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PHARM 233 > GI 3 (Motility and Chronic Bowel Disease) > Flashcards

GI 3 (Motility and Chronic Bowel Disease) Flashcards

1
Q

How to treat Constipation

A

Enhance Motility
- Enhance Peristalsis

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2
Q

How to treat Diarrhea

A

Reduce Motility
- Restore fluid electrolyte balance
- Get rid of infection
- Opioid-based Drugs

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3
Q

Bisacodyl

A

Stimulant Laxatives

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4
Q

Sodium Picosulfate

A

Stimulant Laxatives

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5
Q

Senna

A

Stimulant Laxatives

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6
Q

Dantron

A

Stimulant Laxatives

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7
Q

Stimulant Laxatives
- MOA

A

Increases electrolyte secretion (thus increasing water secretion) by the mucosa
–> More Water Content, easier for stools to flow

  • Increases Peristalsis
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8
Q

Stimulant Laxatives
- Adverse Effects

A

Abdominal Cramps

Do not use if there is an obstruction in the bowel
–> Causes Atonic Colon

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9
Q

Methylcellulose

A

Bulk Laxatives

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10
Q

Sterculia

A

Bulk Laxatives

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11
Q

Agar Bran

A

Bulk Laxatives

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12
Q

Ispaghula Husk

A

Bulk Laxatives

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13
Q

Bulk Laxatives
- MOA

A

Polysaccharide Polymers that are not digested in the upper GI tract
- Gives mass to stools and allows them to be pushed out through peristalsis

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14
Q

Bulk Laxatives
- Adverse Effect

A

No serious adverse effects
- Slow Acting
- Good for Children

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15
Q

Magnesium Salt

A

Osmotic Laxative

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16
Q

Magnesium Salt
- MOA

A

Creates an Osmotic Load
= Traps volume in bowel lumen

  • Build up of water in lumen (distension) resulting in peristaltic movement and cleansing of the bowel (purgation)
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17
Q

Magnesium Salt
- Adverse Effects

A
  • Diarrhea
  • Should be avoided in young children
  • Should be avoided in patients with renal dysfunction
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18
Q

Lactulose

A

Osmotic Laxative
- Semisynthetic disaccharide

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19
Q

Osmotic Laxative
- MOA:

A

Pulls water from the body and into the bowels
- Allows for peristalsis by softening stools

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20
Q

Polyethylene Glycol (PEG)
- MOA

A

Osmotic Laxative
- Binds water and causes water to be retained in the stool

Used for Chronic Constipation

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21
Q

Lubiprostone
- MOA

A

Treats Opioid-Related Constipation

Activates Chloride Channel-2 on apical membrane cells of the small intestine
–> Promotes Chloride
–> Promotes Fluid Secretion

22
Q

Naloxegol
- MOA

A

Treats Opioid-Related Constipation

Mu Receptor Antagonist
- Is pegylated (Limits entry into CNS)
= Blocks Mu Receptor in GI, does not block Mu Receptor in Brain

23
Q

Prucalopride

A

5-HT(4) activator in GI tract
= Stimulates Colonic Propulsive Activity

Used when other laxatives have failed for chronic constipation

24
Q

Codeine

A

Opioid
- Treats Diarrhea

25
Q

Diphenoxylate

A

Opioid
- Treats Diarrhea

26
Q

Diphenoxylate
- MOA

A

Mu Receptor Agonist
- Activation results in inhibition of peristalsis in colon
- Enhances Anal Sphincter Tone
- Delays absorption of feces through bowels
–> Increases fluid absorption from feces
–> Drying effect on stool

27
Q

Diphenoxylate
- Adverse Effect

A

Constipation
Paralytic Ileus (Impaired motor activity of bowel, non physical)

Delays transit of invasive diarrheas

28
Q

Loperamide

A

Opioid
- Treats Diarrhea

Specifically good for traveler’s diarrhea

29
Q

Loperamide
- MOA

A

Mu Receptor Agonist
- Activation results in inhibition of peristalsis in colon
- Enhances Anal Sphincter Tone
- Delays absorption of feces through bowels
–> Increases fluid absorption from feces
–> Drying effect on stool

30
Q

Loperamide
- Adverse Effect

A

Constipation
Paralytic Ileus (Impaired motor activity of bowel, non physical)

Delays transit of invasive diarrheas

31
Q

Opioid (GI)
- MOA

A
  • Increase tone and rhythm contractions of intestine
  • Decrease Propulsion in Colon = Constipation
32
Q

Racecadotril

A

Treats Diarrhea

Prodrug of Thiorphan
- Which inhibits enkephalinase

Enkephalins
- Delta Receptor Agonists
–> Inhibits Intestinal Secretions (Fluid, Cl-)

33
Q

Racecadotril
- MOA

A
  1. Inhibits Enkephalinase
  2. Build up of Enkephalins
  3. Greater action on Delta Receptors
  4. Greater inhibition of intestinal secretions

Combined with rehydration therapy
- To replenish lost fluids and prevent dehydration

34
Q

Racecadotril
- Adverse Effects

A
  • Less risk for constipation than Loperamide
  • Higher risk for itch than Loperamide
35
Q

Bismuth Subsalicylate

A

Bulk Forming Agent
- Anti Secretory
- Anti Microbial

36
Q

Eluxadoline
- MOA

A

Treats IBS with Diarrhea
- Mixed Mu and K Opioid Receptor Agonist
- Delta Receptor Antagonist
–> Acts on enteric nerves to slow peristalsis

37
Q

Linaclotide

A

Treats IBS with Constipation
- Synthetic Peptide that acts as an Guanylate Cyclase C Receptor Agonist in intestinal epithelial cells
–> Increases cGMP levels
–> Augments Chloride and Bicarbonate secretions

38
Q

Prednisolone

A

Glucocorticoids for acutely reducing inflammation in IBS/IBD

  • Not to be used for long term due to side effects
39
Q

Budesonide

A

Glucocorticoids for acutely reducing inflammation in IBS/IBD

  • Not to be used for long term due to side effects
40
Q

Methotrexate
- MOA

A

Anti-inflammatory agent for IBS/IBS

Folic Acid Antagonist
- Cytotoxic and Immunosuppressant Activity

Inhibits Dihydrofolate Reductase (DHFR)
–> Inhibiting DNA Synthesis
–> Thus, Inhibits Purine Synthesis which results in an anti inflammatory response

41
Q

Sulfasalazine

A

Anti-inflammatory agent for IBS/IBS

Sulfonamide sulfapyridine linked to 5-aminosalicyclic acid (5-ASA)

42
Q

Sulfasalazine
- MOA

A
  • Decreases superoxide generation by acting as a free radical scavenger
  • Inhibits leukotriene production (An inflammatory mediator)
  • Decreases neutrophils chemotaxis
43
Q

Sulfasalazine
- Adverse Effects

A

Hypersensitivity
- Caused by sulfapyridine component

44
Q

Cyclosporine
- MOA

A

Immunosuppressant for IBS/IBD
- Cyclic Peptide that binds to cyclophilin and inhibits calcineurin
–> Decreases IL-2 Synthesis and the Proliferation of T-Cells

45
Q

Cyclosporine
- Adverse Effects

A
  • Nephrotoxicity
    –> Caused by vasoconstriction of renal arteries
  • Hepatotoxicity
  • Hypertension

Dampens Immune Response
–> More prone to infection

46
Q

Azathioprine
- MOA

A

Immunosuppressant for IBS/IBD
- Is converted into Mercaptopurine which interferes with purine/DNA synthesis
–> Dampens Immune Response

47
Q

Azathioprine
- Adverse Effects

A

Bone Marrow Depression
- Reduced production of blood cells

48
Q

Infliximab
- MOA

A

Chimeric neutralizing antibody against Tumour Necrosis Factor a (TNFa)
- Prevents adhesion and propagation of inflammation

49
Q

Adalimumab
- MOA

A

Humanized monoclonal antibody against TNFa

50
Q

Golimumab
- MOA

A

Humanized monoclonal antibody against TNFa

51
Q

Vedolizumab
- MOA

A

Humanized monoclonal antibody against alpha 4 beta 7 (a4b7) integrin on T-helper (Th) lymphocytes

Prevents Th Lymphocytes from interacting with mucosal adhesion molecule-1 (MCAM-1) on GI tract epithelial cells
–> Reduces inflammation

52
Q

Ustekinumab
- MOA

A

Humanized monoclonal antibody

Targets p40 protein subunit of IL-12 and IL-23
- Prevent binding of these cytokines to their corresponding IL-12 and IL-23 receptors on immune cells
–> Decreases inflammation

PHARM 233 (10 decks)

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