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Gastrointestinal System > Laxatives, Antidiarrheals, Antiemetics, Prokinetics > Flashcards

Laxatives, Antidiarrheals, Antiemetics, Prokinetics Flashcards

1
Q

Bulk-forming laxatives

A
  • Psyllium, Methylcellulose. wheat dextrin, polycarbophil
  • Hydrophilic colloids which absorb water and form emollient gel that distends colon + promotes peristalsis
  • Ind: Chronic constipation; pregnancy const
  • AE: Bloating/flatulence
  • Contra: OIC; HF; PD; intestinal ulceration
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2
Q

Docusate Sodium

A
  • Stool Softener detergent
  • Indications: Hard stool, chronic constipation, Fe supplementation
  • AE: Hypomagnesemia
  • Contra: >7 days; pain, N/V present; concomitant use w/ mineral oil
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3
Q

Mineral Oil

A
  • Stool softenre; coats bowel w/ waterproof film
  • Ind: Acute or Chronic constipation
  • AE: Aspiration Pneumonial DEC nAKED absorption; anal leakage
  • Contra: Debillitated patients; docusate use; <6YO; *Pregnancy
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4
Q

Salt-laxatives

A
  • MagCit, MagOH, MagSO4, NaPO4
  • Osmotic retention of water in intestinal lumen
  • Ind: Enema for constipation; Bowel prep;
  • Contra: Electrolye abnormalites; Rena;/cardiac patients; Nephrotoxicity in NaPO4
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5
Q

Salt-free osmotic laxatives

A
  • Glycolytely; PEGs - Mirolax
  • Indications: Bowel Prep; Miralax for occasional constipation
  • AE: CV/Renal Disease; Diuretics; NSAIDS
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6
Q

Nondigestable sugars/alcohols

A
  • Lactulose
  • INC pH -> inhibition of NH3 diffusion -> osmotic retention of fluid in lumen
  • Ind: Constipation
  • AE: Electrolyte imbalance; dehydration; cramping; distention; diarrhea
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7
Q

Bisacodyl

A
  • Irritates smooth muscle of intestine
  • Ind: Bowel cleaning; constipation
  • AE: cramping, electrolyte imbalance
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8
Q

Arthraquinone (derivatives)

A
  • Senna, Aloe, Cascara
  • Stimulate peristasis via nerve plexus
  • Ind: Occasional constipation; off-label to empty the bowel
  • AE: cramping; electrolye imbalance
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9
Q

Linaclotide/Plecanatide

A
  • Chloride secretion activators; bind GCC -> INC cGMP -> INC Cl/HCO3 secretion
  • Ind: CIC; IBS-C
  • AE: Abdominal distention, diarrhea, flatulence, headache; dehydration
  • Contra: Mech obstruction; <6YO
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10
Q

Lubiprostone

A
  • activating chloride channels on the apical membrane of the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit.
  • Ind: CIC, OIC, IBS-C
  • AE: Diarrhea, headache, nausea
  • Contra: Mechanical Obstruction
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11
Q

Diphenoxylate

A
  • Opioid Agonist
  • Ind: Acute/chronic diarrhea
  • AE: CNS effects like sedation; Opioid dependence
  • synergistic w/ atroine
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12
Q

Difenoxin

A
  • Active metabolite of Diphenoxylate
  • More powerful; habit-forming
  • Used w/ Atropine to prevent misuse
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13
Q

Loperamide

A
  • Mu Opioid agonist in Myenteric plexus leading to relaxation f smooth muscle w/ NO CNS activity (No BBB)
  • Ind: acute/chronic diarrhea; Traveler’s diarrhea; Cancer diarrhea
  • AE: Constipation/ileus; Torsades
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14
Q

Eluxadoline

A
  • Mu/Kappa agonist + delta antagonist
  • Ind: IBS-D
  • AE: Sphincter of Oddi spasm -> pain, pancreatitis, INC enzymes
  • Contra: Biliary obstruction, Sphincter of Oddi dysfunction, pancreatic Dx. Obstruction, hepatic impairment, alcoholism
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15
Q

Bismuth Subsalicylate

A
  • Antimicrobial + stimulates fluid/electrolyte absorption
  • Ind: Traveler’s diarrhea + dyspepsia
  • AE: Large dose Neurotoxic; CNS effects; Discoloration of tonuge or fecal matter; Hearing loss + Tinnitus
  • Contra: ASllergy, Ulcer, Coagulopathy, Salicylate use, Reye’s Syndrome (viral illness)
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16
Q

Octreotide

A
  • Analog of endogenous somatostatin -> reduce VIP, serotonin, gastrin, secretin,+ PPT -< INC transit + absoprtion\
  • Ind: Severe/watery Diarrhea by carcinoid syndrome; Diarrhea of chemo, HVG, short-gut, and Dumping syndrome
  • AE: GI distress, Headaches, gallstones
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17
Q

Bile Resins

A
  • Binds excess bile acids + bacterial toxins
  • Ind: Cholesterolemia, Bile salt-induced diarrhea
  • AE: Drug absoprtion
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18
Q

Sulfasalazine

A
  • Broken down by gut bacteria to 5-ASA, an antiinflammatory + Anti-secretorya gent; DEC PGE, IL-1, TNF-a, + lipoxygenase
  • Ind: Ulcerative Colitis S/S
  • AE: Folate deficiency; Rash, nausea, anorexia, headache
19
Q

Scopolamine

A
  • Competitive M1 antagonist that interferes vestibular neurons
  • Ind: Motion sickness; post-op Nausea
  • AE: CNS (psychosis exacerbation, etc); Somnolence; Xerostomia
20
Q

Meclizine (Dromamine)

A
  • H1 antihistamine in vestibular apparatus
  • Ind: N/V; Pregnancy N/V; Motion Sickness
  • AE: Drowsiness, dry mouth, dry/blurry vision, tachycardia
21
Q

Dimenhydrinate

A
  • 1st gen H1 antagonist
  • Ind: Chemotherapy-induced N/V
  • AE: Drowsiness, dry mouth, blurry vision, tachycardia
22
Q

Prochlorperazine

A
  • Blocks postsynaptic D1/2 + a1 receptors on the vomiting centers
  • Indications: Severe N/V; CINV;
  • AE: Extrapyramidal effects, Drowsiness, dry mouth, blurred vision, orthostatic hypotension
  • Contra: Parkinsons; Dementia; Psychosis
23
Q

Promethazine

A
  • Inhibits postsynaptic D1/2 receptors + alpha1 receptors in vomiting centers
  • Ind: Post-Op N/V; CINV
  • AE: Extrapyramidal effects; drowsiness, dry mouth, blurry vision; orthostatic hypotension
  • Contra: Parkinson’s; Children
24
Q

Droperidol

A
  • Dopamine receptor antagonist
  • Ind: Only PONV
  • AE: extrapyramidal effects; QT Prolongation; Torsades
  • Contra: Parkinsons; QT prolonged
25
Q

Metoclopramide

A
  • D2 antagonist + ACh enhancer
  • Ind: CINV; Diabetic Gastroparesis; GERD; Dyspepsia;
  • AE: Tardive Dyskinesia; extrapyramidal; fatigue; somnolesence; headache;
26
Q

Domperidone

A
  • D2 receptor antagonist Only

- Ind: Prevention induced GI symptoms w/ dopaminergic agonists used in PD; Promotes Motility

27
Q

Ondansetron

A
  • 5-HT3 antagonist
  • Ind: CINV; PONV; Acute raiation-induced N/V
  • AE: headache, constipation, fatigue
  • Contra: Use of Apomorphine
28
Q

Dolasetron

A
  • 5-HT3 Antagonist
  • Ind: CINV
  • AE: QT Prolongation; Headache, constipation, fatigue
29
Q

Granisetron

A
  • 5HT-3 antagonist
  • Ind: CINV
  • AE: Constipation, headache, fatigue, ileus, injection sire reaction
30
Q

Palonosetron

A
  • 2nd gen 5HT-3 antagonist
  • Longer T1/2; increased efficacy
  • Ind: CINV; PONV
  • AE: Constipation; headache fatigue ileus, injection site reaction
31
Q

Dronabinol

A
  • CB1 antagonist
  • Ind: CINV
  • AE: Tachycardia; Orthostatic hypotension; increased appetite; somnolence; euphoria
32
Q

Nabilone

A
  • CB1 receptor antagonist
  • Ind: CINV
  • AE: Tachycardia, erthostatic hypotensionl inc appetite somnolencel euphoria
33
Q

Benzodiazepine Antiemetics

A
  • Alprazolam; Lorazepam
  • Anti GABA-A agonist
  • Ind: anxiety; anticipatory N/V
  • AE: Dizziness, sedation, appetite changes; memory impairment
34
Q

Aprepitant

A
  • Inhibits Substance P/neurokinin-1 receptor -> INC 5-HT activity
  • Ind: CINV; PONV
  • AE: dizziness; diarrhea; fatiguel constipation; hiccups
  • Contra: CYP3A4 inhibitor -> DEC dexamethosone
35
Q

Fosaprepitant

A

I.V prodrug of Aprepitant

36
Q

Netupitant

A
  • Substance P/Neurokinin-1 inhibitor -> INC 5-HT activity
  • Ind: CINV; PONV
  • AE: Dizziness; fatiguel constipationl hiccups
  • Contra: CYP3A4 inhibitor -> Reduce Dexamethasone
37
Q

Rolapitant

A
  • Inhibits Substance P/Neurokinin-1 receptor
  • CINV/PONV
  • NO Dose adjustment for dexamethasone
38
Q

Bethanechol Ind:

A
  • Post-op distention

- Gastric atony follwing vagotomy

39
Q

Neostigmine indications

A
  • Colonic pseudo-obstruction
40
Q

Motilin + Macrolide

A
  • MAcrolides (erythromyocin, etc) mimic motilin -> Gastric emptying
  • Ind: Preo-op for gastroparesis
41
Q

Prucalopride

A
  • 5-HT4 agonist -> peristalsis, secretions, +_ motility
  • Ind: CIC; OIC
  • AE: distentionl diarrhea; dizziness; headache
42
Q

Tagaserod

A
  • 5-HT4 agonist -> peristalsis, secretions, +_ motility
  • Ind: IBS-C in women under 65YO
  • AE: distentionl diarrhea; dizziness; headache
43
Q

Dexcamethasone

A
  • Corticosteroid w/ antiemetic properties
  • enhances 5-HT3 antagonists;
  • Ind: CINV

Gastrointestinal System (32 decks)

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