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GI 3 > Lower GI Meds > Flashcards

Lower GI Meds Flashcards

1
Q

Many anti-diarrheal act by decreasing intestinal motility and shouldbe avoided as much as possible in acute diarrheal illnesses caused by _____. In such cases, these
agents may mask the clinical picture, delay clearance of organisms, and increase the risk of systemic invasion.

A

invasive organisms

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2
Q

In severe cases of diarrhea, dehydration and electrolyte imbalances occur. Oral rehydration is critical. In theenterocyte: glucose, sodium and chloride transport are linked.
**A balance of_____ and____ is required for patient rehydration

A

glucose and salts

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3
Q

Loperamide and Diphenoxylate are both _____ and used for what?

A

both are Narcotic (opiod derivatives) and are anti-diarrheals

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4
Q

Narcotic opiod with low CNS penetration, given as anti-diarheal

A

Loperamide = Imodium

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5
Q

what receptor do both Loperamide and Diphenoxylate act on?

A

Mu receptor agonist

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6
Q

In Diphenoxylate, the active metabolite is difenoxin via what mechanism?

A

(de-esterification).

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7
Q

What is a concern of giving patients Diphoxylate?

A

its has some CNS effects so it is given with ATROPINE to prevent abuse potential

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8
Q

What is the mechanism of fiber and what do we use it for?

A

for mild cases of diarrhea, can act to increase BULK and bind toxins
ii. Mechanism:? Alters stool viscosity, bind water and increases bulk, may bind toxins

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9
Q

What can we give to pts for prevention adn tx of travelers diarrhea?

A

Bismuth subsalicylate (pepto!)

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10
Q

preparations containing a variety of bacterial strains have shown some degree of benefit in acute diarrheal conditions, antibiotic-associated diarrhea and infectious diarrhea.

A

Probiotics

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11
Q

a Somatostatin analog that is effective in inhibiting secretory diarrhea brought about by hormone-secreting tumors of the pancreas and the GI tract. subcutaneously or IV.

A

Octreotide

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12
Q

What is the Theraputic use of Octreotide?

A

Tumor-related secretory diarrhea. Off label it is used for other forms of secretory
diarrhea and the “dumping syndrome” seen in some patients after gastric surgery and pyloroplasty and the control of bleeding of esophageal varices.

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13
Q

Short term and long term complications of Octreotide?

A

transient nausea, bloating, or pain at sites of injection. Long-term therapy can lead to
gallstone formation and hypo- or hyperglycemia.

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14
Q

an opioid receptor agonist. Used to treat diarrhea. Does not penetrate into the CNS

A

Loperamide

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15
Q

a meperidine analog, (opioid receptor agonist). Used to treat diarrhea. CNS effects at
high doses – preparations contain small doses of atropine.

A

Diphenoxylate

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16
Q

bismuth (Bi3+), salicylate and magnesium aluminum silica clay used to treat
travelers’ diarrhea and may be used in conjunction with other therapies for H.Pylori associated ulcers.

A

Bismuth subsalicylate

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17
Q

a somatostatin analog used to treat hormone secreting tumor-related secretory diarrhea.

A

octreotide

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18
Q

Three actions of laxitives

A

1) enhance the retention of intraluminal fluid by hydrophilic or osmotic mechanisms
2) decrease net absorption or increase secretion of fluid by effects on fluid and electrolyte transport
3) to alter motility by either inhibiting segmenting (nonpropulsive) contractions or stimulating propulsive contractions.

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19
Q

Fiber may be fermented by colon bacteria to produce short chain fatty acids which are_____ and____ for the endothelium. Fermentation increases stool bacterial mass

A

prokinetic

trophic

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20
Q

_______fiber retains water and increases stool bulk

A

Unfermented

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21
Q

side effects of fiber and who shouldn’t get fiber

A

Types of fiber: Bran, cellulose, pectin, lignin etc.
Side effects include: bloating and gas (fermentable fiber)
Contraindicated in patients with obstruction, megacolon.

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22
Q

Milk of Magnesia or Mg(OH)2 mechanism of action

A

osmotic water retention: inorganic salts that are not absorbed, thus brings water with

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23
Q

Magnesium- and phosphate-containing preparations should be
used with caution in patients with

A

renal insufficiency, cardiac disease, or preexisting
electrolyte abnormalities, and in patients on diuretic therapy.

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24
Q

What saline chatartic do we need to know?

A

Mg(OH)2 which is a laxitive

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25
Q

A non-absorbed disaccharide, hydrolyzed
in the intestine to short-chain fatty acids, which stimulate colonic
propulsive motility by osmotically drawing water into the lumen

A

lactulose

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26
Q

Side effects of lactulose

A

gas and abdominal distention (first 24-48 hrs)

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27
Q

Drug that is useful in pts with porta-systemic encephalopathy to decrease ammonia levels

A

lactulose

Patients with severe liver disease have an impaired
capacity to detoxify colon ammonia. The drop in luminal pH (acidification) that accompanies hydrolysis to short-chain fatty acids “traps” ammonia by its conversion to the polar ammonium ion. Combined with increases in colonic transit, this therapy significantly lowers circulating ammonia levels.

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28
Q

are osmotic agents which bind water and cause water to be retained within the stool. They lack of intestinal enzymatic degradation or bacterial metabolism

A

Polyethylene Glycol (PEG) come in powder form = Miralax

29
Q

how can we prevent net ionic shift when we give pts MiraLax or PEG?

A

give with isotonic Na and K salts

30
Q

Therapeutic use of Polyethylene Glycol

A

treatment of constipation and for colonic cleansing prior to radiological,
surgical, and endoscopic procedures. When used in high volume, these preparations shouldcontain isotonic mixtures of sodium sulfate, sodium bicarbonate, sodium chloride, and potassium chloride

31
Q

Functions as an anionic surfactant. It lowers the surface tension of the stool to
enhance mixing. It also stimulates intestinal fluid and electrolyte secretion and alters intestinal mucosal permeability.

A

Docusate salts (laxitive)

32
Q

Uses of Ducosate salts

A

Treatment of constipation; colonic cleansing prior to procedures or examination

33
Q

Two laxitives that work by causing low grade irritation on the mucosa in the small and large bowel to promote accumulation of water and electrolytes and stimulate intestinal motility.

A

Bisacodyl and Senna

34
Q

Both mucosal irritant laxitives are _____ and act on the ____ intestine

A

prodrugs

large

(Senna and Bisacodyl)

35
Q

Anthraquionone cathartic, plant derivative that is activated by colonic bacteria

A

Senna

36
Q

Prodrug that acts on large intestine and is converted to its active form by bowel esteratese to act as irritant laxitive

A

Bisacodyl

37
Q

A prostanoid that activates chloride channels in the apical portion of the intestine
and promotes the secretion of a chloride-rich fluid; NOT absorbed and acts only in the intestinal lumen

A

Lubiprostone

38
Q

Used to tx adult chronic constipation and women with IBS. Has poor bioavailabilty and acts only in lumen of bowel

A

Lubiprostone

39
Q

Side effects of Lubiprostone

A
40
Q

What is the MOA of Linaclotide?

A

Binds and activates c-GC receptor on lumial surface of epi cells to increase intra and extracellular cGMP

– Cl- and bicarb secreation increased

-extracellular cGMP can decrease visceral pain

41
Q

Common use for Linaclotide

A

IBS with constipation together or either one

sides = diarrhea and abdominal cramping

42
Q

a peripheral acting opioid receptor antagonist which blocks opioid binding at
the mu receptor.

A

Methylnaltrexone

43
Q

Very restricted use to short term tx of post operative ileus post bowel resection

A

Methlynaltrexone

44
Q

– reduces surface tension in stool (surfactant cathartic). Used to treat constipation.

A

Docusate salts –

45
Q

– a nonabsorbed sugar fermented by bacteria to organic acids and causes osmotic retention of fluids. Used to treat portal systemic encephalopathy and constipation.

A

Lactulose

46
Q

is not absorbed and causes osmotic retention of water. Used to treat constipation,
colon cleansing.

A

Polyethylene Glycol

47
Q

a diphenylmethane. Causes enteric mucosal irritation/inflammation to increase intestinal fluid accumulation. Used to treat constipation.

A

Bisacodyl –

48
Q

activates chloride channels to increase intestinal fluid secretion and intestinal motility. Used to treat chronic constipation in adults and women with irritable bowel syndrome constipation.

A

Lubiprostone

49
Q

– a peripherally acting opioid receptor antagonist used for the treatment of opioidinduced
constipation.

A

Methlynaltrexone

50
Q

The treatment of IBS (either diarrhea or constipation) is predominantly symptomatic. Patients withpain episodes often are treated with agents that

A

may reduce smooth muscle contractility in the gut

51
Q

New focus of tx for people with IBS is _______ but concerned with increased indicidence of ischemic colitis

A

Alosetron- 5-HT3 receptor antagonist; role of serrotonin

52
Q

Therapy goals with treating Irritable Bowl Diseae: UC or Crohns

A
  1. Treat acute attacks
  2. Maintain remisssion
  3. Treat complications
53
Q

Corticosteroid used to treat moderate to severe acute attacks of IBD

A

Prednisone

54
Q

Three patient groups when treatint IBD with Presnisone:

  1. Responsive
  2. Dependent
  3. Unresponsive
A
  1. Responsive (improve within 1-2 weeks and remain in remission as the steroids are discontinued)
  2. Dependent (respond to glucocorticoids but experience a relapse as the steroid is tapered)
  3. Unresponsive (do not improve even with prolonged high-dose steroids)
55
Q
A
56
Q

An oral enteric release glucocorticoid used to treat mild-moderate acute Crohn’s. It
is proposed to deliver adequate steroid therapy to a specific portion of inflamed gut while minimizing systemic side effects. Also used as topical therapy

A

Budesonide

57
Q

What is our first line tx for ulcerative colitis?

A

5-Aminosalicylates (5-ASA)
Olsalazine, Mesalamine and Sulfasalazine

58
Q

What two 5-ASA drugs are prodrugs?

A

Olsalazine and Sulfasalazine

*Mesalamine does have delayed time or pH dependent release

59
Q

Mechanism of Mesalamine, Oslazine, Sulfasalazine

A

?? inhibition of IL-1 and TNF production, possible inhibition of lipoxygenase, savenging of free radicals and oxidants. NOT related to COX inhibition

60
Q 
The prodrugs (olsalazine and sulfasalazine) contain an\_\_\_\_ that  preventsabsorption in the stomach and small intestine. The bond is cleaved by colonic bacteria which liberates
the components for absorption. 5-ASA is the therapeutic moiety. This effectively delivers the drug to the\_\_\_\_ GI tract.
A

azo bond

distal

61
Q

_____mesalamine is released throughout the small intestine and colon, whereas _____ mesalamine is released in the terminal ileum and colon

A

Delayed-release

pH sensitive

62
Q

What are the side effects of sulfasalazine?

A

fever, malaise, vomiting, headache

63
Q

What are the side effects of mesalamine?

A

usually infrequent and minor: headache, dyspepsia, skin rash

64
Q

What are some immmunosuppresive and anti-cancer therapies used to treat IBD?

A

6-MP, Azathiprine but have lots of bad side effects like bone marrow suppresion, jaundice,

Methotrexate for crohns

cyclosporine for UC

65
Q

Immunoglobulin against TNF-alpha to cause lysis of cells by antibody-dependent or cell-mediated cytotoxicity: to treat severe Crohns and UC

A

Infliximab

66
Q

Additional therapies for IBD

A

antibiotics, probiotics, some helminths and helminth associated molecules may help

67
Q

Glucocorticoid-dependent patients may be treated long-term with

A

budesonide

68
Q

is useful in closing fistulas associated with Crohn’s disease; increasingly, along with other biological agents, it is used in acute flares of this condition.

A

INfliximab

69
Q

a glucocorticoid used to treat acute attacks of inflammatory bowel disease.

A

prednisone

GI 3 (15 decks)

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