYL (Metronidazole)
2nd line: VANCOMYCIN
Tenesmus
The feeling of incomplete defecation
Dysentery
Bloody diarrhea
IBS
- Triggers?
Inflammatory Bowel Syndrome - CNS dysregulation of normal motility
Triggers: stress, menstruation, diet, food intolerances
S+S:
- Ab pain, discomfort, cramping, bloating, diarrhea/constipation
Fecal impaction
A procedure that removes a mass of stool.
If not removed , can cause partial/complete bowel obstruction
Hirschsprung Disease
Congenital disease that causes issues w/ peristalsis in GI.
- D/t parasympathetic ganglion n. cells (responsible for bowel mvt) in the wall of colon not developing before birth
Paralytic ileus
“Pseudo-obstruction” - Impaired bowel motor activity w/o physical obstruction.
- Often d/t surgery
What are factors that affect constipation?
- Diet
2. Perstalsis
