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Pharm II MHM - Exam 3 > GI Part I > Flashcards

GI Part I Flashcards

1
Q

Meds that can cause constipation

A
  • Opioids
  • Anticholinergics
  • Antacids w/Al or Ca
  • CCBs
  • Thiazides
  • Iron supplements
  • NSAIDs
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2
Q

When should meds be taken when treating constipation?

A

At bedtime

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3
Q

What MOAs are there to treat constipation?

A
  1. Soften stool
  2. Ease passage (lubricants)
  3. Add bulk to stool
  4. Stimulate GI tract
  5. Stimulate GI secretory process
  6. Increase GI motility
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4
Q

How do stool softeners work?

A
  • Anionic surfactants
  • Detergents that mix aqueous and fatty substances
  • Fecal mass is softened
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5
Q

How do stool softeners help constipation?

A
  • Prevention
  • Softens fecal mass
  • Avoids straining
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6
Q

Onset of stool softeners?

A

1-3 days

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7
Q

How are stool softeners given?

A

Often combined with other agents

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8
Q

Example of a stool softener

A

Docusate (Colace)

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9
Q

How do lubricants work in constipation?

A
  • Coats stool and prevents absorption of water

- Easier passage

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10
Q

Onset of lubricants?

A

24 hours

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11
Q

What is glycerin, its use, and its onset?

A
  • Lubricant for constipation
  • Suppositories sized for infant, kids or adults
  • Commonly used in children
  • 30 min onset
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12
Q

What lubricant is MC used in children for constipation?

A

Glycerin

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13
Q

Features of mineral oil

A
  • Lubricant for constipation
  • Avoid in bedridden pts bc of aspiration pneumonia
  • Can affect absorption of fat soluble vitamins, warfarin, OCPs
  • Avoid long term use
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14
Q

How do bulk forming agents work?

A
  • Adds bulk to feces

- Promotes peristalsis

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15
Q

How should bulking agents be given?

A
  • Take w/lots o’ liquids!
  • Do NOT use in bedridden pts
  • Separate other meds by 1-2 hrs
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16
Q

Onset of bulking agents?

A

1-3 days

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17
Q

Side effects of bulking agents

A

Bloating and gas

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18
Q

Examples of bulking agents

A
  • Psyllium (Metamucil)

- Benefiber, Bran (dietary)

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19
Q

What are osmotic bulking agents and how do they work?

A
  • Nonabsorbable sugars
  • Prevention and treatment of chronic constipation
  • Pull water into colon, soften stool, increase volume
  • Lactulose and 33% sorbitol
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20
Q

What is lactulose?

A
  • Osmotic bulking agent for constipation

- Onset 1-3 days

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21
Q

What is 33% sorbitol?

A
  • Osmotic bulking agent for constipation

- Quick effect

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22
Q

What are saline cathartics and how do they work?

A
  • Bulking agent for constipation
  • Nonabsorbable cations and anions
  • Pull fluid into GI tract
  • Milk of Magnesia, Sodium Phosphate
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23
Q

How are saline cathartics used to treat constipation?

A
  • Occasional use! Every few weeks
  • Take adequate fluids with it
  • 6 hour onset
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24
Q

What are electrolyte solutions and how do they work?

A
  • Bulking agent for constipation
  • Polyethylene Glycol (PEG)
  • Nonabsorbable osmotically active sugar
  • Draws water into GI lumen
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25
Q

What is PEG and how is it used?

A
  • Polyethylene Glycol (bulking agent)
  • Used to treat constipation
  • Used for colonic cleaning prior to diagnostic procedures
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26
Q

What is PEG 3350?

A
  • MiraLax, electrolyte bulking agent for constipation
  • Powder mixed in liquid
  • Fewer side effects than other laxatives
  • No prescription needed
  • Can give w/narcotics
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27
Q

What are GI stimulants and how are they used?

A
  • Directly stimulates intestinal peristalsis through local mucosal irritation
  • Used to treat constipation
  • Can give w/narcotics
  • Bisacodyl (Ducolax), Senna
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28
Q

What type of GI stimulant is Bisacodyl (Ducolax)?

A

Diphenylmethane derivative

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29
Q

What type of GI stimulant is Senna?

A

Anthraquinone derivative

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30
Q

Onset of oral GI stimulant vs. rectal GI stimulant?

A

Oral 6-12 hrs

Rectal 15-60 mins

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31
Q

What are GI secretory agents and how are they used?

A
  • Stimulates secretion of fluid into gut, strong purgative action
  • Used for constipation (NOT regularly)
  • Onset 1-3 hours
  • Castor oil
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32
Q

What is castor oil and how is it used?

A
  • GI secretory agent for constipation

- NOT for regular use

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33
Q

What are GI motility stimulants and how are they used?

A
  • Prescription agents to increase colonic motility and shorten transit time
  • Used for constipation
  • Metoclopramide (Reglan)
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34
Q

What is metoclopramide (Reglan) and how is it used?

A
  • GI motility stimulant for constipation
  • Dopamine antagonist
  • Variable results
  • Onset 6-48 hours
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35
Q

Which patients are most affected by opioid induced constipation?

A
  • Cancer pain (95%)

- Nonmalignant pain (80%)

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36
Q

Pathophys of opioid-induced constipation

A

Results from action on mu-opioid receptors in the GI tract (decreased motility, secretions, defecation)

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37
Q

What are the targeted therapies of constipation?

A
  • Mu opioid receptor blockers

- Chloride channel activators

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38
Q

How do mu-opioid receptor antagonists work?

A
  • Inhibit peripheral receptors without affecting the analgesic effects of opioids
  • Do NOT cross BBB
  • Wake up the bowel
  • Methylnaltrexone (Relistor)
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39
Q

What is methylnaltrexone (Relistor) and how is it used?

A
  • 2nd line treatment after laxatives of opioid induced constipation
  • SQ injection
  • Onset within 4 hours
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40
Q

What is naloxegol (Movantik) and what does it do?

A
  • New mu opioid receptor blocker
  • Available oral (unlike Relistor)
  • Minimal risk of counteracting analgesic effects of opioids
  • CYP3A4 metabolism
41
Q

What is the chloride channel activator and how is it used?

A
  • Lubiprostone (Amitiza)
  • Stimulates Type 2 chloride channels in small intestine
  • Used for: chronic idiopathic constipation, IBS in women, OIC
42
Q

What is Lubiprostone?

A
  • Chloride channel activator
  • Used for: chronic idiopathic constipation, IBS in women, OIC
  • Onset usually within 24 hrs
  • Nausea common due to delayed emptying
43
Q

Meds that can cause diarrhea

A
  • PPIs
  • Antacids w/magnesium
  • Digoxin
  • Abx (clinda, tetra, augmentin)
  • ACEI
  • NSAIDs
44
Q

Non-pharm treatment of diarrhea

A
  • BRAT diet
  • Hold laxatives and other contributing meds
  • Replenish fluids
45
Q

Use of oral rehydration products in diarrhea

A
  • Available as premixed solutions

- Pedialyte MC

46
Q

How do oral rehydration products differ?

A
  • Osmolality
  • Carb load
  • Calories
  • Electrolytes
47
Q

What drug classes are used to treat diarrhea?

A
  • Antimotility
  • Adsorbents
  • Antisecretory
  • Anticholinergics
  • Microflora replacement
48
Q

How do antimotility agents work and what are they used for?

A
  • Stimulate mu-opioid receptors to reduce intestinal motility, slow flow of liquid, and increase absorption
  • Used in acute or chronic diarrhea
49
Q

When are antimotility agents contraindicated?

A

Bloody or infectious diarrhea

50
Q

How should antimotility agents be given?

A
  • Cautiously: addiction potential

- NOT recommended in children under 6 yo

51
Q

Examples of antimotility agents

A
  • Loperamide (Imodium)
  • Diphenoxylate w/atropine (Lomotil)
  • DTO
52
Q

What is kaolin-pectin and how is it used?

A
  • Adsorbent agent for traveler’s diarrhea
  • Adsorbs bacteria, toxins, fluid
  • Decreases stool liquidity and frequency
  • May reduce absorption of some meds like warfarin
53
Q

What meds are used for traveler’s diarrhea?

A
  • Kaolin-pectin (adsorbent)

- Bismuth subsalicylate (antisecretory)

54
Q

What is bismuth subsalicylate and how is it used?

A
  • Pepto Bismol
  • Antisecretory and adsorbent
  • Anti-inflammatory and antibacterial
  • Used in traveler’s diarrhea
55
Q

What should you be aware of regarding pepto-bismol?

A

Can blacken tongue and/or stool

56
Q

What are antisecretory agents used in diarrhea?

A
  • Bismuth subsalicylate (Pepto Bismol)

- Octreotide

57
Q

What is octreotide and how is it used?

A
  • Synthetic somatostatin
  • Antisecretory agent
  • Useful in secretory type diarrhea (carcinoid, VIPoma)
58
Q

What happens with increased dosage of octreotide?

A
  • Inhibits GI motility

- Used for diarrhea caused by short bowel syndrome or AIDS

59
Q

What happens with decreased dosage of octreotide?

A
  • Stimulates motility

- Used for diarrhea w/small bowel bacterial overgrowth or scleroderma

60
Q

ADRs of octreotide

A
  • Hyperglycemia

- Impaired fat absorption

61
Q

What is Lomotil and Dicyclomine? What are they used for?

A
  • Anticholinergic agents
  • Used in IBS
  • Decrease vagal tone, prolong gut transit time
62
Q

What are microflora replacements and what are they used for?

A
  • Probiotics
  • Nonpathologic bacteria that can restore normal GI flora
  • Used for variety of causes of diarrhea
  • Activia yogurt, Lactobacillus
63
Q

What components protect the stomach lining from acid damage?

A
  • Mucus and bicarb secretions

- Prostaglandins

64
Q

What meds can cause GERD?

A
  • NSAIDs
  • Bisphosphonates
  • CCBs
  • Iron
  • Potassium
65
Q

How do antacids work and what are they used for?

A
  • Neutralize acid and raise intragastric pH
  • Used for intermittent GERD
  • Ca, Mg, Al based agents
66
Q

Onset of antacids

A

10 mins (short duration of 1-2 hrs)

67
Q

ADRs of Ca and Al based antacids

A

Constipation

68
Q

ADRs of Mg based antacids

A

Diarrhea

69
Q

Antacids drug interactions

A
  • Chelation (binding): Fluoroquinolones

- Increases pH and reduces absorption (Itraconazole, Iron)

70
Q

What are H2 blockers?

A
  • Compete with histamine at H2 receptors on parietal cells to suppress acid secretion
  • Used for GERD
71
Q

Which GERD/PUD drug class is most effective for reducing nocturnal acid?

A

H2 blockers

72
Q

ADRs of H2 blockers

A
  • Minimal (HA, dizzy, diarrhea/constipation)

- Cimedtidine: increase in prolactin, may see gynecomastia/galactorrhea

73
Q

When is H2 blocker dosing adjusted?

A

Moderate to severe renal impairment OR elderly

74
Q

Limitations of H2 blockers

A
  • Tolerance
  • Not effective in H pylori ulcers
  • Avoid in pregnancy
  • Less potent than PPIs
  • Drug interactions
75
Q

Which H2 blocker has the most drug interactions?

A

Cimetidine

76
Q

Describe PPIs

A
  • Inhibit acid secretion for up to 24 hours
  • Omeprazole, pantoprazole, etc.
  • More effective than H2 blockers
  • All are equally effective and tolerance does not develop
77
Q

Safety concerns of PPIs

A
  • May increase fracture risk
  • May decrease absorption of Mg and B12
  • Increase risk of infection (disruption of acid barrier)
78
Q

Describe sucralfate

A
  • Aluminum salt of sulfated disaccharide that combines w/protein
  • Adheres to base of ulcer and forms a barrier to acid and pepsin
  • Stimulates PG release and mucus/bicarb secretion
79
Q

What are prostaglandin analogs?

A
  • Synthetic PG
  • Stimulate production of mucus and bicarb (protective against acid)
  • Misoprostal (PGE1)
80
Q

What is Misoprostal?

A
  • Synthetic PG
  • Decreases incidence of NSAID related ulcers (PPIs are still better though)
  • Severe GI side effects
  • Preg Cat X (stimulates uterine contractions)
81
Q

Describe bismuth salts

A
  • Unclear MOA: no acid inhibitory effects, but antimicrobial
  • Treatment of H pylori
  • Pepto Bismol
82
Q

What is Metoclopramide?

A
  • Motility agent
  • Stimulates upper GI tract without increasing acid secretion
  • Central acting anti-nausea and anti-emetic
  • Given multiple times/day
  • Numerous side effects
83
Q

What is Metoclopramide used for?

A
  • Given with PPI to reduce heartburn with GERD

- Enhances gastric emptying in post-op pts

84
Q

How are high risk pts treated for chemo induced N/V?

A

NK1 antagonist, 5HT3 antagonist AND corticosteroid

85
Q

How are moderate risk pts treated for chemo induced N/V?

A

Dopamine antagonist AND corticosteroid

86
Q

How are low risk pts treated for chemo induced N/V?

A

Corticosteroid alone

87
Q

What is acute CINV?

A

0-24 hrs after chemo

88
Q

What is delayed CINV?

A

24+ hrs after chemo

89
Q

What are 5HT3 antagonists?

A
  • Serotonin blockers (central and peripheral)
  • Used for CINV, PONV, RINV
  • Ondansetron (Zofran)
  • All available PO/IV
90
Q

Do 5HT3 antagonists treat acute or delayed CINV?

A

Acute more than delayed (give before chemo)

91
Q

Side effects of 5HT3 blockers?

A
  • Constipation, mild HA

- Potential QT prolongation

92
Q

What are NK-1 antagonists used for?

A
  • Prevention of acute and delayed NV
  • Given as a 3 day regimen (IV then PO 2 days)
  • CYP interactions
  • Apreptitant
93
Q

Corticosteroids used in NV treatment and how do they work?

A
  • Dexamethasone
  • Methylprednsiolone
  • MOA unclear
  • Acute or delayed CINV
94
Q

What are dopamine antagonists used for?

A
  • Delayed CINV
  • Moderate to low emetogenic chemo
  • Lower potency
  • Prochlorperazine, promethazine
95
Q

What are benzodiazepines used for?

A
  • Prevent anticipatory CINV
  • No antiemetic properties, good if want to sleep through the NV
  • Lorazepam
96
Q

What are cannabinoids used for?

A
  • Refractory, delayed CINV

- Medical marijuana

97
Q

What are antihistamines used for?

A
  • H1 blockers
  • Used for motion sickness
  • SHORT trips
  • Weak anticholinergic activity
98
Q

Which motion sickness meds are used for short trips vs. long trips?

A
  • Short: antihistamines

- Long: anticholinergic

99
Q

What is scopolamine?

A
  • Anticholinergic used for motion sickness of long trips

- Patch behind ear at least 3 hrs before exposure and reapply every 3 days

Pharm II MHM - Exam 3 (5 decks)

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