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DEMS I > lower GI pharmacology > Flashcards

lower GI pharmacology Flashcards

1
Q

anti-emetics for cancer chemo

A

Class I: PRN- lorazepam, prochlorperazine + diphenhydramine, metoclopramide + diphenhydramine. class II: dexamethasone. Class III: ondansetron + Dex. Class IV: Granisetron + Dex. Class V: granisetron + Dex

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2
Q

anti-emetics for pregnancy

A

First line: pyridoxine (B6) + doxylamine (H1 antagonist). If persists: add diphenhydramine or meclizine. Then: proclorperazine (D2 antagonist) or metoclopramide. If dehydration requiring hospitalization: ondansetron. If refractory n/v (2nd trimester): methylprednisone

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3
Q

list 5HT3 receptor antagonists

A

Ondansetron

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4
Q

5HT3 antagonists uses

A

prevent chemotherapy induced n/v, post-op emesis, N/V associated with post-op opioids

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5
Q

list Dopamine (D2) receptor antagonists

A

Prochloroperazine , Metoclopramide (also blocks 5HT3)

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6
Q

dopamine antagonist side effects

A

Extrapyramidal symptoms (movement disorders)

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7
Q

dopamine antagonist uses

A

Metoclopramide used for n/v of chemotherapy. Prochlorperazine less effective against emetic stimuli in gut (mediated via 5HT3 receptors). But also blocking M and H1 receptors increases their utility in nausea with motion sickness

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8
Q

List Antihistamines (1st generation)

A

Meclizine, promethazine, Diphenhydramine (dimenhydrinate)

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9
Q

antihistamine uses

A

motion sickness and postoperative emesis

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10
Q

list Anticholinergic agents

A

Scopolamine

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11
Q

Anticholinergic agents uses

A

Primarily prevention/treatment of motion sickness. Also post operative n/v

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12
Q

Anticholinergic agents pharmacokinetics

A

transdermal- duration of action 72 hrs

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13
Q

Which drugs can induce constipation

A

antimuscarinics, drugs with antimuscarinic side effects (antihistamines, TCAs, antipsychotics), antacids, Ca channel blockers (verapimil), opioids, 5HT3 antagonists

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14
Q

List Bulk-forming / fiber laxatives

A

Psyllium Seed (metamucil)

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15
Q

Fiber uses and MOA

A

first line agent for constipation. Approximates physiological mechanism (facilitates passage-stimulates peristalsis via H20 absorption > bulk expansion)

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16
Q

Fiber pharmacokinetics

A

•Effective in 12-24 hrs to 3 days - take with fluids. May combine and interact with other drugs (digoxin / salicylates), so space dosing

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17
Q

List Saline (osmotically-active) cathartics

A

Mg(OH)2, Polyethylene glycols, lactulose

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18
Q

Saline (osmotically-active) cathartics uses

A

Added to fiber as second line/step for constipation.Mg(OH)2 used for mild/moderate constipation. Polyethylene glycol used for bowel cleansing before medical procedures (high volume) or difficult constipation (low volume). lactulose: used in elderly Also used in purging doses for food/drug poisoning

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19
Q

Saline (osmotically-active) cathartics MOA

A

Non-absorbable ions > osmotic retention of intestinal water > increased peristalsis

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20
Q

Saline (osmotically-active) cathartics pharmacokinetics

A

Mg(OH2): avoid in renal dysfunction. Can lead to electrolyte imbalance. PEG: high volume has electrolyts added to prevent net transfer but low volume solns may lead to electrolyte depletion.

21
Q

List Stimulant / irritant laxatives

A

Bisacodyl (dulcolax)

22
Q

Stimulant / irritant laxatives uses

A

used for constipation if fiber/saline fails.

23
Q

Bisacodyl MOA

A

increases peristaltic activity via local irritation > accumulation of water and electrolytes > increased motility

24
Q

Bisacodyl side effects

A

electrolyte / fluid deficiencies, severe cramping

25
Q

List Wetting agents / emollient laxatives

A

Docusate (ex lax extra gentle)

26
Q

Ducosate MOA

A

surfactant that acts as stool-softener (facilitates admixture of aqueous and fatty substances)

27
Q

Ducosate uses

A

primary prevention in pts with CV dz, hernia, post partum

28
Q

List meds used for opioid induced constipation

A

Managed with stool softeners (docusate), stimulant laxatives (bisacodyl - senna), osmotic laxatives (PEG [Miralax®] - milk of magnesia)

29
Q

two causes of diarrhea

A

decreased absorption of fluid/electrolytes (osmotic) or increased secretion of fluid and electrolyes

30
Q

Causes of osmotic diarrhea

A

Carbohydrate malabsorption (lactose, sorbitol, fructose) , osmotic laxatives (magnesium, colonoscopy preps)

31
Q

causes of secretory diarrhea

A

bacteria (cholera, e.coli), neuroendocrine tumors, ileal bile salt malabsorption, stimulant laxatives, disordered motility (diabetic neuropathy, IBS)

32
Q

drugs that can induce diarrhea

A

antibiotics, colchicine (anti inflammatory for gout), digoxin, misoprostol (prostaglandin anolog), muscarinic agents, reserpine, SSRIs

33
Q

Which antibiotics are given for C. difficile, cholera and e.coli?

A

c. diff: metronidazole, vancomycin, rifaximin. Cholera: doxycycline, tetracycline or macrolide. E. coli: none

34
Q

List antidiarrheal Opioids

A

Loperamide

35
Q

opioids MOA

A

•Opioid receptor agonist affecting intestinal motility (m), intestinal secretion (d), and absorption (m and d)

36
Q

opioids uses

A

Anti-secretory activity against cholera toxin. Effective against traveler’s diarrhea, alone or with antibiotics - discontinue if no improvement in 48 hours

37
Q

opioid side effects

A

low addiction (low solubility), overdose can cause CNS depression and paralytic ileus

38
Q

Polycarbophil MOA

A

binds free fecal water

39
Q

polycarbophil uses

A

•Useful in diarrhea (absorbs 60X weight in H2O) and constipation (prevents fecal desiccation)

40
Q

List Absorbent Agents

A

Bismuth, Kaolin / Pectin

41
Q

absorbent agent uses

A

manages mild/moderate diarrhea by adsorbing toxins that cause irritation.

42
Q

absorbent agents side effects

A

•Avoid use of bismuth subsalicylate in children under 12 y/o (salicylate risk for Reye’s syndrome)

43
Q

List Drugs for IBS

A

Tegaserod (for constipation), Alosetron (for diarrhea)

44
Q

Alosetron MOA

A

seretonin 5Ht3 antagonist- Block of 5-HT3 receptors on sensory and motor neurons reduces pain and inhibits colonic motility

45
Q

alosetron uses

A

Severe IBS in women with diarrhea as the prominent symptom - restricted use due to risk of ischemic colitis

46
Q

Tegaserod MOA

A

Serotonin 5-HT4 Agonist > release of NTs > peristaltic reflex > gastric empyting and intestinal motility

47
Q

Tegaserod uses

A

IBS patients with predominant constipation

48
Q

tegaserod side effects

A

•heart attacks, strokes, and unstable angina leading to restricted use

DEMS I (28 decks)

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