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Year2 GI Exam I > NVDC Tx II > Flashcards

NVDC Tx II Flashcards

1
Q

what are time frames for acute, persistant and chronic diarrhea

A

acute 14 days

chronic >30 days

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2
Q

what viruses and bacteria cause acute diarrhea

A

norwalk, rotavirus
shigella, salmonella, campylobacter, staph, e coli
don’t forget protozoa

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3
Q

what drugs induce diarrhea

A

reserpine, sulfonamides, tetracylcines, broad spec antibiotics, cholinergic agonists, osmoitc and stimulant laxatives, prokinetic agents, PGs and quinidine

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4
Q

MOA loperamide

A

inhibit presynaptic cholinergic nerves in submucosal and myenteric plexuses, increase transit time, increase fecal water absorption, decrease mass colonic movements

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5
Q

why is loperamoid non prescription even though opiod

A

does not cross bbb
no analgesic properties
no potential for addiction

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6
Q

therapeutic use loperamide

A

mainstay nonspecific Tx diarrhea

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7
Q

adverse effects loperamide

A

toxic megacolon in those with active IBD

not used in patieints with ulcerative colitis or acute bacillary or amoebic dysentery

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8
Q

what is ocreotide and MOA

A

somatostatin analog

inhibits secretion of hormones and transmitters because it acts like somatostatin

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9
Q

therapeutic use ocreotide

A

those with advanced symotomatic tumors
diarrhea due to vagotomy or dumpign syndrome as well as diarrhea for short bowel syndrome or AIDS
used in small doses to stimulate motility

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10
Q

adverse effects ocreotide

A

inhibits pancreatic secretion
nausea, abdominal pain, flatulence, diarrhea
can cause gallstones
hyperglycemia, hypothyroidism, bradycardia

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11
Q

when do you not use anti diarrheals

A

bloody diarrhea, high fever, systemic toxicity

if diarrhea worsens with Tx

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12
Q

what is criteria for constipation

A

<3 bowel movement per week

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13
Q

what drugs can induce constipation

A

opiog analgesics, antichoinergics, antacids with Al or CaCo, Fe and NSAIDs

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14
Q

most important feature of Tx for constipation

A

dietary modification (increase fiber)

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15
Q

first line for constipation prevention

A

bulk forming laxatives and docusates

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16
Q

types of bulk forming laxatives

A

metamucil, citrucel, fiber con etc…

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17
Q

MOA bulk forming laxatives

A

indigestible, hydrophilic colloids which absorb water that forms a gel that distends colon and promotes peristalsis

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18
Q

adverse effects bulk formint laxatives

A

bloating and flatus

need to take in suffiecient fluid to avoid obstruction

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19
Q

what are the stool softeners

A

docusate oral or enema and glycerin suppository

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20
Q

MOA stool softener

A

allows water and lipids to prenetrate stool which softens it

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21
Q

therapeutic use stool softeners

A

to prevent constipatino and minimize straining (post operative patients)

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22
Q

what is used to prevent and treat fecal impaction

A

mineral oil

23
Q

MOA osmotic liaxatives

A

soluble non absorbable, increase stool liquidity

24
Q

therapeutic use of non-absorbable sugars or salts

A

Tx acute constipation

prevent chronic constipation

25
Q

why is MgOH not used prolonged in patients with renal insufficiency

A

hyper Mg

26
Q

adverse effects of sorbitol and lactulose

A

severe flatus and cramps

27
Q

types of osmotic laxatives

A

Mgcitrate, MgOH, NaPO4,

polyethylene glycol

28
Q

adverse effects NaPO4

A

cardiac arrhythmias from hpokalemia, hypernatremia, hypocalcemia, hyperphosphatemia
can lead to acute renal fialure from CaPO4 deposition

29
Q

What is used for colon cleansing before procedure

A

polyethylene glycol

30
Q

MOA polyethylene glycol

A

isotonic fluid, contains inert osmotically active sugar with Nasulfate, NaCl, NaHCO3, KCl
ingest 2-4 L over 2-4 hours

31
Q

MOA stimulant laxatives

A

direct stimulation Enteric nervous system and colonic electrolyte and fluid secretion

32
Q

therapeutic use stimulant laxatives

A

not 1st line

intermittend use from patients who do not respond to bulking and osmoitc agents

33
Q

risks of long term use stimulant laxatives

A

dependence and destruction of mesenteric plexus resulting in colonic atony and dilation

34
Q

what are the anthraquinone derivavties

A

aloe, senna, cascara

35
Q

what are the diphenylmethane derivatives?

used for?

A

bisacodyl tab or suppository

used with PEG for colonic cleansing prior to colonscopy

36
Q

What is used in patients with chronic constipation who fail to conventional 1st line therapy

A

chloride channel activator that stimulates Cl in small intestine increasing motility

37
Q

MOA opiod R antagonists

A

inhibit opoid R
do not cross bbb
inhibits peripheral without analgesic effects

38
Q

therapeutic use methylnaltrexone

A

opoid antagonist
approved for opiod induced constipation
subcut

39
Q

contraindication methynaltrexone

A

GI obstruction

40
Q

what is used short term to shorten period of post operative ileus

A

alvimopan

41
Q

what is use of serotonin R agonist

A

increase GI motility and cardiac rate

enhance LES pressure and peristalsis, accelerates gastric emptying

42
Q

What is linaclotide and MOA

A

guanylate cyclase C agonist
binds g cyclase on luminal surface intestine and increases cGMP which increase Cl and HCO3 secretion increasing intestinal fluid and dec GI transit time

43
Q

what is used for chronic idiopathic constipation and IBS with constipation >18 y.o

A

linaclotide

44
Q

diabetic gastroparesis is common finding in which DM

A

II

45
Q

what prokinetic agents are available for GI

A

metoclopramide and serotoni agonists and erythromycin/macrolides

46
Q

MOA metoclopramide

A

central and peripheral dopamine R antagonist, serotonin agonist, serotonin antagonists, cholinesterase inhibitor

47
Q

metoclopramide does what

A

enhances motility of upper GI tract, accelerates gastric emptying, increases esophageal peristalsis, increases LES pressure

48
Q

therapeutic use metoclopramide

A

prior to meals and at bedtime to control nausea and vomiting

49
Q

adverse effects metoclopramide

A

cross bbb so extrapyramidal Sx: tardive dyskinesia
restlessness, drowsiness, insomnia, anxiety, agitation, depression
hyperprolactinemia can cause galactorrhea, breast tenderness and menstrual irregularities

50
Q

What is adverse effect of serotonin agonists for prokinetic GI

A

fatal cardiac arryhthmias

51
Q

MOA erythromcyin and macrolids for prokinetic GI

A

agonist at motilin T increased frequency and amplitude of antral contractions and initiats gastric phase III contractions

52
Q

therapeutic use erythromycin

A

short term improvement gastric emptying in diabetic gastroparesis
long term limited by concerns about toxicity, pseudomembranous colitis and induction of resistant bacterial strains, development of tolerance

53
Q

adverse effects of erythromycin

A

abdominal pain, cramping, nausea, diarrhea, vomiting
malabsorption
tolerance develops rapidly (motilin downregulation)

Year2 GI Exam I (18 decks)

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