Pharm 24 drugs Flashcards
Use of natural and synthetic fiber?
Softens and increases fecal mass, used for maintenance for constipation
List the 3 major bulk forming laxatives
Psyllium
Polycarbophil
Methylcellulose
Psyllium (Metamucil) clinical use?
Constipation
Hypercholesterolemia
Psyllium (Metamucil) ASEs?
Flatulence
Borborygmi
Abdominal pain
Anorexia
N/V/D
Psyllium (Metamucil) is formed from seeds of plantago psyllium, what are some warnings w/ use of this drug?
Chocking/esophageal obstruction
Allergic reaction
Polycarbophil clinical use?
Soften and stabilizes content
Methylcellulose clinical uses?
Constipation
More stable than psyllium, less flatulence and non-allergic.
Docusate Sodium clinical use?
Only good for softening “mush” not useful for “push”
less effective than psyllium
Docusate Sodium ASEs?
Usually well tolerated
Rash + throat irritation
List lubricants used
Mineral and castor oil
Lubricant clinical use?
Coats intestinal content, prevents absorption of water, and helps maintain a soft stool
Lubricant ASEs?
skin irritation and fecal urgency
Don’t give at bedtime
List secretory/osmotic drugs
Sugar alcohols (Sorbitol)
Polyethylene Glycol
Sodium phosphate
Magnesium
Glycerin
Lactulose
Sorbitol MOA?
stimulates bowel movement, increases water content in large intestine
Sorbitol ASEs?
Abdominal pain
Angina
Back pain
Flatulence
GI bleed
Vertigo
N/V
Xerostomia
Hyperglycemia
Polyethylene glycol (MiraLAX) MOA?
Binds to water, retains water, softens stool, increases stool frequency, helps induce evacuation.
Polyethylene glycol (MiraLAX) ASEs?
Rhinorrhea
Flatulance
Fecal urgency
Urticaria
Sodium Phosphate MOA?
Draws water into intestinal lumen, softens, stretches wall, and stimulates peristalsis.
Sodium Phosphate ASEs?
Dehydration
Renal Tox
Sodium retention
Magnesium Hydroxide MOA?
Unabsorbed magnesium draws water into the intestine, increases pressure, and increases motility.
Magnesium Citrate is only used in?
Severe cases
Glycerin 1st line for who?
Babies who are constipated
Glycerin MOA?
osmotically draws water into the colon aiding in defication
List surface active/stimulant laxatives
Senna
Bisacodyl
Surface active/stimulant laxatives MOA?
Stimulate sensory nerve endings produce parasympathetic reflexes and peristalsis.
Senna ASEs?
Hypocalcemia
Hypokalemia
Urine/stool discoloration
Clubbed finngers
Nephritis
Severe electrolyte imbalances
Bisacodyl ASEs?
More GI irritation
Proctitis (w/rectal suppository)
Hypokalemia
Lactulose MOA?
Breaks down bacteria from lactose into lactic acid
Local acidity ionizes ammonia to ammonium
Lactulose unique use?
Useful to lower GI ammonia absorption in pts w/ hepatic encephalopathy
Lactulose AESs?
Abdominal pain
Diarrhea
Flatulance
N/V
Hypokalemia
Hyponatremia
Metabolic acidosis
List opioid antagonists
Naloxegol
Methylnalrexone
Naloxegol clinical use?
FDA indicated for tx of OIC
chronic and non-cancer pain
Naloxegol is contraindicated in?
Pts receiving strong CYP3A4 inhibitors (clarythromycin, ketoconazole)
pts w/GI obstruction d/t perforation.
Naloxegol ASEs?
Abominal pain
Diarrhea
Flatulence
N/V
Arthralgia
HA
W/d sign and sxs
List pro-secretory drugs used for IBS-C
Lubiprostone
Linaclotide
Plecanatide
Lubiprostone MOA?
Chloride channel activator
acts locally on membrane on the GI tract to increase intestinal fluid secretion and improve fecal transit in IBS and OIC.
Linaclotide and Plecanatide MOA?
Increase secretion of chloride and bicarbonate
bypass antisecretory effects of opiates, suppresses secretomotor neuron excitability
Contraindications of pro-secretory drugs?
<6 yrs of age = risk for dehydration.
Loperamide (imodium) MOA?
acts on circular and longitudinal muscles of intestines = slows peristalsis
Inhibits fluid and electrolyte secretion and reduces fecal volume
Loperamide (imodium) ASEs?
Abdominal pain
Constipation
Dizziness
Fatigue
Flatulence
HA
Urinary retention
N/V
Loperamide (imodium) contraindications?
Children <2 yrs old
Dysentery
GI bleeding
Infections
Pseudomembranous colitis
UC
Loperamide (imodium) drug interactions?
Alosetron (L1 -severe)
Metaclopramide, Cisapride, Atropine (L2-major)
Bismuth subsalicylate (Pepto Bismol) clinical uses?
Nausea
Heartburn
Indigestion
Upset stomach
Diarrhea
YAY PEPTO BISMOL!
Diphenoxylate/atropine (Lomotil) MOA?
Used as antidiarrheal agent RX ONLY C-V
- Diphenoxylate opioid w/low bioavilability
- Atropine slow peristalsis and reduces abuse potential
Eluxadoline clinical use?
C-IV drug
IBS-D in adults
Eluxadoline MOA?
Mixed mu-opioid receptor agonist
works to reduce abdominal pain and diarrhea in pts with IBS-D w/o constipation side effects
Eluxadoline ASEs?
Dizziness
Fatigue
Drowsiness
Euphoria
Intoxicated feeling
Sedation
Rash
Constipation
N/V
Abdominal pain
Increase AST and ALT
Eluxadoline contraindications?
Hypersensitivity
Pts w/o gallbladder
h/o pancreatitis
Biliary duct obstruction
Alcoholism
Chronic/severe constipation
GI obstruction
Alosetron MOA?
Targets 5-HT3 and 5-HT4 receptors
Serotonin 3 receptor antagonists
Alosetron clinical use?
IBS-D
Cholestyramine is an antidiarrheal drug that causes what?
Binding of bile acids needed for vitamin D absorption results in vitamin d deficiency
List bowel preps
GoLYTELY
MoviPrep
Suprep Bowel Prep Kit
What bowel preps do you avoid in pts with kidney problems?
Phosphate containing preps
Clinical use of bowel preps?
GI scopes
Simethicone (Gas-X) clinical use?
Dissolve gas bubbles
Relieves pressure, bloating, fullness, and GI gas discomfort.
List hemorrhoid tx: protectants
Petrolatum
Glycerine
Aloe
Various oils(shark liver oil)
List hemorrhoid tx: vasoactive substance
CCB: nifedipine and diltiazem
Nitroglycerine ointment
Intra-anal application of NTG: reduces sphincter tone and resting intra-anal pressure”
List hemorrhoid tx: topical anti-inflammatory drugs
Hydrocortisone cream or suppositories.
Lactose intolerant tx?
Lactase dietary supplment
Take PO: whole, chewed, swallowed, or sprinkled on food
Indication for pancreatic enzyme replacement?
Exocrine pancreatic insufficiency: chronic pancreatitis or pancreatectomy
Pancreatic insufficiency: CF and others
MC pancreatic enzyme replacement drug?
Creon
How do you administer pancreatic enzyme replacement drugs?
Swallow cap whole
DO NOT crush
OK to sprinkle into infants mouth or applesauce.
ASEs of pancreatic enzyme replacement drugs?
Hyperuricemia and Hyperuricosuria
Folic acid deficiency
Irritation of oral mucosa (take with meals)
What is listed on Creon medication guide?
May increase chance of having a rare bowel disorder: fibrosing colonopathy,
This may require surgery.
What is the clinical use of TCAs?
Slow intestinal transit time
Used for IBS-D
Start low and go slow.
