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Pharm II > N/V/C/D > Flashcards

N/V/C/D Flashcards

1
Q

What are some causes of GI irritation? 9

A 
GI irritation
Motion sickness
Vestibular disease
Hormone disturbance
Drugs and radiation
Exogenous toxins
Pain
Psychogenic factors
Intracranial pathology
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2
Q

How else to N/V present clinically besides N/V

A

*Dehydration can occur as a result of vomiting(Pinching skin takes longer to go down)
Increased thirst and dry mouth.
Less frequent urination
Tachycardia

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3
Q

What are 3 nonpharm therapies for NV

A 
Rehydrate- Oral rehydration Solutions
Avoid dairy
BRAT diet- 24 hours after fluid diet
Banana
Rice
Apple Sauce
Toast (Dry)
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4
Q

What are the 4 types of pharm therapy for N/V?

A

5-HT3 Antagonists
Dopamine Antagonists
Antihistamines
Cannabinoids

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5
Q

Name 3 types of 5-HT3 antagonists and what is the drug of choice for NV?

A

Ondansetron (Zofran) - DOC
Granisetron (Kytril)
Dolasetron (Anzemet)

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6
Q

What is the MOA of 5-HT3 antagonist?

A

Antagonism of the 5-HT3 receptor in the chemo-receptor trigger zone (CTZ)

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7
Q

What are the ROA for 5-HT3 Antagonists?

A

Oral, rectal, IM, IV

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8
Q

What are the 2 Indications of 5-HT3 antagonists?

A

Treatment and prevention of postoperative N/V

Chemotherapy-induced N/V

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9
Q

What are the ADRs of the 4 5-HT3 antagonists?

A

HA
Dizziness
Diarrhea
Abdominal pain

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10
Q

What are 3 examples of DA antagonists?

A

Metoclopramide (reglan)
Trimethobenzamide (Tigan)
Phenothiazines - Prochlorperazine (Compazine

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11
Q

what are the 3 MOA of DA antagonists?

one is specific for high dose of Metoclopramide

A

Antagonist of D2 receptors in the CTZ
At higher doses metoclopramide also blocks 5-HT3 receptors
Also promote gastric emptying and small intestine peristalsis—prokinetic effects.

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12
Q

5 contraind for DA Antagonists

A 
GI—hemorrhage, obstruction or perforation
Cautiously in patients w/depression
Pheochromocytoma
Seizure 
Use very cautiously in children
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13
Q

ADRs of DA antagonists?

A

Extrapyramidal effects
Restlessness, anxiety, drowsiness, fatigue, hallucinations
CV—HTN, HPOTN, AV block, bradycardia
Agranulocytosis

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14
Q

What is one antihistamine used in NV?

A

Promethazine (Phenergan)

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15
Q

What are the ROA of Promethazine?

A

IV PO IM PR

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16
Q

What are 2 MOA of Promethazine?

A

Block H1 effectiveness appear to be with motion sickness and vestibulochochlear disease
Antagonist of D2 receptors in the CTZ

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17
Q

What are the ADRs of antihistamines?

A

dry mouth, dizziness etc.
Parkinsonian symptoms (dyskinesia, dystonias, akathisia)
Neuroleptic malignant syndrome
Blood dyscrasias

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18
Q

In what conditions should you use caution in with promethazine? 3

A

BPH
Urinary retention
glaucoma

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19
Q

What is a cannabinoid used in NV

A

Dronabinol (Marinol)

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20
Q

What is the MOA of Dronabinol

A

Not well definded

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21
Q

What are the 3 ADRs of Dronabinol?

A

Drowsiness. sedation, and increased appetite

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22
Q

What 2 things does normal motility do in the intestines?

A

Acts to mix bowel contents thoroughly

To propel them in a caudal direction

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23
Q

Regulation of normal intestinal motility is by? 2

A

Neuronal

Hormonal

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24
Q

What nerve influences motility and what does it do?

A

The vagus nerve of the intestinal (enteric) system
Stimulates peristaltic movements
Relaxes digestive sphincters
Promotes GI secretion

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25
Q

What are the 5 classes of drugs that effect GI motility?

A 
Laxatives
Antidiarrheal Agents
Prokinetic Agents
Antiemetic Agents
Antispasmodics
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26
Q

What is the Medical Definition of Constipation?

A 
2 or more of the following:
Straining > 25% of time
Lumpy or hard stools > 25% of time
Feeling of incomplete evacuation > 25% of time
2 or fewer BM in 1 week
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27
Q

What Metabolic diseases may cause constipation? 4

A

Hypothyroid, hypercalcemia, hypokalemia, diabetes

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28
Q

What 3 GI d/o may cause constipation?

A

Tumors, IBS, Diverticulitis

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29
Q

what 3 neurogenic d/o may cause constipation?

A

Trauma to brain/spinal cord, CNS tumor, Parkinson’s

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30
Q

What 6 meds may cause constipation?

A 
Opiates
Ca and Al antacids
Iron
Calcium channel blockers
Clonidine
Anticholinergics (Antihistamines, antiparkinsonians, TCA)
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31
Q

what are the 3 best ways to prevent constipation?

A

Drink plenty of water and fluids (“P” juices (pear, prune, peach))
Adequate exercise (Do not hold it (water will be reabsorbed and stools will harder))
High fiber diet (insol and sol) -

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32
Q

What does insol fiber do for constipation? 2 ex

A

Insoluble-shorten intestinal transit time and increase stool bulk.
Whole grains
Bran

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33
Q

What does sol fiber due for constipation

A

more moist stool and less effect on transit time.
Fresh fruits
Fresh vegetables

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34
Q

what do laxatives do? (2)

A

Drugs used to hasten transit time in the gut and encourage defecation.
Drugs are also used to clear the bowel prior to medical and surgical procedures.

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35
Q

what are 6 types of laxatives?

A 
Bulk-Forming Laxatives
Emollients and Lubricants
Saline Cathartics 
Osmotic Laxatives
Stimulant Laxatives
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36
Q

what are 3 times of bulk-forming laxatives?

A

Psyllium (Metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)

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37
Q

when is bulk-forming laxative onset time?

A

2-3days

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38
Q

what is the MOA of bulk-formong laxatives? (what is very imp to do along with these)

A

Increases the volume of the non-absorbable solid residue with water, distending the colon and stimulating peristaltic activity increasing the rate of colonic transit
(Adequate fluid intake is very important with these agents)

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39
Q

what is the 1st line for bedridden or geriatric with chronic constipation, and in Pregnancy?

A

bulk forming laxatives

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40
Q

What are the 3 contraindications for bulk-forming laxatives?

A

Patients with stenosis
Ulceration or adhesions
Fecal obstruction

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41
Q

what are the ADRs of Bulk forming laxatives? 3

A

flatulence, abdominal distension, gastrointestinal obstruction

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42
Q

What are drug interactions with bulk forming laxatives? what is the proper way to take other meds and bulk-forming lax?

A

Binds drugs & reduces absorption—separate from other medication administration.
take med 1st-wait 2 hrs then lax
take lax 1st-wait 4 hrs to take med

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43
Q

What are 3 other uses of bulk forming laxatives?

A

The ability of these agents to absorb water makes them useful for relieving symptoms of mild diarrhea.
Several months use can relieve symptoms of irritable bowel syndrome
Lowering cholesterol

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44
Q

what is one example of an emollient?

A

Docusate sodium (Colace)

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45
Q

what are the indications for emollients? DOC for?

A

To avoid straining
After MI, rectal surgery, opiates
1st line Pregnant women (along with bulk forming)

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46
Q

Onset of emollient is?

A

1-3 days

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47
Q

What is the MOA of emollients?

A

surfactant brings water into stool, facilitates mixing of aqueous and fatty materials within intestine, increase H20 and electrolyte secretion in small/ large bowel

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48
Q

what are contraindications for emollients?

A

Fecal Impaction

Signs and symptoms of appendicitis

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49
Q

What is an example of Lubricant used for constipation?

A

Mineral Oil

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50
Q

What is discouraged for mineral oil?

A

Chronic Use

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51
Q

What is Mineral Oil used for?

A

mainly for prevention
To avoid straining
After MI, rectal surgery

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52
Q

What is the Onset of mineral oil?

A

6hr-3days

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53
Q

what is the MOA of mineral oil?

A

coats stool (allows easier passage), inhibits colonic absorption of water

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54
Q

what are the cautions of mineral oil use? 4

A

Avoid in elderly, aspiration risk and decrease absorption of fat-soluble vitamins (DEAK)
May leak from anal sphincter

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55
Q

What are 2 examples of osmotic agents used for constipation?

A

Lactulose and sorbitol

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56
Q

What is lactulose’s MOA

A

disaccharide that is metabolized by bacteria in the colon to low-molecular weight acids = osmotic effect

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57
Q

what is lactulose NOT considered?

A

1st line agent in constipation

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58
Q

What are ADRs of lactulose?

A

May result in flatulence, cramps, electrolyte imbalances

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59
Q

What is lactulose more commonly used for (other than const)

A

More commonly used in patients with hepatic encephalopathy

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60
Q

what is the onset of lactulose

A

Oral dose softens stool in 1-3 days

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61
Q

what is sorbitols MOA

A

monosaccharide creates an osmotic gradient when used as a 70% solution

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62
Q

what is an ADR of sorbitol

A

hyperglycemia

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63
Q

what is the onset for sorbitol?

A

1-3days

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64
Q

What are 4 examples of saline cathartics used for diarrhea?

A

Magnesium hydroxide (Milk of Magnesia), magnesium sulfate (Epsom salts), sodium phosphate (Fleets Enema), magnesium citrate (Citrate of Magnesia)

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65
Q

What is the onset of saline cathartics?

A

30min-6hr (oral), 5-30min (rectal)

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66
Q

What is the MOA of cathartics?

A

Mg++ or Na+ salts are poorly absorbed; they increase the water content of the bowel through osmosis

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67
Q

What are 3 contraindications for cathartics

A

impaired renal function Mg and Na accumulation, CHF, no sodium for HTN pts

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68
Q

What is the MOA of glycerin suppository?

A

osmotic cation in rectum

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69
Q

Onset of glycerin suppository?

A

<30mins

70
Q

What might glycerin suppository cause?

A

Rectal irritation

71
Q

Indications for glycerin suppository

A

Very safe laxative/ Can be used in children

Intermittent use

72
Q

Example are 2 ex of glycerin/hyperosmotic?

A

Polyethylene glycol (Miralax) (PEG, GoLYTELY)

73
Q

How do you use Miralax

A

17g mixed in water or juice, usually 2 weeks duration, chronic use OK

74
Q

what is the onset of miralax?

A

1-3days

75
Q

what is the MOA of miralax?

A

osmotic

76
Q

what is the indication for miralax?

A

Relatively safe and OK in children

77
Q

What is the indication for PEG, GoLYTELY

A

for colonic cleansing before diagnostic procedures

78
Q

what is the onset of action of PEG, GoLYTELY

A

1hr after initiation

79
Q

what is the MOA of PEG, GoLYTELY

A

osmotic agent that causes retention of water resulting in softer stool and more frequent defecation

80
Q

how do you take PEG, GoLYTELY

A

4 liters over 3 hrs (8oz glass every 10 minutes), not for chronic use

81
Q

what pts should avoid use of PEG, GoLYTELY

A

Avoid in patients with intestinal obstruction

82
Q

what are 2 stimulant laxatives?

A 
Diphenelymethane deriv (bidacodyl (dulcolax))
Anthraquinone lax (senna (senokot))
83
Q

what is the MOA of Bisacodyl (Dulcolax)

A

MOA stimulate nerve plexus of colon

84
Q

who may take Bisacodyl (Dulcolax)

A

> 12y/o

85
Q

what is the onset of Bisacodyl (Dulcolax)

A

Onset: 6-8hr (PO); 1-6h (PR)

86
Q

when should you not take Bisacodyl (Dulcolax)

A

Should not take within 1 hour of antacids, milk or milk products

87
Q

what are 3 ADRs of Bisacodyl (Dulcolax)

A

Intestinal cramps
Can cause fluid and electrolyte inbalance.
Pink colored urine and feces

88
Q

what can long term use of Bisacodyl (Dulcolax) cause?

A

Could cause damage to the nerve plexi
Resulting in deterioration of intestinal function
Atonic colon

89
Q

what is Senna (Senokot)?

A

Anthraquinone laxative

90
Q

what is the MOA of Senna (Senokot)

A

Increased peristalsis

91
Q

what is Senna (Senokot) coformulated with

A

docusate

92
Q

who can take Senna (Senokot)

A

> 12y/o

93
Q

what is the onset of Senna (Senokot)

A

6-12 hr

94
Q

what are the ADRs of Senna (Senokot) 2

A

Yellow-brown to red colored urine

Large doses can produce nephritis

95
Q

what can long term use of Senna (Senokot) cause?

A

Could cause damage to the nerve plexi
Resulting in deterioration of intestinal function
Atonic colon

96
Q

what are the contraind of Senna (Senokot) -2

A

Pregnancy and acute intestinal inflammation

97
Q

what is the MOA if Lubiprostone (Amitiza)

A

chloride-channel activator…works by increasing fluid secretion locally in the small intestine by activating the ClC-2 chloride channel

98
Q

what are the ADRs of Lubiprostone (Amitiza)

A

Nausea and diarrhea

99
Q

what is the onset of Lubiprostone (Amitiza)

A

1d-1wk or more

100
Q

what are the contraind of Lubiprostone (Amitiza)

A

Intestinal obstruction, Pregnancy

101
Q

what is the MOA of Methylnaltrexone

A

Peripherally acting antagonist of mu

Reduces effects of opioids peripherally- Not centrally

102
Q

what do you need to do if CrCl <30 for Methylnaltrexone

A

renal dose adj

103
Q

does Methylnaltrexone cross the BBB?

A

No

104
Q

who gets constipation

A

Diabetics, pregnant, opiate users

105
Q

how do you treat diabetic related constipation?

A

Sugar-free products (Metamucil)

106
Q

how do you treat pregnancy constipation?

A

bulk formers or emolients

107
Q

what is contrind for preg constipation

A

mineral oil, castor oil, and osmotics

108
Q

how do you treat opiate related constipation

A

exersice, adequate fluid, fiber, methylnaltrexone

109
Q

what is best to use in elderly with constipation

A

Bulk-forming laxatives, enemas, glycerin, lactulose (especially good for bed-ridden patients)
“P” juices (peach, pear, prune)

110
Q

what is best to avoid in elderly with constipation

A

Best to avoid saline laxative due to potential changes in electrolytes

111
Q

how do you treat kids with constipation

A

“P” juices (peach, pear, prune)
<5yrs: glycerin suppositories, malt soup extract (mix with juice or breast milk), dark corn syrup, MOM, bisacodyl
Senna or mineral oil

112
Q

what should you avoid using in kids with constipation?

A

stimulants and excessive use of enemas

113
Q

why do kids get constipated?

A

diet and habits

114
Q

how many days is considered acute diarrhea? Chronic

A

14 days is chronic

115
Q

when should try not to use antimotility agents for diarrhea? why>

A

NO ANTIMOTILITY AGENTS IN DYSENTERY OR IF C.Diff IS POSSIBLE

Diarrhea is usually a healthy response

116
Q

what does rotavirus cause?

A

Watery diarrhea lasting 3-7 days, 1/3 have fever

117
Q

what are the 4 types of diarrhea?

A

secretory, osmotic, exudative, altered intestinal transit

118
Q

what is secretory diarrhea? Does fasting help? whats the characteristic of stool?

A

excess H2O and electrolytes
NO
Clinically recognized by large stool volume > 1L/day with normal ionic contents/osmolality

119
Q

what is osmotic diarrhea?

does fasting help?

A

substances that draw intestinal fluids
Poorly absorbed substances lead to retention of intestinal fluids = diarrhea
Clinically recognized if diarrhea stops when patient does not eat

120
Q

what is exudative diarrhea?

A

d/t inflammatory disease of GI that discharge mucus, serum proteins, and blood into gut

121
Q

3 alterations of the transit of colon

A

Reduced contact time in small intestine
Premature emptying colon
Bacterial Overgrowth

122
Q

what causes reduced contact time in sm int

A

Intestinal Resection or Bypass Surgery

123
Q

what causes premature emptying of the colon?

A

Metoclopramide

Erythromycin

124
Q

what can lead to bacterial overgrowth in the colon?

A

Increased time of exposure can lead to bacterial overgrowth

125
Q

drugs that induce diarrhea? lots…

A 
Laxatives
Antacids containing Mg
Antineoplastics
Colchicine
NSAIDs
Orlistat
Antibiotics: Clindamycin, Broad spectrum ABX
Antihypertensives- ACEI, 
Cardiac Agents-digoxin
Cholinergics
PPIs-esomeprazole
H2-Blockers-famotidine
126
Q

how does diarrhea present?

A

N/V, abdominal pain, HA, fever, chills, malaise
Weight Loss
Dehydration

127
Q

4 ways to treat diarrhea nonpharmacologically

A

Discontinue consumption of solids and dairy for 24 hours (osmotic)
With N/V: mild low residue diet, as BM decrease begin bland diet
Rehydrate: Oral Rehydration Solutions, LR, D5W, NS
Maintain electrolytes

128
Q

4 examples of antimotility agents

A

Diphenoxylate
Loperamide
Paregoric
Difenoxin

129
Q

3 examples of absorbents used in diarrhea

A

Kaolin-pectin mix
Polycarbophil
Attapulgite

130
Q

example of antisecretory used in diarrhea?

A

Bismuth susalicylate

131
Q

anticholinergic used in diarrhea

A

atropine

132
Q

what is a bacterial replacement used in diarrhea

A

Lactobacillus

133
Q

enzymes used in treatment of diarrhea

A

lactase

134
Q

antibiotics to treat diarrhea

A

metronidazole and vancomycin

135
Q

what is the MOA of antimotility drugs in diarrhea?

A

Slow intestinal transit
Prolong contact and absorption
Increase gut capacity

136
Q

what can antimotility agents do if diarrhea is infectious?

A

Make it worse

137
Q

what is lomotil?

A

diphenoxylate

138
Q

what is the onset of lomotil and when should you change if not working?

A

Clinical benefit usually within 48 hours

If no benefit within 10 days, change therapy

139
Q

what is the contraindications for lomotil?2

A

Cdiff or entertoxin-producing bacteria

140
Q

what is the MOA of loperamide?

A

Acts directly on intestinal muscles to inhibit peristalsis, prolonging transit time

141
Q

what is the onset of loperamide?

A

w/in 48 hrs

142
Q

what are the contraind of loperamide? 4

A

Patients w/a fever exceeding 101 F (38.3C)
Acute ulcerative colitis
Antibiotic associative colitis
Children under

143
Q

what is the MOA of absorbents?

A

absorb nutrients, toxins, drugs, and digestive juices

144
Q

what is Cholestryamine (questran)

A

An absorbent for bile salts and C.diff

145
Q

what is the MOA of pepto-bismol

A

Stimulates Absorption of Fluid and Electrolytes Across the Intestinal Wall
Antisecretory, anti-inflammatory, and antibacterial effects

146
Q

what can pepto-bismol cause in kids under 12

A

reye’s syndrome

147
Q

what are the ADRs of pepto-bismol - 3

A

Blackened stools and tongue
Salicylism
Can induce gout attacks in susceptible patients

148
Q

what are the drug int with pepto-bismol? 3

A

Anticoagulants and tetracycline; May interfere with radiologic studies

149
Q

what is the onset of pepto-bis

A

<48 hrs

150
Q

what is octreotide (sandostatin)

A

an antisecretory for diarrhea

151
Q

what is the moa of octreotide (sandostatin)

A

Blocks the release of serotonin, Direct inhibitory effects

Reduces motility and facilitates water absorption from the gut

152
Q

what is the official indication of octreotide (sandostatin)

A

control symptoms in pts with metastic vasoactive intestinal peptide-secreting tumor associated diarrhea

153
Q

what is the offlabel use of octreotide (sandostatin)

A

Treatment of refractory diarrhea

154
Q

what is the onset of octreotide (sandostatin)

A

1-3 days up to a week

155
Q

what are the 2 adr’s of octreotide (sandostatin)

A

bradycardia, hyperglyc

156
Q

what is the MOA of atropine in diarrhea

A

blocks vagal tone and prolongs gut transit time

157
Q

what is ADR of atropine

A

anticholinergic

158
Q

contraindications of atropine

A

Glaucoma, prostatic hypertrophy

159
Q

what is the MOA of lactobacillus

A

Restores normal flora and intestinal function

160
Q

what is the contraindication for lactobacillus

A

immuno-compromised pts

161
Q

what is the lactase enzyme used for?

A

lactose intolerance

162
Q

what is Zn used for in diarrhea?

A

adjunct to ORS
Reduction of stool output
Reduction of diarrhea duration

163
Q

what is the proposed MOA of Zn

A

possibly action on intestinal ion transport

164
Q

what is travelers diarrhea typically?

A

4-5 loose/watery stools per day with cramping, +/- fever, lasting 3-4 days without treatment
>80% bacterial
>90% occur in 1st two weeks of travel

165
Q

what are risks associated with travelers diarrhea?

A

Ingestion of contaminated food or drink

meals eaten at home<restaurants
Age: small children and 21-29 yr olds
Type of infection correlated with destination, season, type of travel

166
Q

what foods are at risk and may cause traveler’s diarrhea?

A

undercooked veggies, unpeeled fruit, raw/undercooked meat

167
Q

3 prophylaxis for traveler’s diarrhea?

A

Dietary counseling
Bismuth subsalicylate (PeptoBismol)
Antibiotics
-Effective but irresponsible prophylaxis

168
Q

what is problem with prophyl and abx

A

-Gives false sense of security
Resistance huge problem
Cipro 500mg daily is 95% effective in some areas
Campylobacter in Thailand 84% resistance within 4 year

169
Q

if someone traveled to thialand and got diarrhea what might they have been infected with?

A

campylobacter

170
Q

how do we treat travelers diarrhea - 2

A

Rehydration is key

Antibiotics
Cipro 500mg BID X 3 days
Azithromycin 1gm X1 or 500mg daily x 3 days

171
Q

who gets C.Diff

A

Hospitalized or recently on abx

172
Q

how do we treat c.diff?

A

metronidazole and vanco

Pharm II (8 decks)

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