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Pharm II Exam 4 > Motility Disorders > Flashcards

Motility Disorders Flashcards

1
Q

What are prokinetic agents?

A

Drugs that selectively stimulate gut motor fxn

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2
Q

What is the action of intrinsic primary afferent neurons (IPANs)?

A

Activate enteric neurons responsible for peristalsis & secretory reflex

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3
Q

What action enhances the release of Ach & calcitoningene-related peptide, promoting reflex activity?

A

Stimulation of 5-HT4 receptors on presynaptic terminals of IPANs

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4
Q

What are cholinomimetic agents used for?

A

GERD
Impaired gastric emptying
Nonulcer dyspepsia
Prevention of vomiting

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5
Q

What cholinoimetic agent is NOT approved by FDA or available in the US?

A

Domperidone (pospartum lactation stimulation)

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6
Q

What are ADEs of metoclopramide?

A

Extrapyramidal effects
Tardive dyskinesia
Elevated prolactin

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7
Q

What is the MOA of erythromycin (a macrolide)?

A

Stimulate motilin receptors

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8
Q

How do you treat a patient w/ constipation who has no underlying dx?

A

Symptomatic therapy

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9
Q

List the laxative agents (8)

A 
Bulk forming 
Stool surfactant (softeners)
Osmotic 
Stimulant 
Chloride channel activator
Guanylate cyclase c activator
Opioid receptor antagonists
Serotonin 5-HT4 agonists
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10
Q

What 3 agents result in soft or semifluid stool in 6-12 hrs?

A

Bisacodyl (oral)
Senna
Mg sulfate (low dose)

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11
Q

What 6 agents cause watery evacuation in 1-6 hrs?

A 
Mg citrate
Mg hydroxide
Mg sulfate (high dose)
Na phosphates 
Bisacodyl (rectal)
PEG
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12
Q

What are 2 common preparations of bulk forming laxatives?

A

Natural plant products:

Psyllium
Methylcellulose

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13
Q

What is an example of a stool surfactant agent?

A

Docusate (oral or enema)

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14
Q

What can mineral oil cause?

A

Aspiration –> severe lipid pneumonitis

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15
Q

What are examples of osmotic laxatives?

A

Mg hydroxide (Milk of Mag)

Sorbitol & lactulose

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16
Q

What is the MOA of stimulant laxatives?

A

Direct stimulation of the enteric NS

17
Q

Cathartics may be required on a _______

A

long-term basis

18
Q

What are examples of stimulant laxatives?

A

Anthraquinone derivatives: aloe, senna, cascara

Diphenylmethane derivative:
bisacodyl

19
Q

What are characteristics of bisacodyl (a diphenylmethane derivative)?

A

Minimal systemic absorption

Appears to be safe for acute & long-term use

20
Q

What are 3 examples of opioid receptor antagonists?

A

Methylnaltrexone

Alvimopan

Naloxegol

21
Q

What are clinical controversies?

A
  1. Withholding food is considered inappropriate in pts w/ no signs of severe dehydration
  2. In osmotic diarrhea, food may control the problem
  3. If the mechanism is secretory, diarrhea persists
22
Q

What are examples of antidiarrheal agents?

A

Opioid agonists:
loperamide, diphenoxylate

Bile salt-binding resins (cholestyramine, colestipol, colesevelam)

23
Q

Colesevelam does not appear to have significant effects on…

A

absorption of other drugs

24
Q

Describe somatostatin

A

Antisecretory: octreotide

14-amino-acid peptide released in the GI tract & pancreas from paracrine cells, D cells, enteric nerves, & the hypothalamus

25
Q

What is the MOA of somatostatin?

A

Inhibits the secretion of numerous hormones & transmitters

Reduces intestinal fluid secretion & pancreatic secretion

Slows GI motility & inhibits gallbladder contraction

26
Q

What do GI neuroendocrine tumors cause?

What inhibits this?

A

Secretory diarrhea

Antisecretory: octreotide

27
Q

What are ADEs of octreotide?

A

Steatorrhea

Nausea, abd pain, flatulence, diarrhea

Prolonged tx –> hypothyroidism

Brady

28
Q

What is the MOA of metoclopramide?

A

D2 receptor antagonist

Blocks D2 receptors in the trigger zone of the medulla

29
Q

What is the action of metaclopramide?

A

Increases:

  • esophageal peristalsis
  • LES pressure
  • gastric emptying
30
Q

What is the MOA of bethanechol (a cholinomimetic)?

A

Stimulates M3 receptors at myenteric plexus synapses

31
Q

What is the MOA of neostigmine (a cholinoimetic)?

A

Acetylcholinesterase inhibitor

32
Q

What are ADEs of cholinomimetics?

A

Salivation, N/V/D, brady

33
Q

Which types of laxative cause softening of feces in 1-3 days?

A

Bulk-forming
Emollients (softeners)
PEG

34
Q

What are 2 examples of purgatives (laxatives)?

A

Mg citrate & Na phosphate

35
Q

What are ADEs of anthraquinone derivatives: aloe, senna, & cascara?

A

Melanosis coli

Concern that these agents may be carcinogenic, but studies do not suggest relation

36
Q

What is alvimopan (an opioid receptor antagonist) used for?

A

shortens the period of postop ileus in hospitalized pts who undergo small or large bowel resection

37
Q

What are 3 adsorbents?

A

Kaolin-pectin

Polycarbophil

Attapulgite

Pharm II Exam 4 (14 decks)

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