Module 3: GI Unit C Flashcards
What classes of drugs are used to treat chronic constipation?
Bulking agents: Psyllium (Metamucil)
Osmotic laxative: PEG (Miralax)
Stimulant laxatives: Biscodyl (Dulcolax)
Chloride channel activators: Lubiprostone (Amitiza)
Guanylate cyclase-C agonists Linaclotide (Linzess), Plecanatide (Trulance)
Management of Irritable Bowel Syndrome (IBS) is based on what?
On classification:
Diarrhea-predominant
Constipation-predominant
Mixed presentation IBS with alternating diarrhea and constipation
BBW for Alosetron (Lotronex)
Ischemic colitis
indication for Alosetron (lotronex)
For women with severe IBSD that has lasted more than six months and have not responded to other medications
MOA for Alosetron (lotronex)
Blockade of 5 HT receptors decreases abdominal pain, increases colonic transit time, reduces intestinal secretions, and increases water reabsorption. This results in increasing stool firmness and decreased fecal urgency and frequency.
Indication for Eluxadoline (Viberzi)
IBS-D in both men and women.
MOA for Eluxadoline (Viberzi)
Mu-and kappa receptor agonist. Activation of these receptor sites decreases the motility of the bowel.
Indication for Lubiprostone (Amitiza)
IBS-C in women > 18 years old
idiopathic constipation in adults
Treatment of opioid-induced constipation
MOA of Lubiprostone (Amitiza)
Activates chloride channels in the intestine, increases chloride-rich fluid in the intestines, and increases motility.
Contraindication for laxative Lubiprostone (Amitiza)
Known or suspected GI obstruction
Non-specific treatments for IBS?
soluble fiber, peppermint oil, antibiotics, and tricyclic antidepressants or SSRIs or SNRIs.
MOA of peppermint oil?
antispasmodic effect on intestinal smooth muscles, reduction of gastric motility, and an anti-inflammatory and antimicrobial effect in the small intestine. use up to 8 weeks.
MOA of TCAs (Palemor)?
improve visceral pain by acting on norepinephrine, and dopaminergic receptors
MOA of SSRIs for IBS?
Antidepressants improve abdominal pain and overall symptom scores
Example of Antibiotic for IBS-D?
Rifaximin (Xifaxan) is a nonabsorbed antibiotic that has FDA approval for IBS-D.
Patho of IBD?
an exaggerated immune response that is directed against normal bowel flora
What drug classes can help IBD?
5-aminosalicylates, glucocorticoids, immunosuppressants, immunomodulators, and antibiotics
Who should not use probiotics?
Probiotics should not be used in the severely ill or immunocompromised.
Indication for prodrug Sulfasalazine (Azulfidine) ?
Mild to moderate ulcerative colitis and Crohn’s disease. (Rheumatoid arthritis)
MOA of 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?
Possible: suppressions of prostaglandin synthesis and mitigations of inflammatory cells. Reduces inflammation.
Safety considerations with 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?
Not for patients with sulfa drug allergies.
Hematologic disorders may occur- Periodic CBC monitoring is needed.
Adverse effects of 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?
nausea, fever, rash, and arthralgia
examples of gluccocoricoid?
Dexamethasone
Budesonide
Reason to prescribe Glucocorticoids for IBD? MOA?
For remission- not long-term.
Anti-inflammatory
Safety considerations with glucocorticoids?
Prolonged use can cause adrenal suppression, osteoporosis, increased susceptibility to infection, and Cushing syndrome.
What antibiotics can we use for IBD?
metronidazole (Flagyl) and ciprofloxacin (Cipro)
Warnings with Immunosuppressants Cyclosporin
Potentially toxic. Renal impairment, neurotoxicity, and general immune suppression.
Indication for Cyclosporin
Long-term therapy in selected pts with ulcerative colitis and Crohn’s disease.
It is reserved for non responders to other treatments.
Indication for methotrexate?
Selected pts with ulcerative colitis and Crohn’s disease.
It is reserved for non responders to other treatments.
Safety considerations with methotrexate?
Embryo-fetal toxicity, Hypersensitiy reactions, myelosuppression, GI toxicity, hepatotoxicity, pulmonary toxicity, and Derm reactions (SJS/TENS).
Severe adverse reactions, including death, have been reported with methotrexate. Closely monitor for adverse reactions of the bone marrow, gastrointestinal tract, liver, lungs, skin, and kidneys.
Example of Immunomodulators
Infliximab (Remicade)
MOA of Infliximab (Remicade)
Monoclonal antibody designed to neutralize TNF.
What are DMARDS?
Immunosuppressive drugs that target specific components of the inflammatory process. T cells, TNF, B cells.
What is the key take away concerning DMARDS?
increased risk for TB, Hep B. Serious potential of lymphoma and other malignancies. Avoid live vaccines.
