Exam 2 Flashcards
1
Q
Highly emitogenic drugs
A
carboplatin, cisplatin, carmustine, cyclophosphomide, dactinomycin, doxorubicin
2
Q
Receptors in the medulla triggering vomiting
A
cholinergic, histaminic, dopaminergic, opioid, serotonergic, benzodiazepine
3
Q
Sensory input is received from ____ _____ ____.
A
chemoreceptor trigger zone (CTZ)
4
Q
Clinical presentation of nausea and vomiting
A
simple
complex
psychogenic
5
Q
What is simple N&V?
A
infrequent and usually self-limiting
6
Q
What is complex N&V?
A
symptoms not relieved by simple, mono therapy
7
Q
What is psychogenic N&V?
A
deep emotional cause
8
Q
When is antiemetic therapy indicated?
A
electrolyte imbalances or dehydration
anorexia or weight loss
refuse potentially curative therapy
9
Q
What is the treatment for simple N&V?
A
nothing-symptomatic relief, spontaneous resolution
10
Q
When is lack of relief most debilitating in simple N&V?
A
in patients receiving mitogenic chemotherapy
11
Q
Pharmacotherapy consideration of N&V
A
most conditions require mono therapy, if symptoms continue or get worse, consider combination therapy
12
Q
What is the treatment of simple N&V?
A
usually minimal and usually effective in small, infrequent doses
- numerous OTC agents
- Prescription antiemetics
13
Q
What is treatment of complex N&V?
A
more aggressive compared to simple,
often with 2 or more drugs in small-moderate doses
Achieve control via 2 mechanisms
14
Q
What are the OTC antacids available? (3)
A
magnesium hydroxide
aluminum hydroxide
calcium carbonate
15
Q
How do antacids work?
A
neutralization of gastric acidity
16
Q
When are antacids used?
A
heartburn and GERD
17
Q
What are the AE of antacids?
A
MG: osmotic diarrhea
Ca/AI: constipation
18
Q
When are Histamine 2 Antagonists used? (H2RAs)
A
simple N&V of heartburn
19
Q
How do H2RAs work?
A
they competitively inhibit histamine at H2 receptors
20
Q
What does low toxicity and short half life allow of H2RAs?
A
daily or BID dosing
21
Q
What are common OTC histamine 2 antagonists? (4)
A
cimetidine (Tagamet HB)
Famotidine (Pepcid AC)
Nizatidine (Axid AR)
Rantidine (Zantac)
22
Q
Why is cimetidine (Tagamet) used less out of the OTC Histamine 2 antagonists?
A
potential drug interactions
23
Q
How do anticholinergics work?
A
interrupt visceral afferents
24
Q
What are anticholinergics useful for?
A
simple N&V
25
What are the AE of Anticholinergics? (5)
```
drowsiness
confusion
blurred eyes
dry mouth
urinary retention
```
26
What are the common anticholinergics? (5)
```
Diphenhydramine (Benadryl)
hydroxyzine (ataraxic, vistaril)
meclizine (antivert)
Promethazine (phenergan)
Trimethobenamide (Tigan)
```
27
Accidental intra-aterial injection of Promethazine (phenergan) has caused what?
intravenous thrombosis
nerve damage
paralysis
tissue necrosis and gangrene
28
What is the limit concentrations of promethazine (phenergan)?
25mg/mL max
29
How is promethazine given?
IVPB NOT IVP
| large bore needle to large veins. Inject into farthest port of running IV
30
What are the most widely prescribed antiemetics?
Phenothiazines
31
How do phenothiazines work?
block dopamine receptors in the CTZ
32
What are SE of phenothiazines?
```
extrapyramidal reactions
hypersensitivity
liver dysfunction
marrow aplasia
excessive sedation
```
33
What are the common phenothiazines? (2)
prochlorperazine (compazine)
| chlorpromazine (thorazine)
34
What are Butyrophenones?
competitive D2 antagonists
35
What are the 2 agents of Butyrophenones?
haloperidol (haldol)
| droperidol (Inapsine)
36
When are butyrophenones used?
moderately emitogenic chemotherapy
37
What are the adverse reactions of Butyrophenones?
```
sedation and dystonias (usually occur late in therapy and typically respond to IV diphenhydramine)
QT prolongation (esp haldol)
```
38
What are the effective corticosteroids for N&V? (2)
methylprednisolone (solu-medrol, IV)
| Dexamethasone (Decadron, IV)
39
Corticosteroids are NOT indicated for SNV. why?
due to secondary risks
40
How was metoclopramide (reglan)work?
dopaminergic blockade
| accelerates GI transit (pro kinetic)
41
What are the AE of metoclopramide?
fairly well tolerated at high IV doses- but extrapyramidal effects
42
How do you treat extrapyramidal effects of metoclopramide (reglan)?
treat with IV diphenhydramine
43
What is metoclopramide frequently combined with?
benzodiazepines
corticosteroids
antimuscarinics
H1RAS
44
When are selective serotonin antagonists useful?
in CINV with highly emitogenic agents
| *increasingly important in recent years)
45
What are available agents of Selective serotonin antagonists? (4)
ondansetron (zofran) generic
granisetron (kytrol, sancuso)
dolansetron (Anzemet)
Palonsetron (Aloxi)
46
When are combination regimens used?
reserved for patients with CNV & CINV
47
What is the goal of combination regimens?
use agents with different MOAs to limit toxicities
48
What steroid is best studied?
dexamethasone
49
When is dexamethasone beneficial?
helpful in patients with delayed NV & in combination with metoclopramide and lorazepam
50
What is unique to cytotoxic chemo?
Anticipatory VN (ANV)
51
Who experiences ANV?
up to 25% of chemo patients especially with high emitogenic
52
What med works best for ANV?
benzodiazepines (Ativan & valium)
53
What are common causes of post op N;V?
surgery of the abdomen, eye, ear, nose & throat
54
What is the female to male ratio in post op N&V?
3:1
55
What is the ratio of children to adults for post op N&V?
2:1
56
What are risk factors for post op N&V?
| What medication has a high risk for post op N&V?
obesity
increased age
h/o motion sickness
prior post op N&V
inhaled anesthetics cyclopropane &
N2O are especially emitogenic
57
What meds are very effective for post op NV?
serotonin antagonists
58
What percentage of pregnant women experience N&V?
50%
59
What dictates what antiemetic will be used in pregnancy?
teratogenicity
60
What are the current recommendations of antiemetics and pregnancy?
Peridoxine (vitamin B6)
| Antihistamines (antivert, bendryl, doxylamine)
61
What are recommended antiemetics and children? (3)
corticosteroids
diphenhydramine
serotonin receptor antagonists
62
What can few GERD cases progress to?
erosive esophagitis
63
What do serious symptoms of GERD require?
serious symptoms may require intensive acid-suppressive therapy & long term maintenance therapy
64
What are the 2 factors involved in GERD?
defensive factors
| aggressive factors
65
What is the omeprazole test?
omeprazole 40-60mg daily x 7 days
66
What are the phases of GERD treatment?
Phase I: lifestyle changes
| Phase II: OTC & prescription intervention
67
Which antacids are the most effective?
chewable tabs
68
What SE can be caused by combination products for GERD therapy?
diarrhea constipation
demineralization
drug-drug interactions
69
What is the standard dose for nonerrosive GERD?
twice daily
70
What is the dose for nonresponders and erosive disease for GERD?
high dose &/or QID
71
What is the duration of therapy for GERD?
longer than or PUD
PUD: 4-6 weeks
GERD: 8 weeks or more (12-16)
72
What are the SE of cimetidine(Tagamet)
several drug-drug interactions including warfarin
73
How do PPIs work?
inhibit gastric H+/K+ ATP pump that result in potent acid suppression
74
PPIs only inhibit what?
actively secreting pumps
75
How should PPIs be taken?
dose 15-30 mins before breakfast (and before meals or snack and 12h later if BID
76
What is the S-isomer of omeprazole and "proven superior"?
esomeprazole
77
What are the AE of PPIs?
diminished therapeutic effect of clopidogrel (pantoprazole effects less)
osteoporosis- bone fractures (Ca needs acid for absorption)
Hypomagnesemia
78
What supplements should be taken with PPIs think: osteoporosis?
Ca and VIt D supplements
79
How long should PPIs be used?
lowest effective doses for the SHORTEST duration
80
PPIs are well tolerated with -____ side effects
few
81
What is a pro kinetic agent?
metoclopramide (reglan)
82
Why do pro kinetics have limited use in GERD?
profiles of bethanecol & metoclopramide limit their use in GERD
83
What is the main mucosal protectant?
sucralfate (carafate)
84
How do mucosal Protectants work?
binds to exposed mucosal ulcers (protein changes) and prevents acid contact to promote healing
85
When are mucosal protectants used?
only for mildest forms of GERD
86
What is the dose of sucralfate (carafate)?
1 gram QID
87
What drug is the effective for mild maintenance therapy of GERD?
H2RAs
88
What is usually the drug of choice for maintenance therapy of GERD?
PPIs
89
What is significant about GERD in the elderly?
many elders have decreased mucosal defenses
90
Why are PPIs the drug of choice for GERD in the elderly?
superior efficacy
| once daily dosing
91
What are the 3 common forms of PUD?
H pylori- associated
NSAID- induced
stress ulcers
92
What are the terms associated with PUD?
dyspepsia-uninvestigated dyspeptic symptoms
| Non ulcer dyspepsia-dyspeptic symptoms & negative endoscopy
93
What percentage of Americans will develop PUD?
10%
94
What might be the reason why PUD mortality has decreased overall but has INCREASED in the elderly?
Increased NSAID use?
95
Most peptic ulcers are caused by: (4)
acid
pepsin
H pylori
NSAID
96
What is the cytoprotection of mucosa?
mucosal integrity is maintained by endogenous prostaglandins
(COX-1)
97
Mucosal defense and healing is a balance of what?
agressive and defensive factors
98
Most its with PUD have H pylori, but _____ of H. pylori infections develop PUD
15%
99
How does H pylori affect PUD?
infection leads to hypersecretiojn of gastric acid
100
What percentage of regular NSAID users develop duodenal ulcers?
15-30%
101
How do NSAIDs damage the mucosa?
direct or topical irritation
| systemic inhibition of endogenous GI mucosal PG synthesis
102
What are the complications of PUD?
upper GL bleed (mortality is 6-10%)
Peforation
Obstruction
103
What is the COX-1 selectivity for aspirin?
166
104
What is the COX-1 sensitivity for ibuprofen?
15
105
What is the COX-1 sensitivity for naproxen?
0.6
106
What is the COX-1 sensitivity for etodolac?
0.1
107
What is the COX-1 sensitivity for selective COX 2 inhibitor?
0.0025
108
What are the general recommendations of PUD? (3)
1. eliminate or reduce psychological stress, ciggs and NSAIDs
2. minimize and eliminate alcohol
eradicate HP (use diff abs if second course is required)
109
What is the main treatment recommendation for PUD with H2RA or PPI?
high-risk patients with ulcer complications
patients who fail HP eradication
Pts with h pylori negative ulcers
110
When should a PPI or PPI + misoprostol be given?
The NSAID cannot be discontinues and the ulcer is large. patient is at risk of developing serious ulcer related complications
111
What is the efficacy of H pylori treatment with 3 drug regimens?
> 90%
112
What are the preferred regimens for treatment of H pylori?
Clarithromycin 500mg BID
Amoxicillin 1g BID
PPI BID
ALL for 14 days
can switch amox with metronidazole 500mg BID x 14 days
113
When was the prepackaged regimen for H pylori Helidac discontinues?
Dcd by manufacturer 4/25/14
114
What are the 2 prepackaged H pylori regimens?
Prevpac (1 pack is 14 days)
| Pylera
115
What are the conventional treatments of active peptic DUODENAL ulcers?
PPIs x 4 weeks
H2RAs x 4 weeks
Sucralfate x 6 weeks
OTC antacids x 8 weeks
116
How is the conventional treatment of gastric ulcers different compared to duodenal ulcers?
same meds but higher doses with a longer duration. Gastric ulcers are usually larger than duodenal
117
What is the cause of most refractory ulcers?
H pylori positive
118
How do you treat refractory ulcers?
doubling the dose heals most refractory ulcers
119
When is prostaglandin-misoprostol used?
in patients that are unable to stop NSAID use
120
What kind of prostaglandin is misoprostol?
exogenous
121
What is the mechanism of misoprostol?
replaces endogenous PGs lost by NSAID- mediated COX- 1 inhibition
122
What are the AE of misoprostol?
GI
| N&V 100% lasts < 3 days
123
What is a common AE of misoprostol in 10% of pts?
myelosuppression
124
What category is misoprostol for pregnancy?
category X
125
What is the unlabeled use of a PPI for prevention of rebleeding in PU bleed? And the dosage?
pantoprazole (protonix)
80mg IVP x1
then 8mg/hr CIV x 72 hours
126
Why is 40mg of pantoprazole not given for PPI prevention of rebelled in PU bleed?
40mg infusion daily does NOT raise gastric pH sufficiently to enhance coagulation in active GIB
127
What is the general approach to pharmacotherapy in GI?
question about diet and concurrent medications
128
How can fiber affect diet?
Fiber without fluids will WORSEN constipation
129
What are the medications for constipation in order of increasing effectiveness? (7)
emollient laxatives (stool softeners)
lubricants
bulk forming laxatives (fiber)
saccharides (lactulose and sorbitol)
Stimulants (Dipenylmethane/Antheaquinon Derivatives)
Saline Cathartics (Mg, SO4, PO4, Citrate)
Polyethylene Glycol- Electrolyte lavage solution
130
How do emollients, stool softeners, work?
they absorb water by increasing surface tension, acts as surfactants
131
What is an example of an emollient?
docusate
132
What is an example of a combined medication including an emollient?
pericolace (docusate & senna)
133
What is the only lubricant in routine use for constipation?
Mineral oil
134
What are common side effects of lubricants? (2)
may be aspirated (chemical pneumonitis)
| decreases absorption of fat soluble vitamins
135
What do bulk forming laxatives require to be affected?
sufficient fluid intake
136
How long is the onset of bulk forming laxatives?
12 hours- 3 days
137
What are the benefits of bulk forming laxatives compared to other meds for constipation?
minimal side effects
| safe for pregnant females**
138
Lactulose is a synthetic ______.
disaccharide
139
How does lactulose work?
It's metabolized by colonic bacteria to low MW acids resulting in osmotic effect in the colon
140
Sorbitol is a ______ with osmotic action.
monosaccharide
141
How do stimulants work for treating constipation?
function by stimulating peristalsis
142
What are examples of stimulants? (2)
Senna
| bisacodyl
143
When are stimulants not recommended for constipation? (2)
pregnancy
| for regular daily use
144
How do saline cathartics medications work for constipation?
increase intestinal water by osmotic pressure, water moves into hypertonic GI tract, swelling stretched GI wall and increases peristalsis
145
How soon will higher doses of saline cathartics work?
2-6 hours (more cramping compared to lower dosage)
146
What are PO examples of saline cathartics?
milk of magnesia
| magnesium citrate
147
What medication is commonly used prior to diagnostic examination?
saline cathartics
148
What medication is used to cleanse bowel for procedures (colonoscopy)
polyethylene glycol (PEG) electrolyte lavage solutions
149
How much polyethylene glycol (PEG) electrolyte lavage solutions needs to be ingested?
4L
150
When can polyethylene glycol (PEG) electrolyte lavage solutions be discontinued?
when stools turn clear
151
Why is important to wait until you get home to start polyethylene glycol (PEG) electrolyte lavage solutions?
rapid onset of action!
152
What are examples of polyethylene glycol (PEG) electrolyte lavage solutions?(2)
GoLytely
| Miralax
153
What is important to remember when starting opioids?
anticipate and prophylax for OIC (opiate induced constipation)
154
Does tolerance develop to OIC?
NO
155
What are the Peripherally acting mu-opiod receptor antagonists (PAMORAs) prescribed for OIC?
```
Methylnaltrexone bromide (Relistor)
Naloxegol (Movantik)
```
156
What is the MOA of methylnaltrexone bromide (Relistor)?
inhibition of peripheral GI mu receptors
157
What kind of derivative is methylnaltrexone bromide (Relistor) and how does it work?
quaternary naltrexone derivative, limits CNS access
158
How are are the PO and SC doses of methylnaltrexone bromide (Relistor)?
PO: $1600/month
SC: $3300/month
159
What is a SE of methylnaltrexone bromide (Relistor)?
may precipitate symptoms of opioid withdrawal
160
Does methylnaltrexone bromide (Relistor) affect opioid analgesic affects?
NO- limited CNS access
161
What is the MOA of Naloxegol (Movantik)?
inhibition of peripheral GI mu receptors
162
Why does Naloxegol (Movantik) have limited CNS access?
its naloxone conjugated with PEG polymer
163
What is the pregnancy category of Naloxegol (Movantik)??
Category :C
164
What are the side effects of Naloxegol (Movantik)?
may precipitate symptoms of opioid withdrawal
| may reduce analgesia with disruptions to blood brain barrier
165
What is important to determine with diarrhea that is a symptom of a disease?
infectious vs non-infectious
166
What usually causes acute diarrhea?
viral gastroenteritis
167
What are the 2 things about BM in acute diarrhea?
BMs are frequent and never bloody
168
What is important to maintain with clinical presentation of diarrhea?
medication history to identity drug induced diarrhea
169
What are common drugs classes that cause diarrhea? (3)
Laxatives
Mg-containing antacids
Antibiotics (mostly broad spectrum)
170
What are the 4 mechanisms that cause diarrhea?
osmotic diarrhea
secretory diarrhea
altered transit
infection (exudative)
171
What is an example of antibiotic-associated diarrhea?
clostridium difficle
172
How can you differentiate from osmotic diarrhea and secretory?
fasting will control osmotic diarrhea, if secretory diarrhea will persist with fasting
173
how can water and electrolytes be replaced?
if not severe, enteral is preferred since less costly
174
What are pharmacologic therapies for diarrhea?
opiates and opiate derivatives
adsorbants
anti secretory agents
175
Why are opiates little used for diarrhea treatment?
due to decrease respiratory rate and decreased peristalsis
| some opiates were developed specifically for this indication
176
What are examples of opiate/opiate derivatives for diarrhea?
loperamide (Imodium)
| Diohenoxylate/atropine (lomotil)
177
What is the MOA of adsorbents for diarrhea?
coat the GI tract walls-absorbing toxins
178
What are examples of adsorbents? (2)
```
bismuth salts (pepto bismol)
Kaolin & pectin (kaopectate)
```
179
What is a SE of all adsorbents?
may inhibit other drug absorption
180
What are common anti secretory agent medications?
```
bismuth subsalicylate (pepto bismol)
Octreotide (sandostatin)
```
181
Other than diarrhea when else will octreotide be used?
carcinoid tumors $$$$$$$
182
Traveler's diarrhea is commonly caused by what?
e-coli
183
How is travelers diarrhea treated?
fluoroquinolone antibiotics
| cipro 500mg BID x3 days
184
What causes C. dif diarrhea?
the MINOR anaerobic gut flora dominates gut flora after broad spectrum antibiotics
185
What are the treatments for c diff diarrhea? (3)
metronidazole
vancomycin (if failed metronidazole)
rifaximin (xifaxin)
186
What are the 2 principal types of IBD?
ulcerative colitis
| crohns disease
187
What IBD is associated with "crypt abscesses" and "pseudo polyps"?
ulcerative colitis
188
What IBD involved the colon and rectum?
ulcerative colitis
189
What IBD involves the mouth to anus
crohns disease
190
What IBD involves transmural inflammation (deep ulcers), "cobblestone appearance", and often skip lesions
Crohn's disease
191
Why is 'infectious' an etiology for IBD?
up to 1/3 of CD patients have altered anaerobic bowel flora
192
Which IBD has a greater genetic component?
Crohn's
| first degree relatives have a 10X increased incidence
193
What suggests that IBD has an immunological etiology?
responsiveness to immunosuppressive drugs (CS's azathioprine)
194
What are common extra intestinal manifestations of IBD?
arthritis/arthralgias
| hepatobiliary (increased LFTs)
195
What are the common clinical signs and symptoms for IBD for mild?
Mild: <4 stools/day with or without blood, ESR normal
196
What are the common clinical signs and symptoms for IBD for moderate?
Moderate: > 4 stools/day, minimal systemic effects
197
What are the common clinical signs and symptoms for IBD for severe?
Severe: >6 stools/ day with blood, systemic OR ESR>30
198
What are the non pharmacological IBD treatments? (3)
nutritional support
medical management
surgery
199
When to consider nutritional support for IBD treatment?
"short gut" secondary to multiple small bowel resections (Crohns patients)
200
What type of IBD is surgery curative?
ulcerative colitis
201
What are the IBD pharmacology treatments? (5)
```
anti-inflammatory agents
corticosteroids
antibiotics
immunosupressants/immune modulators
Pain control
```
202
How can corticosteroids by given? and what determines route?
PO, IV or PR
| severity dependent
203
What is the corticosteroid dose for moderate to severe IBD?
prednisone 40-60mg daily PO
204
What is the generic cost of prednisone per month?
205
Which corticosteroid has minimal systemic absorption and can cost $600/month?
budesonide
206
what are the immunosuppressant agents used for IBD? (4)
Azathioprine (AZA)
6-mercaptopurine (6MP)
cyclosporine (CSA)
Methotrexate (MTX)
207
What immusuppressant agents are used for steroid refractory UC & CD?
Azathioprine (AZA)
| 6-mercaptopurine (6MP)
208
What immunosuppressant is used for acute, severe ulcerative colitis?
cyclosporine (CSA) by CIV
| 4mg/kg/d
209
What type of biologics are used for IBD? and examples (2)
anti TNF
| Infliximab, Remicade
210
What are the biologics class prototypes now available?
"biosimilars"
211
What are the Biologics- chimeric monoclinal antibodies?
75% human; 25% mouse
212
What is important to do prior to starting biologics (Anti TNF)?
numerous deaths from TB therefore all patients need PPD test BEFORE therapy
213
How much are Anti-TNF agents (biologics) monthly?
$3-10K/monthly
214
What biologics are restricted to patients who fail steroids, immunosuppressants, or anti TNF agents?
anti-integrin antibodies ($6-12K/monthly)
215
What antibiotic is mainly used for active crohns disease for perineal lesions or fistulas?
metronidazole (flagyl)
216
What is the usual adult dose of metronidazole for IBD therapy?
500mg po TID
217
What other 2 antibiotics besides metronidazole are used for IBD?
ciprofloxacin (500mg Q12)
| clarithromycin
218
What is a selected complication of IBD especially in ulcerative colitis?
toxic megacolon- may be life threatening
219
What medication is used for mild IBD?
Sulfasalazine PO 3-6g/daily every 6 hours
220
What medication used for moderate IBD?
Sulfasalazine PO 3-6g/daily every 6 hours
| Prednisone PO 40-60mg/daily
221
What mediation is used for severe IBD?
IV steroids
| Hydrocortisone (solucortef) 100mg IVP every 6-8 hours OR methylprednisolone (solumedrol) 20-40mg IVP every 6 hours
222
What GI disorder is characterized by symptom constellation?
Irritable bowel syndrome (IBS)
223
What are common complaints of IBS?
pain & bloating
224
What are the proposed features of IBS? (3)
altered bowel motility
visceral hypersensitivity
psychosocial factors
225
What is the currently primary means of IBS identification?
symptoms
| dominant symptoms remain constant in 75%
226
What are the alarm symptoms of IBS that may suggest organic disease? (7)
```
weight loss
rectal bleeding
anemia
steatorrhea
fever
family h/o colon ca
initial onset after 50
```
227
What are the 3 subgroup classifications of IBS?
```
diarrhea-predominant (IBS-D)
constipation predominant (IBS-C)
Mixed pattern (IBS-M)
```
228
What are the IBS treatments for pain? (3)
Anticholinergic (antispasmodica) agents
Triclyclics
SSRIs
229
What are examples of Anticholinergic (antispasmodica) agents?
```
hycosamine
Atropine combo (lomotil)
```
230
What are the examples of tricyclics used for IBS pain?
amitriptyline (elavil)
| Desipramine (Norpramin)
231
What are the examples of SSRIs used for IBS pain?
Paroxetine (Paxil)
Citalopram (lexapro)
Fluoxetine (Prozac)
232
What medications are used in diarrhea predominant IBS?
loperamide
diphenoxylate
Cholestyramine (questran)
233
What medication was originally withdrawn of GlaxoSmithKline in 2000 to due 70 cases is ischemic colitis but reproved by FDA in 2002 with restrictions?
Alosetron (Lotronex)
234
When is Alosetron (Lotronex) indicated?
for females with IBS-D & no response to other antidiarrheal agents greater than 6 months
235
What medication is an opioid mu receptor agonist and mu receptor antagonist (mixed) due decrease GI motility and water secretion?
Eluxadoline (Viberzi)
236
What classification is Eluxadoline (Viberzi)? and why?
scheduled IV
| may cause euphoria and drunkedness
237
What are the treatment options for IBS-C
osmotic laxative
lactulose
lubiprosone (Amitiza)
Linaclotide (Linzess)
238
What type of medication is approved for idiopathic constipation that is a PGE-1 derivative, activates chloride channels, and produced Cl rich fluid secretion?
lubiprosone (Amitiza)
239
What are the SE of lubiprosone (Amitiza)?
```
diarrhea (13%)
headache (13%)
abdominal distention (7%)
abdominal pain (7%)
flatulence (6%)
```
240
What medicine approved for IBS-C is a guanylate cyclase C agonist that increases fluid secretion and increases GI motility?
Linaclotide (Linzess)
241
What are the AE of Linaclotide (Linzess)?
```
diarrhea (20%)
abdominal pain (7%)
```
