Module 3: GI Unit C

Question 1

What classes of drugs are used to treat chronic constipation?

Answer 1

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)

Question 2

Management of Irritable Bowel Syndrome (IBS) is based on what?

Answer 2

On classification:
Diarrhea-predominant
Constipation-predominant
Mixed presentation IBS with alternating diarrhea and constipation

Question 3

BBW for Alosetron (Lotronex)

Answer 3

Ischemic colitis

Question 4

indication for Alosetron (lotronex)

Answer 4

For women with severe IBSD that has lasted more than six months and have not responded to other medications

Question 5

MOA for Alosetron (lotronex)

Answer 5

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.

Question 6

Indication for Eluxadoline (Viberzi)

Answer 6

IBS-D in both men and women.

Question 7

MOA for Eluxadoline (Viberzi)

Answer 7

Mu-and kappa receptor agonist. Activation of these receptor sites decreases the motility of the bowel.

Question 8

Indication for Lubiprostone (Amitiza)

Answer 8

IBS-C in women > 18 years old
idiopathic constipation in adults
Treatment of opioid-induced constipation

Question 9

MOA of Lubiprostone (Amitiza)

Answer 9

Activates chloride channels in the intestine, increases chloride-rich fluid in the intestines, and increases motility.

Question 10

Contraindication for laxative Lubiprostone (Amitiza)

Answer 10

Known or suspected GI obstruction

Question 11

Non-specific treatments for IBS?

Answer 11

soluble fiber, peppermint oil, antibiotics, and tricyclic antidepressants or SSRIs or SNRIs.

Question 12

MOA of peppermint oil?

Answer 12

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.

Question 13

MOA of TCAs (Palemor)?

Answer 13

improve visceral pain by acting on norepinephrine, and dopaminergic receptors

Question 14

MOA of SSRIs for IBS?

Answer 14

Antidepressants improve abdominal pain and overall symptom scores

Question 15

Example of Antibiotic for IBS-D?

Answer 15

Rifaximin (Xifaxan) is a nonabsorbed antibiotic that has FDA approval for IBS-D.

Question 16

Patho of IBD?

Answer 16

an exaggerated immune response that is directed against normal bowel flora

Question 17

What drug classes can help IBD?

Answer 17

5-aminosalicylates, glucocorticoids, immunosuppressants, immunomodulators, and antibiotics

Question 18

Who should not use probiotics?

Answer 18

Probiotics should not be used in the severely ill or immunocompromised.

Question 19

Indication for prodrug Sulfasalazine (Azulfidine) ?

Answer 19

Mild to moderate ulcerative colitis and Crohn’s disease. (Rheumatoid arthritis)

Question 20

MOA of 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?

Answer 20

Possible: suppressions of prostaglandin synthesis and mitigations of inflammatory cells. Reduces inflammation.

Question 21

Safety considerations with 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?

Answer 21

Not for patients with sulfa drug allergies.

Hematologic disorders may occur- Periodic CBC monitoring is needed.

Question 22

Adverse effects of 5-Aminosalicylates: Sulfasalazine (Azulfidine) ?

Answer 22

nausea, fever, rash, and arthralgia

Question 23

examples of gluccocoricoid?

Answer 23

Dexamethasone

Budesonide

Question 24

Reason to prescribe Glucocorticoids for IBD? MOA?

Answer 24

For remission- not long-term.

Anti-inflammatory

Question 25

Safety considerations with glucocorticoids?

Answer 25

Prolonged use can cause adrenal suppression, osteoporosis, increased susceptibility to infection, and Cushing syndrome.

Question 26

What antibiotics can we use for IBD?

Answer 26

metronidazole (Flagyl) and ciprofloxacin (Cipro)

Question 27

Warnings with Immunosuppressants Cyclosporin

Answer 27

Potentially toxic. Renal impairment, neurotoxicity, and general immune suppression.

Question 28

Indication for Cyclosporin

Answer 28

Long-term therapy in selected pts with ulcerative colitis and Crohn’s disease.
It is reserved for non responders to other treatments.

Question 29

Indication for methotrexate?

Answer 29

Selected pts with ulcerative colitis and Crohn’s disease.

It is reserved for non responders to other treatments.

Question 30

Safety considerations with methotrexate?

Answer 30

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.

Question 31

Example of Immunomodulators

Answer 31

Infliximab (Remicade)

Question 32

MOA of Infliximab (Remicade)

Answer 32

Monoclonal antibody designed to neutralize TNF.

Question 33

What are DMARDS?

Answer 33

Immunosuppressive drugs that target specific components of the inflammatory process. T cells, TNF, B cells.

Question 34

What is the key take away concerning DMARDS?

Answer 34

increased risk for TB, Hep B. Serious potential of lymphoma and other malignancies. Avoid live vaccines.