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Pharm 4 > Lower GI > Flashcards

Lower GI Flashcards

1
Q

Effect of smoking on UC and CD

A

decreases risk of UC

increases risk of Crohn’s

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2
Q

2 conditions with increased risk if you have chronic IBD

A

osteoporosis and colorectal cancer

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3
Q

Drug classes for remission of UC

A

aminosalicylates and glucocorticoids

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4
Q

MOA sulfasalazine

A

contains sulfapyridine or mesalamine; cleaved by colon flora -> mesalamine to block AA metabolism that makes proinflammatory cytokines

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5
Q

ADR sulfasalazine

A

d/t sulfapyridine: n/v, diarrhea, arthralgias, HA
severe: hepatotoxicity, BM suppression
HS: sulfa allergy or ASA allergy

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6
Q

benefit of mesalamine-containing drugs

A

avoids sulfa allergy b/c no sulfapyridine component

*still ASA allergy

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7
Q

olsalazine, balsalazide

A

mesalamine prodrugs acting in colon

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8
Q

MOA of glucocorticoids for UC

A

inhibits PL-A2 = anti-inflammatory effect

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9
Q

use of GCs for UC

A

acute treatment of mod-severe disease, discontinued once under control to avoid long-term adverse reactions
*used if aminosalicylates ineffective

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10
Q

hydrocortisone rectal treatment options

A

enema -> back to splenic flexure

rectal foam -> last 20 cm of colon only

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11
Q

budesonide extended-release for UC

A

distributes throughout the colon

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12
Q

drug classes for maintenance of UC

A

aminosalicylates and thiopurines

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13
Q

MOA thiopurines

A

immunomodulatory agents that inhibit purine synthesis and induce apoptosis in T-cells

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14
Q

azothioprine

A

thiopurine for UC
to maintain remission of UC
effect delayed by several months, allows reduction/discontinuation of steroids

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15
Q

6-mercaptopurine

A

thiopurine for UC
active metabolite of azathioprine
ADR: BM suppression, neutropenia

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16
Q

drugs for refractory treatment of UC

A

cyclosporine or infliximab

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17
Q

MOA cyclosporine

A

calcineurin inhibitor, inhibits T-cell signal transduction

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18
Q

uses and ADR of cyclosporine for UC

A

for fulminant UC refractory to other agents; last resort before surgery
ADR: common: nephrotoxicity, neurotoxicity, HTN

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19
Q

MOA infliximab

A

TNF-a inhibitor by binding bound and soluble TNF-a

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20
Q

uses and ADR of infliximab

A

for mod-severe UC unresponsive to conventional therapy and severe Crohn’s not responding to steroids
ADR: increased risk serious infection (diss/react TB, HBV), inc risk lymphoma and leukemia, expensive

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21
Q

drugs for Crohn’s disease

A

same as UC but aminosalicylates not recommended + budesonide (reaches ileum and ascending colon), methotrexate +/- metronidazole and/or ciprofloxacin for perianal disease, TNF-a inhibitors

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22
Q

adalimumab, certolizumab

A

TNF-a inhibitors
ada - every 2 weeks at home
cert - every 4 weeks at home

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23
Q

diagnosis of IBS

A

abdominal pain and altered bowel habits diagnosis of exclusion

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24
Q

types of IBS

A

IBS-C: constipation predominant
IBS-D: diarrhea predominant
IBS-M: mixed pattern

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25
Q

non-pharmacologic treatment of IBS

A

high placebo response rate

reduce food triggers like raw fruits/veggies, high fat, caffeine, fructose, sorbitol

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26
Q

non-pharmacologic treatment specific to IBS-C

A

fiber (soluble > insoluble), hydration, exercise

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27
Q

causes of constipation

A

anti-ACh, tricyclic antidepressants, antipsychotics (anti-ACh), Ca-channel blockers, diuretics, antacids and supplements with Al, Ca, Fe; opiates

28
Q

MOA bulking agents

A

laxatives for IBS-C; stimulate natural mechanism b/c hydrophilic colloids that draw water into lumen; use in low-residue diet, elderly, pregnancy

29
Q

polycarbophil

A

bulking laxative

30
Q

psyllium

A

bulking laxative

31
Q

methylcellulose

A

bulking laxative

32
Q

MOA saline for IBS-C

A

osmotically pulls water into gut lumen for acute evacuation, contains Mg and phosphate which are poorly absorbed ions

33
Q

cautions with bulking laxatives

A

esophageal obstruction and fecal impaction

34
Q

docusate

A

emollient laxative

35
Q

MOA emollient laxatives

A

anionic surfactant softens fecal mass by facilitating mixing of aqueous and fatty substances; used as prophylaxis and in pregnancy for constipation

36
Q

cautions with saline laxative

A

may cause fluid and electrolyte imbalance

37
Q

glycerin suppository

A

hyperosmotic/ lavage osmotic and local irritant

38
Q

lactulose and sorbitol

A

hyperosmotic agent for IBS-C b/c nonabsorable sugars

39
Q

polyethylene glycol

A

hyperosmotic agent for IBS-C
with electrolytes in golytely
without electrolytes in miralax

40
Q

IBS-C drug useful for hepatic encephalopathy and cause of hep enceph

A

lactulose

hep enceph d/t uremia d/t cirrhosis

41
Q

when to use hyper osmotic and lavage laxatives

A

for procedures

lactulose can be used for hepatic encephalopathy

42
Q

MOA stimulants for IBS-C and when to use

A

irritants induce peristalsis (dose-related)

for procedures and constipation d/t opiates

43
Q

senna

A

stimulant anthraquinone for IBS-C

DOC for constipation d/t opioids

44
Q

bisacodyl

A

oral or suppository stimulant for IBS-C

45
Q

castor oil

A

small intestine stimulant for IBS-C

46
Q

ADR of stimulants for IBS-C

A

cramping, diarrhea, electrolyte imbalance -> severe diarrhea

47
Q

MOA Cl- channel activators and uses

A

increase intraluminal fluid and BMs by increasing Cl- and bicarb secretion
for IBS-C and idiopathic constipation

48
Q

lubiprostone

A

cl- channel activator for IBS-C

49
Q

linaclotide

A

cl- channel activator for IBS-C

50
Q

ADR of cl- channel blockers

A

nausea, diarrhea, HA

51
Q

herbals that may be useful in IBS-C

A

aloe, chicory, dandelion, feverfew, licorice, rose hips

52
Q

drugs/treatments to avoid in IBS-C

A

mineral oil - significant absorption affects absorption of drugs and vitamins
phenolphthalein - SJS

53
Q

loperamide

A

weak opioid derivative anti-diarrheal for IBS-D

peripherally acting = no CNS opioid effects

54
Q

diphenoxylate with atropine and ADR

A

Rx weak opioid derivative anti-diarrheal for IBS-D
ADR: atropine = dry mouth/eyes, confusion in elderly, mydriasis, cycloplegia, tachycardia -> arrhythmia in elderly, constipation, retention, etc.

55
Q

kaolin, pectin, attapulgite

A

adsorbent anti-diarrheals for IBS-D

56
Q

bismuth subsalicylate

A

anti-secretory anti-diarrheal for IBS-D; localized anti-inflammatory action

57
Q

lactase

A

anti-diarrheal for IBS-D d/t lactase deficiency

58
Q

hyoscyamine

A

antisposmodic antidiarrheal for IBS-D

59
Q

dicyclomine

A

antisposmodic antidiarrheal for IBS-D

also anti-ACh

60
Q

chlordiazepoxide/ clinidium

A

antisposmodic antidiarrheal for IBS-D

61
Q

amitriptyline

A

tricyclic antidepressant useful in IBS-D, strong anti-ACh effects

62
Q

rifaximin

A

poorly absorbed oral abx for hepatic encephalopathy and traveler’s diarrhea

63
Q

probiotics

A

bacteria or yeast to recolonize intestine with beneficial microbes, prevent pathogenic microbe growth

  • may improve mood if a/w depression
  • bifidobacteria and lactobacilli most common
64
Q

alosteron

A

5HT3-antagonist that decreases intestinal motility and pain signals for IBS-D
ADR: ischemic colitis -> bowel resection (M>F)

65
Q

what to use for fluid and electrolyte replacement for dehydration

A

oral glucose (low) and sodium (mod) (glucose needed for active Na uptake)
also K, Cl, citrate
or IV normal saline or lactated Ringer’s

66
Q

what to avoid with fluid and electrolyte replacement for dehydration

A

hyperosmolar: high sugar, low sodium like soft drinks, Gatorade, Jell-O, juice
low sodium: tea
high sodium: chicken broth (wastes water)

Pharm 4 (8 decks)

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