Final exam lecture 6

Question 1

Name two stimulant laxatives with dosing

Answer 1

Senna (2 tabs 1-2 x daily)
Bisacodyl (1-2 tabs daily)

Question 2

MOA of stimulant laxatives

Answer 2

locally stimulate enteric nerves which stimulates contraction and mobility and increases fluid secretion into lumen

Question 3

advantage vs disadvantage of stimulant laxatives

Answer 3

ADVANTAGES
Drug of choice for opioid induced constipation
quick onset
works` in pts with motility disorders

DISADVANTAGES
Risk of nausea and cramping
Avoid long term use in pts with normal GI activity

Question 4

Stimulant laxative for very quick onset

Answer 4

Bisacodyl suppositories

Question 5

drugs used for chronic isiopathic constipation after all else fails

Answer 5

Lubiprostone
Linaclotide
Plecanatide
Lactitol

Question 6

Therapeutic options for acute constipation relief within 1 hr

Answer 6

Enema (saline, tap water or soap duds)
Bisacodyl or glycerin suppository

Question 7

Therapeutic options for acute constipation relief within 3-6 hours

Answer 7

Citrate of ,agnesia
Larger PEG dose

Question 8

Therapeutic options for acute constipation relief within 24 hrs

Answer 8

Bisacodyl or senna tabs

Question 9

Therapeutic options for acute constipation relief within 48 hrs

Answer 9

milk of magnesia
PEG

Question 10

1st step in Step therapy for chronic constipation

Answer 10

Step 1- relieve acute constipation (are there dietary modifications?)

Question 11

2nd step in Step therapy for chronic constipation

Answer 11

Bulk forming laxative + fluids

Question 12

3rd step in Step therapy for chronic constipation

Answer 12

Miralax

Question 13

4th step in Step therapy for chronic constipation

Answer 13

Short term use of stimulant then maintainence agent

Question 14

when to follow up for acute vs chronic constipation

Answer 14

1-2 days for acute (suppository- anticipate results in a couple hours)
( stimulant a few hours)
1-2 weeks for chronic

Question 15

pharmacologoc treatment for constipation in special populations (spinal cord injury, pregnant, diabetic)

Answer 15

Spinal cord injury pts- usually on suppository stimulants
pregnancy- diet, fiber docusate
diabetic- prokinetic agents (metoclopramide) or stimulants
patients on opioids- stimulants, then add docusate, lactulose or PEG prn (AVOID BULK LAXATIVES)

Question 16

treatment for opioid patients onstipation

Answer 16

-Stimulants, then add docusate, lactulose or PEG prn

-If nothing else works use METHYLALTREXONE
-Naloxegol

Question 17

Treatment for diabetic patients that are constipated

Answer 17

Prokinetic drugs (metoclopramide) or stimulants

Question 18

What is naloxegol used for? Dosing?

Answer 18

Used in treatment of opioid induced constipation.
25 mg QD (1 hr prior to 1st meal or 2 hours after meal)
(high fat meal increases extent and rate of absorption)

Question 19

GI prep procedure

Answer 19

Clear liquid diet
large quantities of fluids

Question 20

oral prep agents for GI procedures

Answer 20

PEG (nulytely, Golytely)
Refrigerate

Question 21

most effective laxatives to soften stool

Answer 21

Bulk laxatives

Question 22

List 5 common causes of nausea

Answer 22

Influenza
CNS disorder
Pain
Pregnancy
Excessive intake of anything

Question 23

Key pathways involved in pathophysiology of nausea and vomiting

Answer 23

Cortex- Anxiety, tumor
GI tract- receptors in GI tract send signals to brain
Vestibular- motion sickness

Question 24

Common neurotransmitters involved in N/V

Answer 24

Muscarinic, histaminic, dopamine, serotonin, NK receptors

Question 25

1st step to n/v treatment non- pcol

Answer 25

Put the gut to rest (avoid fatty, fried sweet or spicy foods)

Question 26

idenntify drug/treatment causes of N/V

Answer 26

chemotherapy radiation/anesthesia anti neoplastic agnets

Question 27

Name the classes of drug therapy for N/V

Answer 27

Antihistamines/cholinergics- meclizine, dimenhydramine, scopolamine (good for motion sickness) (not effective for chemotherpay nausea) Dizziness, sedation, dry mouth, constipation, blurred vision Phenothiazines- prochlorperazine, promethazine. Dizziness, sedation, dry mouth, constipation Serotonin antagonists- ondansetron, granisetron, palonsetron Metoclopramide

Question 28

Advantage/disadvantage of various serotonin antagoists

Answer 28

All end with -setron Ondansetron- multiple dosage forms Granisetron- multiple dosage forms Dolasetron- PO only Palonosetron- longest DOA (half life is 40 hrs)

Question 29

treatment of motion sickness

Answer 29

Scopolamine patches Meclizine PO (30-60 min before needed) dimenhydrinate PO (30-60 min befire needed)

Question 30

Why do we not use zofran (ondansetron) for motion sickness

Answer 30

We use antimuscarinics/anticholinergics It is not used for prevention, only tx

Question 31

Treatment of N/V secondary to gastroenteritis or pain

Answer 31

Ondansetron Promethazine

Question 32

Treatment of post operative nausea and vomiting

Answer 32

Aprepitant (Emend) Moderate-high risk- Treat with 1 or 2 agents Highest risk- always use 2 agents (5 HT3 + metoclopramide)

Question 33

always pre treat motion sickness T/F

Answer 33

True

Question 34

Why is it that the newer agents (NK-1 antagonists and the serotonin antagonists) are more effective? name drugs from each class

Answer 34

They have both central and peripheral activity against receptors. Old ones were only central. NK antagonists- aprepitant, fosaprepitant Serotonin inhibitors- ondansetron etc

Question 35

Predisposing factors for IBS

Answer 35

Female lower Socioeconomic status

Question 36

What is IBS

Answer 36

Abdominal pain associated with abnormal bowel movements

Question 37

IBS diagnosis criteria

Answer 37

Recurrent abdominal pain or discomfort atleast 1 day/week in the previous 3 months Must have 2 or more of the following -increase in pain related to defectaion -associated with change in frequency of stool - associated with change in apperance of stool

Question 38

Differentiate subtypes of IBS

Answer 38

IBS-C and IBS-D IBS-C is constipation predominant IBS-D is diarrhea predominant

Question 39

Treatment of IBS-C

Answer 39

Increase fiber and fluid intake and add bulk forming laxative (psyllium (metamucil))

Question 40

What to do if Psyllium (metamucil) does not work for IBS-C

Answer 40

Use anti-spasmodic or anticholinergic agent for GI symptom

Question 41

Name bulk forming laxatives

Answer 41

Psyllium, peg

Question 42

name antispasmodic/anticholinergic drugs

Answer 42

Dicyclomine, Hyoscyamine

Question 43

Treatment of IBS-D

Answer 43

1. dietary modification (low lactose/caffeine) 2. Loperamide or anti-spasmodic agen (diyclomine)

Question 44

What to do in IBS-D if loperamide or anti-spasmodic agents (dicyclomine) do not work

Answer 44

Eluxadoline, then rifampin

Question 45

Name anti diarrheal drugs

Answer 45

Loperamide (imodium)- no effect on abdominal apin Diphenoxylate (lomotil)