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GI--Wk 4 > Lax, Antidiarrheals, IBS Tx > Flashcards

Lax, Antidiarrheals, IBS Tx Flashcards

1
Q 
Fluoxetine
Paroxetine
Sertaline
MOA
TU
A

MOA: SSRI, increases afferent activity
TU: constipation

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2
Q 
Dietary fiber
Methylcellulose
Polycarbophil
Psyllium
MOA
TU
Tox
A

MOA: bulk laxatives, attract water and increase stool mass–distention causes increased 5-HT release
TU: diarrhea and constipation (normalizes both)
Tox: allergies, flatulance, worsen obstruction

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3
Q

Cascara sagrada
MOA
PK
Tox

A

MOA: anthraquinone, acts only on large intestine as laxative
PK: slow
Tox: dependence and myenteric plexus damage (longterm), pigmentation of mucosa

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4
Q

Danthoron
MOA
PK
Tox

A

MOA: anthraquinone, acts only on large intestine as laxative
PK: slow
Tox: dependence and myenteric plexus damage (longterm), pigmentation of mucosa

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5
Q

Senna
MOA
PK
Tox

A

MOA: anthraquinone, acts only on large intestine as laxative
PK: slow
Tox: dependence and myenteric plexus damage (longterm), pigmentation of mucosa

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6
Q

Bisacodyl
MOA
PK
Tox

A

MOA: acts only on large intestine as laxative
PK: slow, prodrug (6 hr to activation)
Tox: dependence and myenteric plexus damage (longterm), pigmentation of mucosa

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7
Q

Caster oil
MOA
PK
Tox

A

MOA: prokinetic on entire GI
PK: fast, acts as prokinetic
Tox: dependence and myenteric plexus damage (longterm), pigmentation of mucosa, dehydration and electrolyte imbalances, uterine contractions (abortifacent)

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8
Q

Toxicity of contact cathartics

A 
dependency and myenteric nerve damage (long term)
pigmentation of mucosa
uterine contractions (caster oil)
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9
Q 
Alosetron
MOA
PK
TU
Tox
A

alesetron
MOA: 5-HT3 antagonist, block afferent stimulation, decrease peristalsis
PK: longer duration than anti-emetics
TU: diarrhea-predominant IBS–last resort
Tox: excessive hospitalizations, ischemical colitis (may be fatal)–incidence increaes w/ CYP4A2 inhibitor use

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10
Q 
Cisapride
MOA
PK
TU
Tox
A

cisapride
MOA: 5-HT4 agonist on presynaptic, increase NT release, increase peristalsis
PK: tegaserod is more specific
TU: diabetic gastroparesis
Tox: long QT, more w/ comorbids and CYP3A4 inhibitors

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11
Q 
Tagaserod
MOA
PK
TU
Tox
A

tagaserod
MOA: 5-HT4 agonsist, increase NT release, increase peristalsis
PK: more specific than cisapride
TU: constipation-predominant IBS
Tox: long QT, more w/ comorbids and CYP4A4 inhibitors

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12
Q 
Diphenoxylate
MOA
PK
TU
Tox
A

diphenoxylate
MOA: enkephalins, inhibit motility and secretions
PK: co-Tx w/ atropine, so not dependent
TU: anti-diarrheal
Tox: cramps, megacolon if pt has ulcerative colitis, if high levels –> euphoria like opiates

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13
Q 
Loperamide
MOA
PK
TU
Tox
A

loperamide
MOA: enkephalins, inhibit motility and secretions
PK: does not cross BBB
TU: anti-diarrheal
Tox: cramps, megacolon if pt has ulcerative colitis

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14
Q

Alvimopan
MOA
TU
Tox

A

alvimopan
MOA: selective µ-receptor antagonist
TU: constipation 2˚ to opiate Tx in hospital
Tox: increased risk of MI

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15
Q

Methylnaloxone
MOA
TU
Tox

A

methylnaloxone
MOA: selective µ-receptor antagonist
TU: constipation 2˚ to opiate Tx on hospice
Tox: none

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16
Q

Domperidone
MOA
TU
Tox

A

domperidone
MOA: inhibition of inhibitory dopamine interneurons, increasing motility
TU: impaired gastric emptying (vagotomy, gastroparesis)
Tox: somnolence, nervousness, aggitation, tardative dyskinesia (irreversible)

17
Q

Metoclopramide
MOA
TU
Tox

A

Metoclopramide
MOA: inhibition of inhibitory dopamine interneurons, increasing motility
TU: impaired gastric emptying (vagotomy, gastroparesis)
Tox: somnolence, nervousness, aggitation, tardative dyskinesia (irreversible)

18
Q

TCAs

MOA

A

TCAs
MOA: decrease NE reuptake –> increased activation of alpha-2 on cholinergic parasympathetics –> decreased ACh release, decreased motility

19
Q 
Lubiprostone
MOA
PK
TU
Tox
A

lubiprostone
MOA: activates CIC2, increases Cl- secretion
PK: poor absorption, low systemic effects
TU: chronic constipation, constipation IBS
Tox: diarrhea, nausea, headache, fetal loss

20
Q 
Linaclotide
MOA
PK
TU
Tox
A

linaclotide
MOA: activates cGMP –> CFTR
PK: poor absorption, low systemic effects
TU: constipation
Tox: diarrhea, maternal death, peds lethal

21
Q 
Octreotide
MOA
PK
TU
Tox
A

octreotide
MOA: somatostatin analog, decrease fluid secretion, high dose decreases motility (low increases motility)
PK: long t1/2
TU: severe diarrhea (dumping, vagotomy, short gut, AIDS)
Tox: impaired pancreatic secretion, decreased fat absorption –> KADE deficiencies, decrease in gallbladder motility –> stones, insulin/glucagon imbalance, hypothyroidism and bradycardia

22
Q 
Bismuth subsalicylate in secretions
MOA
PK
TU
Tox
A

bismuth subsalicylate
MOA: subsalicylate decreases PG and Cl secretion in large intestine, antimicrobial–binds enterotoxin
TU: prevention of traveller’s diarrhea, opiates better when diarrhea starts
Tox: black stool and tongue, salicylate tox

23
Q

Lactulose, Magnesium hydroxide, Sodium phosphate, Polyethylene glycol
MOA
TU
Tox

A

MOA: osmotic cathartics
TU: constipation when nerves disrupted

24
Q

Lactulose special TU

A

decease plasma ammonia (portal systemic encephalopathy)

25
Q

Sodium phosphate tox

if in blood

A

deplete intravascular volume, hypokalemia

26
Q

Magnesium hydroxide toxo

if in blood

A

hypermagnesemia in renal failure

27
Q

Lactulose tox

if in blood

A

metabolized by gut bacteria –> lots of gas and cramps

28
Q

Cholestyramine, colestipol
MOA
TU
Tox

A

MOA: binds bile acids, prevents osmotic diarrhea 2˚ to bile acid loss
TU: Crohn’s, terminal ileal resection
Tox: constipation, fecal impaction, KADE and drug loss

29
Q 
Docusate
Mineral oil
MOA
TU
Tox
A

MOA: ducusate = surfactant, mineral oil lubricates
TU: widespread
Tox: mineral oil–lipid pneumonitis if aspirated, KADE loss

GI--Wk 4 (11 decks)

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