Lower GI Meds Flashcards
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.
invasive organisms
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
glucose and salts
Loperamide and Diphenoxylate are both _____ and used for what?
both are Narcotic (opiod derivatives) and are anti-diarrheals
Narcotic opiod with low CNS penetration, given as anti-diarheal
Loperamide = Imodium
what receptor do both Loperamide and Diphenoxylate act on?
Mu receptor agonist
In Diphenoxylate, the active metabolite is difenoxin via what mechanism?
(de-esterification).
What is a concern of giving patients Diphoxylate?
its has some CNS effects so it is given with ATROPINE to prevent abuse potential
What is the mechanism of fiber and what do we use it for?
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
What can we give to pts for prevention adn tx of travelers diarrhea?
Bismuth subsalicylate (pepto!)
preparations containing a variety of bacterial strains have shown some degree of benefit in acute diarrheal conditions, antibiotic-associated diarrhea and infectious diarrhea.
Probiotics
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.
Octreotide
What is the Theraputic use of Octreotide?
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.
Short term and long term complications of Octreotide?
transient nausea, bloating, or pain at sites of injection. Long-term therapy can lead to
gallstone formation and hypo- or hyperglycemia.
an opioid receptor agonist. Used to treat diarrhea. Does not penetrate into the CNS
Loperamide
a meperidine analog, (opioid receptor agonist). Used to treat diarrhea. CNS effects at
high doses – preparations contain small doses of atropine.
Diphenoxylate
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.
Bismuth subsalicylate
a somatostatin analog used to treat hormone secreting tumor-related secretory diarrhea.
octreotide
Three actions of laxitives
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.
Fiber may be fermented by colon bacteria to produce short chain fatty acids which are_____ and____ for the endothelium. Fermentation increases stool bacterial mass
prokinetic
trophic
_______fiber retains water and increases stool bulk
Unfermented
side effects of fiber and who shouldn’t get fiber
Types of fiber: Bran, cellulose, pectin, lignin etc.
Side effects include: bloating and gas (fermentable fiber)
Contraindicated in patients with obstruction, megacolon.
Milk of Magnesia or Mg(OH)2 mechanism of action
osmotic water retention: inorganic salts that are not absorbed, thus brings water with
Magnesium- and phosphate-containing preparations should be
used with caution in patients with
renal insufficiency, cardiac disease, or preexisting
electrolyte abnormalities, and in patients on diuretic therapy.
What saline chatartic do we need to know?
Mg(OH)2 which is a laxitive
