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Pharm/Pharmacotherapeutics II > Laxatives, Ant-Diarrheals, IBD > Flashcards

Laxatives, Ant-Diarrheals, IBD Flashcards

1
Q

Metoclopramide (D2 antagonist) MOA

A

Inhibits smooth muscle stimulation

Uses: GERD, impaired gastric emptying, postpartum lactation stimulation

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2
Q

Macrolides MOA

A

Directly stimulate motilin receptors on GI smooth muscle though tolerance develops quickly

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3
Q

Docusate MOA

A

(Stool surfactant agent/softener) Reduces surface tension of oil-water interface of stool resulting in enhanced incorporation of water and fat

Generally well tolerated

Short term use for treatment of constipation is generally safe in pregnancy!

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4
Q

Osmotic Laxatives MOA

A

soluble but nonabsorbable compounds resulting in increased stool liquidity due to obligate increase in fecal fluid

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5
Q

Osmotic Laxatives (drug list)

A

Magnesium hydroxide
magnesium citrate, sulfate solution
Sodium phosphate

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6
Q

Magnesium hydroxide

A

(milk of magnesia)

not for prolonged periods in renal insufficiency due to hypermagnesemia

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7
Q

Magnesium citrate, sulfate solution

A

Purgatives to treat acute constipation or clear bowel prior to procedure

MAINTAIN HYDRATION!

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8
Q

Sodium phosphate

A

Can precipitate arrhythmias or acute renal failure esp in elderly or renal or cardiac disease

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9
Q

Polyethylene glycol

A

Osmotic laxative
Used for complete colonic cleansing before endoscopy
Designed so no significant intravascular fluid or electrolyte shifts occur (SAFE!)

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10
Q

Stimulant Laxatives MOA

A

Induce bowel movements through poorly understood mechanisms; direct stimulation of enteric nervous system & colonic electrolyte & fluid secretion

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11
Q

Stimulant Laxatives (drug list)

A

Aloe
Senna
Bisacodyl

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12
Q

Senna (Senokot)

A

Stimulant laxative

Poorly absorbed and produces bowel movement 6-12 hrs after PO and 2 hrs after PR
Chronic use leads to brown pigment of colon

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13
Q

Bisacodyl (Dulcolax)

A

Stimulant laxative

Treatment of acute chronic constipation

Minimal systemic absorption & safe for acute & long term use!

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14
Q

Lubiprostone (Amitiza) MOA

A

Stimulates type 2 chloride channel in small intestine

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15
Q

Methynaltrexone (Relistor)

A

Opioid receptor antagonist

Doesn’t cross BBB so doesn’t impact analgesic effects in CNS but inhibits peripheral mu-opioid receptors

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16
Q

Loperamide (Imodium) OTC

A

MOA: opioid agonist

Doesn’t cross BBB!

17
Q

Diphenoxylate/Atropine (Lomotil)

A

MOA: opioid agonist

No analgesic properties in standard dose but higher doses have CNS effects

Prolonged use can lead to dependence

Atropine added to discourage overdose & may contribute to antidiarrheal action!

18
Q

Bismuth subsalicylate (Pepto-Bismol) MOA

A

Reduce stool frequency & liquidity due to salicylate inhibition of intestinal prostaglandin & chloride secretion

Has direct antimicrobial effects & binds to enterotoxins

Prevents and treats traveler’s diarrhea!

19
Q

Bile Salt Binding Resins (drug list)

A

Cholestyramine
Colestipol
Colesevelam

20
Q

Aminosalicylates MOA

A

Thought to modulate inflammatory mediators derived from cyclooxygenase and lipooxygenase pathways interfering with production of inflammatory cytokines

21
Q

Aminosalicylates

A

Effectiveness depends on achieving high concentrations and site of active disease

22
Q

Sulfasalazine (Azulfidine) class

A

Aminosalicylate: Azo Compound

23
Q

Sulfasalazine Adverse Effects

A

High incidence associated with sulfapyridine molecule

GI upset, nausea, headache, arthralgias, myalgias, bone marrow suppression, hypersensitivity

Impairs folate absorption & processing (need supplement)

24
Q

Pentasa

A

Aminosalicylate: Mesalamine compound

Contains timed release microgranules

25
Q

Purine Analogs (drug list)

A

Azathioprine (Imuran)

6-mercaptopurine (6-MP)

26
Q

Purine Analogs MOA

A

Purine antimetabolites with immunosuppressive properties

27
Q

Purine Analogs Adverse Effects

A

Nausea, vomiting, bone marrow depression, hepatic toxicity

Interactions: allopurinol!
They are inactivated by xanthine oxidase and allopurinol is xanthine oxidase inhibitor!

28
Q

Methotrexate MOA

A

Inhibits dihydrofolate reductase

High doses inhibit cellular proliferation but lower doses not so much

29
Q

Methotrexate ADE

A

Bone marrow suppression
Megaloblastic anemia
Mucositis

Need folate supplement!

30
Q

Antitumor Necrosis Factor (drug list)

A

Infliximab (Remicade)

Adalimumab (Humira)

31
Q

Infliximab and adalimumab

A

Approved for acute and chronic moderate to severe Crohn’s disease with inadequate response to conventional therapies

Pharm/Pharmacotherapeutics II (5 decks)

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