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MJ- P2 E2 > GI Motility 1 > Flashcards

GI Motility 1 Flashcards

1
Q

Drugs stimulating GI motility

  • What is the name of the agent that can selectively stimulate gut motor function?
A

Prokinetic

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2
Q

Submucosal IPANs activate the enteric neurons responsible for what 2 activities?

A
  • Peristaltic & Secretory reflex activity
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3
Q

Stimulation of 5-HT4 receptors on presynaptic terminals of IPANs enhances release of what 2 substances, therefore promoting reflex activity?

A
  • acetylcholine (ACh)
  • Calcitonin gene related peptide (CGRP)
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4
Q

What are the 3 types of drugs which stimulate GI motility?

A
  • Cholinomimetic Agents (cholingergic or anticholinesterase)
  • Metoclopramide (dopamine & serotonin antagonist)
  • Macrolides (erythromycin antibiotic) motilin receptor
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5
Q

What are the 2 Cholinomimetic Agents?

A
  • Bethanechol
  • Neostigmine
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6
Q

Which Cholinomimetic Agent?

  • Stimulates muscarinic M3 receptors on muscle cells and at myenteric plexus synapses
  • History of use in the treatment of GERD and gastroparesis
A

Bethanechol

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7
Q

Which Cholinomimetic Agent?

  • Acetylcholinesterase inhibitor
    • enhance gastric, small intestine, and colonic emptying
A

Neostigmine

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8
Q

What are the 5 ADEs of Cholinomimetic Agents?

(Drugs stimulating GI motility)

A

(Cholinergic effects)

  1. Excessive salivation
  2. Nausea
  3. Vomiting
  4. Diarrhea
  5. Bradycardia
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9
Q

4 uses of Cholinomimetic Agents

A
  • GERD
  • Impaired gastric emptying
  • Non-ulcer Dyspepsia
  • Prevention of vomiting
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10
Q

Which medication is used to tx the following:

  • treatment of symptomatic GERD
  • not effective in patients with erosive esophagitis
  • prokinetic agents are used mainly in combination with antisecretory agents in patients with regurgitation or refractory heartburn
A

Cholinomimetic Agents

(Bethanechol & Neostigmine)

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11
Q

Which medication is used to tx the following:

Impaired Gastric Emptying

  • treatment of delayed gastric emptying due to postsurgical disorders (vagotomy, antrectomy)
  • diabetic gastroparesis
  • to promote advancement of nasoenteric feeding tubes from the stomach into the duodenum
A

Cholinomimetic Agents

  • Bethanechol
  • Neostigmine
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12
Q

Which medication is used to tx the following:

  • Symptomatic improvement in a small number of patients with chronic dyspepsia
A

Cholinomimetic Agents

  • Bethanechol
  • Neostigmine
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13
Q

Which medication is used for:

  • Prevention and tx of emesis?
A

Metoclopramide

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14
Q

T/F

  • Cholinomimetic agents are approved by FDA and available in the US for postpartum lactation stimulation
A

False

  • NOT approved by FDA or available in the US for this purpose
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15
Q

What drug is “sometimes” recommended to promot postpartum lactation? (Canadian source)

A

Domperidone

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16
Q

Which medication?

  • Stimulates GI motility
  • Dopamine D2 receptor antagonist
  • Prokinetic mechanism
  • Inhibits cholinergic smooth muscle stimulation
A

Metoclopramide

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17
Q

Metoclopramide

(Dopamine receptor antagonist)

  • Increases what 3 things?
  • Has no effect on what 2 things?
A
  • Increases:
    • Esophageal peristaltic amplitude
    • Lower esophageal sphincter pressure
    • Gastric empyting
  • No effect:
    • small intestine
    • colonic motility
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18
Q

Metoclopramide has which 5 ADEs involing the CNS

(especially in what age population?)

A
  1. Restlessness
  2. Anxiety
  3. Agitation
  4. Drowsiness
  5. Insomnia

Age: elderly

(Angry Anxious old ladies get drowsy and restless and cannot fall asleep)

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19
Q

ADEs of which drug?

  • Extrapyramidal effects (dystonias, akathisia, parkinsonian features)
    • central dopamine receptor blockade occur acutely in 25% of patients given high doses and in 5% of patients receiving long-term therapy
A

Metoclopramide

20
Q

ADE of which drug?

  • Tardive dyskinesia
    • sometimes irreversible
    • treated for a prolonged period with metoclopramide
A

Metoclopramide

21
Q

ADE of which drug?

  • Long-term use should be avoided unless absolutely necessary, especially in the elderly
  • Elevated prolactin levels (caused by both metoclopramide) can cause:
    • galactorrhea,
    • gynecomastia,
    • menstrual disorders
    • impotence,
A

Metoclopramide

22
Q

Which drug?

  • Directly stimulate motilin receptors on gastrointestinal smooth muscle and promote the onset of a migrating motor complex
  • Beneficial in some patients with gastroparesis
  • Tolerance rapidly develops
  • Used in patients with acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy
A

Erythromycin

(Cholinomimetic Agents - Macrolides)

23
Q

4 medications which cause Constipation

A
  • Opiates
  • Antacids containing calcium carbonate
  • Diuretics (non potassium sparing)
  • Iron preparations
24
Q

Laxatives

  • Intermittent constipation is best prevented with what 4 things?
A
  • High fiber diet
  • Adequate fluid intake
  • Regular exercise
  • Pooping when you need to
25
Q

If the patient suffers from constipation due to a secondary cause/disease, what is first line tx?

A

Treat the underlying cause

26
Q

If a patient suffers from constipation and has no underlying diagnosis, how should you treat? (5)

A

Choose symptomatic therapy

  • Dietary modification to increase fiber supplementation (bulk agents)
  • Add Osmotic laxative (PEG)
  • Add stmulant laxative (Bisacodyl) if no relief/BM in 2 days
  • Lubiprostone or Linaclotide trial
  • Opioid receptor antagonist (if opioid induced)
27
Q

What types of laxatives are these?

  • Non-absorbable sugars or salts
  • Balanced polyethylene glycol
A

Omsotic Laxatives

28
Q

What type of laxatives?

  • Anthraquinone Derivatives (senna, cascara)
  • Diphenylmethane Derivatives (Bisacodyl)
A

Stimulant Laxatives

29
Q

What type of Laxative?

  • Lubiprostone
A

Chloride Channel Activator

30
Q

Which type of laxative?

  • Linaclotide
  • Plecanatide
A

Guanylate Cyclase C Agonists

31
Q

What are the 3 types of Laxatives / Cathartics that cause:

  • Softening of Feces in 1 - 3 days
A
  • Bulk-forming agents / osmotic laxatives
  • Emollients (softeners)
  • Polyethylene glycol 3350 (PEG)
32
Q

What are the names of the 3 bulking agents?

A
  • Methylcellulose
  • Polycarbophil
  • Psyllium
33
Q

What are the names of the 3 Emollients (softeners)?

A
  • Docusate sodium
  • Docusate calcium
  • Docusate potassium
34
Q

What are the names of the 2 Polyethylene Glycol 3350? (PEG)

A
  • Lactulose
  • Sorbitol
35
Q

3 laxatives which result in:

  • Soft or Semifluid stool in 6 - 12 hours
A
  • Bisacodyl (oral)
  • Senna
  • Magnesium sulfate (low dose)
36
Q

What do these agents do?

  • Magnesium citrate
  • Magnesium hydroxide
  • Magnesium sulfate (high dose)
  • Sodium phosphates
  • Bisacodyl
  • Polyethylene glycol-electrolyte preparation
A

Cause watery evacuation in 1 - 6 hours

37
Q

Which laxative?

  • Indigestible, hydrophilic colloids that absorb water, forming a bulky, emollient gel that distends the colon and promotes peristalsis
A

Bulk-Forming Laxatives

(Psyllium & Methylcellulose)

38
Q

What is the name of the bulk forming laxative made w/ synthetic fibers?

A

Polycarbophil

39
Q

What are the 2 names of the common preparations of bulk forming laxatives which include natural plant products?

A
  • Psyllium
  • Methylcellulose
40
Q

Bulk Forming Laxatives

  • Bacterial digestion of plant fibers within the colon may lead to an increase in what 2 sxs?
A
  • bloating
  • flatus
41
Q

Which laxative?

  • mixing of aqueous and fatty materials within the intestinal tract
  • administered orally or rectally
  • agent include: docusate (oral or enema)
A

Stool Surfactant Agents (Softeners)

42
Q

Which laxative?

  • clear, viscous oil that lubricates fecal material, retarding water absorption from the stool
  • used to prevent and treat fecal impaction in young children and debilitated adults
  • not palatable but may be mixed with juices
A

Mineral Oil

(Stool Surfactant Agents = Softeners)

43
Q

Which laxative?

  • CAUTION–aspiration can result in a severe lipid pneumonitis
  • long-term use can impair absorption of fat-soluble vitamins (A, D, E, K)
A

Mineral Oil

(Stool Surfactant Agents - Softeners)

44
Q

Which laxative?

  • Non-absorbable sugars or salts
  • Colon can neither concentrate nor dilute fecal fluid: fecal water is isotonic throughout the colon
  • laxatives are soluble but nonabsorbable compounds that result in increased stool liquidity due to an obligate increase in fecal fluid
A

Osmotic Laxatives

45
Q

What laxative do you use for acute constipation or prevention of chronic constipation?

A

Non-absorbable surgars or salts (Osmotic)

46
Q

Which laxative?

  • commonly used osmotic laxative
  • not be used for prolonged periods in patients with renal insufficiency due to the risk of hypermagnesemia
A

Magnesium Hydroxide - (milk of magnesia)

47
Q

Which 2 laxatives?

  • nonabsorbable sugars that can be used to prevent or treat chronic constipation
  • sugars are metabolized by colonic bacteria, producing severe flatus and cramps
A
  • Sorbitol
  • Lactulose

MJ- P2 E2 (19 decks)

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