GI Drugs 2 Flashcards
what is the function of somatostatin?
- Decrease gastric acid and pepsinogen secretion
- Decrease pancreatic and small intestine fluid secretion
- Decrease gallbladder contraction
- Decrease insulin and glucagon release
- Decreases GI hormones
what type of drug is docusate?
it is a stool softener; dont give with mineral oil because then the effects will cancel out
a child with constipation predominant IBS is most often prescribed ______
poly-ethylene glycol because lubiprostone cannot be used in kids
which amino glycoside is well tolerated because the 5-ASA in that is linked to an inert unabsorbed carrier molecule? and thus works mainly int he ______
- balsalazide; terminal ileum and colon
methylcellulose and other ________ (type of laxative) should not be given to ____ and ______
bulk forming laxatives (psyllium and bran) should not be given to immobile patients or those on long term opioid therapy
lubiprostone stimulates __________ of the SI and thus ↑ intestinal motility;
what is a contraindication of lubiprostone?
type 2 chloride channels → ↑ secretion of chloride
CANNOT be used in kids
______ is a synthetic form of somatostatin and is used to treat _______ diarrhea
octreotide is used to treat secretory diarrhea (neuroendocrine tumors/ VIPoma) and diarrhea caused by vagotomy, dumping syndrome and short bowel syndrome
5-ASA is almost completely absorbed in the ______
jejunum; thus no therapeutic effect in the distal ileum, colon and rectum
__________ (amino glycoside) has the largest anatomic distribution of areas of the GI that it is effective
mesalamine (delayed response capsules specially but also pH sensitive)
constipation is defend as stool frequency less than ___ / week
< 3 /week
methotrexate inhibits _______ and ↓ the inflammatory actions of _____
dihydrofolate reductase; IL-1
________ type of renal stones are an AE of taking pancrelipase to treat pancreatic insufficiency
uric acid
does alvimopan and methylnaltrexone reverse the analgesic effects of opioids because they antagonize the mu receptors?
NO because these drugs do not cross the blood brain barrier and thus only act at the level of the gut to maintain normal motility
suppression of Th___ activity is an adverse effect of anti TNA alpha drugs
TH1 activity → severe infection and reactivation of latent tb
which of the glucocortocoids is preferred for long term use in patients?
budesonide because ↓ adverse effects because it has a rapid first pass metabolism so it has low systemic availability
glucocorticoids are usually never used for long term
what drugs are used for the most severe IBD’s?
- anti TNF α drugs: infliximab and adalimumab
________ (glucocorticoid) is given via enema for sigmoid and rectal IBD flares
hydrocortisone
MOA of lubricant laxatives such as______
mineral oil; they coat the fecal material and PREVENTS water reabsorption so it should not be given with docusate
what are the 3 bulk forming laxatives?
- methylcellulose
- psyllium
- bran
inhibition of the activity of nuclear factor kB (NF-kB) is the MOA of _______
aminosalicylates
most of the side effects of sulfasalazine is due to _______
systemic absorption of sulfapyridine group;
side effects: nausea, GI upset, headaches, myalgia, bone marrow suppression and HS reactions
natalizumab is indicated in treatment of ________
moderate to severe, unresponsive Crohn’s disease
_____, ______, and ____ are cathartics (stimulant laxatives)
which one is safer for use in pregnant patients
- castor oil, Senna, and bisacodyl
bisacodyl is more safe to pregnant patient beaucse it has minimal systemic absorption
which drug is an osmotic laxative that can be used for long term control?
- polyethylene glycol (PEG); it is common used for complete bowel preparation before GI endoscopy
_______ is the preferred drug to be used in constipation predominant IBS; what is its MOA?
lubiprostone; stimulates type 2 chloride channels → ↑ secretion of chloride
what is the MOA of bismuth subsalicylate (Pepto-Bismol)
- coats the enteric tract that ↓ fluid secretion
- cAMP dependent inhibition of GI fluid secretion
sulfasalazine consists of 5- ASA linked to _______ by a ______ bond which allows it to ↓ the absorption of the 5 ASA in the jejunum
sulfapyridine linked by a azo bond
_______ is the preferred opioid diarrheal agonist
loperamide
use of _______ (stimulant laxative) can cause brown pigmentation of the colonic mucosa.
Senna; melanosis coli and it had NO ↑ risk for colon cancer
what are some AE of dioxyphenolate
- higher doses can have CNS effects and lead to opioid dependence
- it is an opioid agonist use as an anti diarrheal drug
what are 4 MOA of aminosalicylates
- modulation of both cyclooxyrgenase and lipoxygenase pathways
- inhibition of NF-kB
- inhibitor of cellular immunity mechanism
- scavenges reactive oxygen metabolites
in the absence of an underlying medical condition, what are the first line strategies for constipation?
- ↑ dietary fiber
- physical activity
allopurinol should not be coadmisntered with ______ because it can predicate life threatening leucopenia
6-MP;
allopurinol reduces xanthine oxidase and xanthine oxidase breaks down 6 MP
what 3 types of drugs can be given to treat diarrhea predominant IBS?
- opioid agonists: loperamide
- 5HT 3 antagonist: alosetron which ↓ noxious visceral sensations such as nausea, bloating and pain
- anticholinergics: hyoscyamine, dicylomine, glyocpyrrolate and methoscopolamine (not preferred anymore)
what drugs are opioid AGONISTS given as anti-diarrhea drugs
- loperamide
- diphenoxylate
dronabintol stimulates the _____ receptors
CB1 (cannabinoid)
what two drugs are stool softeners?
docusate and glycerin
when do you give infiliximab?
for moderate to severe colitis when patients are not response to mesalamine or corticosteroids
anti TNF α drug
________ targets integrins
natalizumab
what is the MOA of natalizumab?
monoclonal antibodies that targets integrins on circulating inflammatory cells and thus disrupt the leukocyte vascular wall adhesion and transmigration
__________ (class of drugs) are used for long term MAINTENANCE of IBD remission
aminosalicylates (all have a ‘sal’ in the name)
- sulfasalazine
- balsalazide
- mesalamine
opioid induced constipation is due to activation of _____ receptor in the bowel. what are some drugs that are antagonists to this receptor?
mu-opioid receptor;
antagonists: alvimopan and methylnaltrexone
polyethylene glycol, ________, and _______ are osmotic laxatives
magnesium salts/hydroxide, and lactulose;
they exert and osmotic pull to retain water in the intestinal lumen
therapeutic approach to IBD is based on _____
severity
what are some AE’s of octreotide
octreotide is a synthetic form of somatostatin
- steatorrhea (↓ pancreatic exocrine function where there is ↓ lipolysis)
- gallstones (inhibition of gallbladder contractility)
activation of the mu opioid receptors in the gut ↑ / ↓ gut motility
↓ gut motility because they inhibit Ach release from the enteric nervous system
_______ or _______ are given specially for opioid induced constipation
- alvimopan
- methylnaltrexone
________ are used to induce remission of ACUTE exacerbation of IBD
glucocorticoids: prednisolone, prednisone and budesonide
