pharm 2 Flashcards
prokinetic agents
are used for GERD
bethanechol (urecholine)
it is a cholinergic agent that is used when there is urinary retention happening
metoclopramide is a
serotonin receptor modulator and a dopamine receptor modulator that works by blocking the dopamine receptor and suppressing the release of Ach which decreases transit time and stimulating the serotonin receptor that promotes motility
side effects of blocking the dopamine receptor
parkisonian movements
side effect of blocking the serotonin receptor
serotonin syndrome
psyllium, methylcellulose, polycarbophil
bulk forming agents
docusate and mineral oil
softeners/surfactants
saline based agent, sugar/alcohol-based agent
osmotic agents
bisacodyl, senna, cascara
stimulants for constipation
bulk forming agents
are a source of fiber that enhances stool mass but can lead to bloating and abdominal pain so it is good to avoid if there is suspicion of obstruction. there might also be some drug interactions of absorption
metamucil
natural bulk forming agent
softeners/surfactants
lowers surface tension of stool but could lead to impaired absorption of fat soluble agents, oil leakage and lipid pneumonitis
docusate
is a softeners that needs to combined with other laxative agent
osmotic agents
osmotically-mediated water retention stimulates peristalsis but can lead to abdominal discomfort and flatulence and if it is saline based agent then we also need to be concerned with patients who have a renal or cardio disease, underlying electrolyte disorder.
*monitor Ca, K, Mg, Na and Phos
because glycerin is sugar/alcohol based osmotic agent it needs to be coated enterically?
yep, we do not want it to be absorbed before reaching the site of action
polyethylene glycol
it is an osmotic agent that comes from the same family of antifreeze but has no of those pesky side effects due to it being too large to be absorbed
stimulant laxatives
produce migrating colonic contractions but we want to make sure we don’t overuse
type 2 chloride channel agonists and guanylate cyclase agonists are used for
chronic idiopathic constipation, irritable bowel constipation and opioid used constipation
tegaserod
is a serotonin receptor agonist that is used for IBS-C in women <65 years. it was thought that it had a great potential of causing ischemia and thus is just recently got approved and it is not prescribed to patients older than 65 due to their increase chance of ischemic events
peripherally acting Mu-opioid receptor antagonist
they go to the bowel and antagonize Mu receptor to decrease constipation
opioids such as loperamide can be used as
antimotility agents
what efflux keeps loparamide out of the brain
P-gp
what can happen is there is too much loparamide?
it can overwhelm the p-pg efflux transporter located in the BBB
clonidine is a
alpha-2 receptor agaonist that supresses the release of epinephrine and is used as an anti-diarrheal but can cause rebound effect if suddenly taken away
alosetron black box warning
ischemic colitis
alosetron is used
when the primary symtpom is diarrhea; it is a serotonin receptor antagonist
rifaximin
anti-diarrheal that has antibiotic effects but the great thing about it, is that it does not get absorbed systemically, it only changes the flora to exerts its effects
crofelemer
blocks cl- channels and mainly used in people with HIV who have a watery diarrhea
