GI 2 Flashcards
5 questions
most cases of diarrhea are acute and self-limiting; what’s the duration and common causes (3)?
< 2 weeks
bacterial/viral infection
antibiotics = C. diff
food poisoning (salmonella, E. coli)
what are the 3 therapeutic goals for diarrhea?
decrease fluid/electrolyte imbalance
decrease peristalsis
increase absorption
anti-motility agent that stimulates mu receptor on enteric nerves, inhibiting acetylcholine release and decreasing peristalsis
loperamide
what are 2 ADR of loperamide at high doses?
dizziness
drowsiness
what are 3 uses for loperamide?
diarrhea
traveler’s diarrhea
diarrhea component of IBS
what anti-motility agent is opioid-like?
loperamide
what are the 4 mu opioid receptor agonists? how do they work as anti-motility agents?
codeine
morphine
tincture of opium
diphenoxylate
act on mu receptor in bowel to decrease peristalsis
what are the ADR of mu opioid receptor agonists? (2)
CNS effects
abuse potential
what is the name of the anticholinergic used as a anti-motility agent?
how does it work?
atropine + diphenoxylate
atropine decreases the abuse potential of diphenoxylate
what kind of anti-diarrheal agents bind or neutralize bacterial toxins, like E. coli?
absorbents
what is an absorbent use for diarrhea and symptomatic relief?
bismuth subsalicylate (pepto-bismol)
how do the different components of bismuth subsalicylate work as anti-diarrheal agents?
bismuth coats irritated intestinal mucosa
salicylate decreases Cl secretion
what are the symptoms of salicylate toxicity? (2)
N/V
tinnitus
what is the tablet version of bismuth subsalicylate?
kaopectate
what can be used to replace normal colonic microflora to restore intestinal function and suppress growth of pathogenic bacteria?
what’s the specific name?
probiotics
lactobacillus acidophilus
when should probiotics be used?
after antibiotic use
when should diarrhea be treated?
if present over 2-3 days
what should not be used in patients with shigella infection?
loperamide
in management of diarrhea, what can be used for associated N/V?
promethazine
what is the most common organism associated with traveler’s diarrhea?
E. coli
what are the 3 treatment steps for management of traveler’s diarrhea?
rehydration
bismuth subsalicylate
loperamide
what should be added to pepto and loperamide regimen if a patient has severe traveler’s diarrhea + bloody, febrile, or persistent?
antibiotics
what antibiotic is indicated in an adult with traveler’s diarrhea?
fluoroquinolone
what antibiotic is indicated in a child with traveler’s diarrhea?
trime-sulfa
disturbed interaction of intestine, brain, and ANS that results in altered bowel motility, leading to recurrent lower abdominal pain and bloating.
irritable bowel syndrome
what can be used for the pain component of IBS by relieving smooth muscle spasms?
anticholinergic: dicyclomine
what should be used for the diarrhea component of IBS?
loperamide
what can be used for the constipation component of IBS? (3)
fiber
stool softeners
Cl channel activators: lubiprostone or linaclotide
inflammation or chronic swelling of the intestines that is associated with ulcerative colitis and crohn’s disease
IBD
what are the 3 treatment options for mild symptoms of IBD?
5-ASA
olsalazine
sulfasalazine (5-ASA + sulfapyridine)
MOA of 5-ASA?
inhibits leukotriene
MOA of olsalazine?
converted into 5-ASA in large intestine
inhibits leukotriene
2 ADR of sulfasalazine?
crystalluria (drink water to prevent)
hypersensitivity
what is the treatment for moderate symptoms of IBD?
corticosteroids
what are the 2 treatment options for active and chronic symptoms of IBD?
immunosuppressants (thiopurines)
biologics
name the 2 thiopurines used as immunosuppressants for active and chronic symptoms of IBD
azathioprine
mercaptopurine
name 2 immunosuppressants used for active and chronic symptoms of IBD
methotrexate
cyclosporine
what should be monitored in a patient taking an immunosuppressant for IBD? (2)
WBCs
RBCs
how do biologics/anti TNF-alpha antibodies provide management of IBD? (2)
decrease symptoms
heal mucosal ulcers
what are 3 drug classes and 1 drug used for chemotherapy induced emesis?
5-HT3 antagonists
NK1 antagonists
D2 antagonists
dexamethasone
which phase of CINV is the central pathway via chemoreceptor trigger zone associated with?
delayed phase (more than 24 hrs after chemo)
which phase of CINV is the peripheral pathway via chemoreceptor trigger zone associated with?
acute phase (1-2 hrs after chemo)
what drug class is used for the management of central pathway/delayed phase CINV?
NK1 receptor antagonists
what drug class is used for the management of peripheral pathway/acute phase CINV?
5-HT3 antagonists
-pitant
NK1 receptor antagonists
2 uses for NK1 receptor antagonists?
high/moderately emetogenic drugs
postop N/V
4 ADR of NK1 receptor antagonists?
headache
constipation
fatigue
loss of appetite
-setron
5-HT3 antagonists
3 uses for 5-HT3 antagonists?
postop N/V
post-radiation N/V
N/V in pregnancy (off-label)
5 ADR of 5-HT3 antagonists?
headache
abdominal discomfort
constipation
rash/allergy (after IV)
QT prolongation (esp dolasetron)
what can be used for anticipatory CINV?
lorazepam
dopamine D2 antagonist that increases gastric emptying
metoclopramide
ADR of metoclopramide? (2)
movement disorders (crosses BBB)
tardive dyskinesia (black box warning)
what is the FDA rule when using metoclopramide?
do not use for more than 12 weeks/3 months
drug class that is a potent D2 antagonist, an antimuscarinic and an H1 antagonist
phenothiazines
-azine
phenothiazines
-peridol
butyrophenones (antipsychotic)
what is the use of butyrophenones?
prophylactic management of postop N/V
name the H1-receptor antagonists (5)
meclizine
cyclizine
promethazine
dimenhydrinate
diphenydramine
what is the use of H1 receptor antagonists?
motion sickness
what is promethazine (H1 receptor antagonist) used for? (2)
space motion sickness
pregnancy
anticholinergic that blocks muscarinic receptors in the vestibular nuclei
scopolamine
what is the use for scopolamine? administration?
motion sickness
transdermal
MOA of cannabinoids?
THC stimulates CB1 and prevents emesis
name the 2 cannabinoids
dronabinol
nabilone
use for cannabinoids?
adjunctive in CINV
ADR of cannabinoids?
psychoactive
