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Pharm II > N/V/D Constipation IBS > Flashcards

N/V/D Constipation IBS Flashcards

1
Q

What NT are in the chemo receptor trigger zone?

A

5-HT
Dopamine
Muscarinic

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2
Q

What can nausea and vomiting lead to?

A

Dehydration

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3
Q

What should people who are N/V avoid?

A

Dairy (exception is a baby drinking breast milk/ formula)

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4
Q

What is the BRAT diet? (after 24 hour fluid diet)

A

Banana
Rice
Apple Sauce
Toast (dry)

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5
Q

What are 4 pharm treatment to stop N/V?

A

5-HT3 Antagonists
Dopamine Antagonists
Antihistamines
Cannabinoids

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6
Q

What are three 5-HT2 antagonists?

A

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

ROA- oral, rectal, IM, IV

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7
Q

What is the 5-HT antagonist MOA?

A

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

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8
Q

Indications for 5-HT3 antagonists

A

Treatment and prevention of postoperative N/V (FDA)
Chemotherapy-induced N/V (FDA)
also given in ER a lot for N/V

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9
Q

ADRs of 5-HT3 antagonists

A

HA
Dizziness
Diarrhea
Abdominal pain

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10
Q

What are three dopamine antagonists

A

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

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11
Q

MOA of dopamine antagonists

A

Antagonist of D2 receptors in the CTZ

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12
Q

What dopamine antagonist at higher doses also blocks 5-HT3 receptors. Also promote gastric emptying and small intestine peristalsis—prokinetic effects

A

metoclopramide

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13
Q

Contraindications of dopamine antagonist

A

GI hemorrhage, obstruction or perf

Caution in patients w/ depression, seizures, children

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14
Q

ADRs of dopamine antagonist

A 
Extrapyramidal effects (Parkinsonism) 
Restlessness, anxiety, drowsiness, fatigue, halluc.

CV- HPN, HPOTN, AV block, bradycardia, agranulocytosis

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15
Q

What antihistamine is used for N/V?

A

Promethazine

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16
Q

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

ADRs of promethazine

A 
Parkinsonian symptoms (dyskinesia, dystonias, akathisia)
Neuroleptic malignant syndrome
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18
Q

Who should you be cautious with for usage of promethazine

A

BPH
Urinary retention
glaucoma

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19
Q

Used is a tablet of cannabinoids?

A

Dronabinol

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20
Q

ADRs of dronabinol

A

Drowsiness
sedation
increased appetite

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21
Q

Best option for chemo therapy induced N/V

A

5-HT3 antagonist

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22
Q

Regulation of normal intestinal motility is under what control?

A

Neuronal

Hormonal

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23
Q

5 classes of drugs for GI motility

A 
Laxatives
Antidiarrheal agents
Prokinetic agents
Antiemetic agents
Antispasmodics
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24
Q

Medical definition of constipation

A

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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25
Q

Medication causes for constipation

A 
Opiates
Ca and Al antacids
Iron
Calcium channel blockers
Clonidine
Anticholinergics
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26
Q

Best ways to control constipation

A

Drink plenty of water and fluids (P juices)

High fiber diet (whole grains, bran, fresh fruit and veggies)

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27
Q

what do laxatives do?

A

hasten transit time in the gut and encourage defecation

Used prior to medical procedure to clear bowel out

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28
Q

5 types of laxatives

A 
Bulk-Forming Laxatives
Emollients and Lubricants
Saline Cathartics 
Osmotic Laxatives
Stimulant Laxatives
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29
Q

Name the bulk forming laxatives

A

Psyllium (metamucil)
Methylcellulose (Citrucel)
Polycarbophil (Fibercon)

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30
Q

MOA of bulk forming laxatives

A

Increase volume of non-absorbable solid residue in water, stimulates peristalsis and increase rate of colonic transit

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31
Q

What is the first line therapy for bedridden or geriatric with chronic constipation. Good in pregnancy.

A

Bulk-forming laxatives

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32
Q

Contraindications of bulk-forming laxatives

A

Patients w/ stenosis
Ulceration or adhesions
Fecal obstruction

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33
Q

Should you get bulk-forming laxatives with other medications?

A

No- if you give bulk-forming laxative first wait 4 hours before giving meds. If take meds first wait 2 hours before bulk laxatives

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34
Q

Besides constipation, what are bulk-forming laxatives good for?

A

Diarrhea

Lowering cholesterol

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35
Q

What is an emollients?

A

Docusate sodium

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36
Q

WHat is docusate sodium used for?

A

To avoid straining
after MI, rectal surgery, opiates
1st line for pregnancy (along w/ bulk forming)

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37
Q

MOA of docusate sodium

A

Surfactant brings water into stool, mixing of aqueous and fatty material within intestine

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38
Q

Contraindications with docusate sodium

A

Fecal impaction

Signs of appendicitis

39
Q

What is a lubricant used as a laxative?

A

Mineral oil

40
Q

What is the onset of mineral oil?

A

6 hours- 3 days (oral or rectal)

41
Q

What is the MOA of mineral oil?

A

Coats stool (allows easier passage) inhibts colonic absorption of water

42
Q

What can you have trouble absorbing if you have taken mineral oil ?

A

Fat-soluble vitamins

43
Q

What are osmotic agents?

A

Sorbitol

Lactulose

44
Q

What is an osmotic agent that is a disaccharide that is metabolzied by bacteria in the colon to low-molecular weight acids (osmotic effect)

45
Q

Is lactulose a first line agent?

46
Q

Lactulose is used in patients with what?

A

Hepatic encephalopathy

47
Q

what are some saline cathartics that are used for constipation?

A

Magnesium hydroxide
Magnesium sulfate
Sodium phosphate
Magnesium citrate

48
Q

MOA of saline cathartics?

A

Salts are poorly absorbed so they increase th water content of the bowel through osmosis

49
Q

Contraindications of saline cathartics

A

Impaired renal function
CHF
HTN patients

50
Q

Drug that has osmotic action in rectum, onset within 30 minutes and very safe . used often in children.

A

Glycerin suppository

51
Q

What is a glycerin/ hyperosmotic. Relatively safe, ok for kids. Mixed in juice or water. Small amount

A

Polyethylene glycol (miralax)

52
Q

Like miralax but larger. Used for prescription. Used before a colonoscopy. Drink 4 L of fluid over 3 hours.

A

Glycerin/ Hyperosmotic

PEG, GoLYTELY

53
Q

What are some stimulant laxatives

A

Bisacodyl (Dulcolax)

Senna

54
Q

How do BIsacodyl work?

A

Stimulate nerve plexus of colon

55
Q

Some problems with bisacodyl

A

Fluid/ electrolyte imbalances

56
Q

What color feces and urine may someone taking bisacodyl see?

57
Q

Long term use of bisacodyl could result in what?

A

Atonic colon, deterioration of intestinal function

58
Q

You shoudl not take bisacodyl within 1 hour of taking what?

A

Antacids, milk

59
Q

Senna may turn urine what color?

A

Yellow-brown to red

60
Q

What can large doses of senna produce?

A

Neprhritis

61
Q

Contraindications with senna

A

Pregnancy

acute intestinal inflammation

62
Q

What is a drug that is a chloride-channel activator that works by increasing fluid secretion in the small intestine. Expensive

A

Lubiprostone

63
Q

Works by peripherally acting antagonist of mu receptor. Doesn’t cross BBB, reduces effects of opiods peripherally. Very expensive, needs renal adjusting

A

Methylnaltrexone

64
Q

What are some populations that experience constipation.

A

Diabetics
Pregnancy
Opiate Use

65
Q

What should you avoid in pregnant women for laxatives?

A

Avoid mineral oil, castor oil, osmotics

stick to bulk formers or emollients

66
Q

How should you avoid people with opiate use to avoid constipation?

A

Exercise
adequate fluid
fiber

67
Q

What are good things to use in elderly for constipation?

A 
Bulk-forming laxatives
enema
glycerin
lactulose
P juice
68
Q

In kids what should you use for constipation?

A

Improve diet with fiber “p” juices
Glycerin suppositories
Senna or mineral oil
Avoid stimulants, excessive enemas

69
Q

This causes watery diarrhea and 1/3 have fever. Nearly every child in US affected by age 5. Vaccine approved in 2006

70
Q

Who should you not use antimotility agents in?

A

People with dysentery or if C. Diff is possible

71
Q

What type diarrhea has excess water and electrolytes? Type of diarrhea that still happens when you stop eating. Large stool volume.

72
Q

What type diarrhea is from a substance that draws in intesinal fluids. Will stop when you stop taking in food

73
Q

Type of diarrhea due to inflammatory dz of GI. Diseases that discharge mucus, serum proteins, and blood into gut

74
Q

Antibiotics that cause diarrhea

A

Clindamycin

Broach spectrum

75
Q

What are non-pharmacologic ways to treat diarrhea

A

Discontinue consumption of solids and diary for 24 hours (osmotic)
With N/V- resume with BRAT diet
Rehydrate, maintain electrolytes

76
Q

Antibiotics that cause diarrhea

A

Clindamycin

Broach spectrum

77
Q

Antimotility agents that are used to stop diarrhea

A

Opiates and derivitaes

78
Q

MOA of opiates for diarrhea

A

slow intestinal transit
prolong contact and absorption
increased gut capacity

79
Q

Opiates will make what type diarrhea worse?

A

Infectious

80
Q

What are opiates used for diarrhea.

A

Lomotil

Loperamide

81
Q

What are some contraindications for loperamide?

A

Patients w/ fever exceeding 101 F
acute ulcerative colitis
abx associative colitis
children under 2

82
Q

MOA is absorb nutrients, toxins, drugs, and digestives juices. Avaliable OTC, not proven.

A

Kaolin-pectin
polycarbophil
attapulgite

83
Q

An absorbant that absorbs bile salts and C. diff toxin. Requires RX

A

Cholestryamine

84
Q

Interactions with bismuth subsalicylate

A

Anticoagulants and tetracycline

May interfere w/ radiologic studies

85
Q

Should traditional pepto-bismol be given to kids?

A

No, can cause Reyes syndrome

86
Q

What is an antisecretory that blocks the release of serotonin and has direct inhibitory effects. control symptoms in pts with metastatic vasoactive intestinal peptide-secreting tumor associated diarrhea.
Off-label used for refractory diarrhea

A

Octreotide

87
Q

Side effects with octeotide

A

bradycardia

hyperglycemia

88
Q

Anticholingerics used for diarrhea

89
Q

useful in lactose intolerance. Replaces lactase enzyme deficiency.

A

Lactase enzymes

90
Q

How can zinc help with diarrhea?

A

reduction of stool output

reduction of diarrhea duration

91
Q

How do you treat traveler’s diarrhea

A

CIpro

Azithromycin

92
Q

Treatment of C. Diff

A

Metronidazole

Vancomycin

93
Q

Treatment for constipation predominant IBS

A

Add bulk forming laxative, consider antispasmodics

Add serotonin-4 agonist (Tegaserod)

94
Q

Treatment for diarrhea predominant IBS

A

Add bulk fiber
Avoid lactose and caffeine
Add loperamide or another antispasmodic
Add 5_hT3 antagonist (Alostron)

Pharm II (16 decks)

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