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Therapeutics > Final exam lecture 6 > Flashcards

Final exam lecture 6 Flashcards

1
Q

Name two stimulant laxatives with dosing

A

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

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2
Q

MOA of stimulant laxatives

A

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

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3
Q

advantage vs disadvantage of stimulant laxatives

A

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

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4
Q

Stimulant laxative for very quick onset

A

Bisacodyl suppositories

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5
Q

drugs used for chronic isiopathic constipation after all else fails

A

Lubiprostone
Linaclotide
Plecanatide
Lactitol

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6
Q

Therapeutic options for acute constipation relief within 1 hr

A

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

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7
Q

Therapeutic options for acute constipation relief within 3-6 hours

A

Citrate of ,agnesia
Larger PEG dose

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8
Q

Therapeutic options for acute constipation relief within 24 hrs

A

Bisacodyl or senna tabs

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9
Q

Therapeutic options for acute constipation relief within 48 hrs

A

milk of magnesia
PEG

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10
Q

1st step in Step therapy for chronic constipation

A

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

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11
Q

2nd step in Step therapy for chronic constipation

A

Bulk forming laxative + fluids

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12
Q

3rd step in Step therapy for chronic constipation

A

Miralax

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13
Q

4th step in Step therapy for chronic constipation

A

Short term use of stimulant then maintainence agent

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14
Q

when to follow up for acute vs chronic constipation

A

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

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15
Q

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

A

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)

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16
Q

treatment for opioid patients onstipation

A

-Stimulants, then add docusate, lactulose or PEG prn

-If nothing else works use METHYLALTREXONE
-Naloxegol

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17
Q

Treatment for diabetic patients that are constipated

A

Prokinetic drugs (metoclopramide) or stimulants

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18
Q

What is naloxegol used for? Dosing?

A

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)

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19
Q

GI prep procedure

A

Clear liquid diet
large quantities of fluids

20
Q

oral prep agents for GI procedures

A

PEG (nulytely, Golytely)
Refrigerate

21
Q

most effective laxatives to soften stool

A

Bulk laxatives

22
Q

List 5 common causes of nausea

A

Influenza
CNS disorder
Pain
Pregnancy
Excessive intake of anything

23
Q

Key pathways involved in pathophysiology of nausea and vomiting

A

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

24
Q

Common neurotransmitters involved in N/V

A

Muscarinic, histaminic, dopamine, serotonin, NK receptors

25
Q

1st step to n/v treatment non- pcol

A

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

26
Q

idenntify drug/treatment causes of N/V

A

chemotherapy
radiation/anesthesia
anti neoplastic agnets

27
Q

Name the classes of drug therapy for N/V

A

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

28
Q

Advantage/disadvantage of various serotonin antagoists

A

All end with -setron
Ondansetron- multiple dosage forms

Granisetron- multiple dosage forms

Dolasetron- PO only
Palonosetron- longest DOA (half life is 40 hrs)

29
Q

treatment of motion sickness

A

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

30
Q

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

A

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

31
Q

Treatment of N/V secondary to gastroenteritis or pain

A

Ondansetron
Promethazine

32
Q

Treatment of post operative nausea and vomiting

A

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

33
Q

always pre treat motion sickness T/F

A

True

34
Q

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

A

They have both central and peripheral activity against receptors. Old ones were only central.

NK antagonists- aprepitant, fosaprepitant
Serotonin inhibitors- ondansetron etc

35
Q

Predisposing factors for IBS

A

Female
lower Socioeconomic status

36
Q

What is IBS

A

Abdominal pain associated with abnormal bowel movements

37
Q

IBS diagnosis criteria

A

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

38
Q

Differentiate subtypes of IBS

A

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

39
Q

Treatment of IBS-C

A

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

40
Q

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

A

Use anti-spasmodic or anticholinergic agent for GI symptom

41
Q

Name bulk forming laxatives

A

Psyllium, peg

42
Q

name antispasmodic/anticholinergic drugs

A

Dicyclomine, Hyoscyamine

43
Q

Treatment of IBS-D

A
  1. dietary modification (low lactose/caffeine)
  2. Loperamide or anti-spasmodic agen (diyclomine)
44
Q

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

A

Eluxadoline, then rifampin

45
Q

Name anti diarrheal drugs

A

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

Therapeutics (46 decks)

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