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Maddy - GI II Exam I - some pharm > Pharm - Diarrhea, Abd Pain, and Constipation > Flashcards

Pharm - Diarrhea, Abd Pain, and Constipation Flashcards

1
Q

what are the 4 families of drugs used to treat diarrhea

A
  • prostaglandin inhibitors
  • opioid agonists
  • serotonin (5HT3) antagonists
  • chloride channel inhibitors
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2
Q

list the prostaglandin inhibitors used to treat diarrhea

A

bismuth

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3
Q

list the opioid agonists used to treat diarrhea

A
  • loperamide
  • diphenoxylate
  • eluxadoline
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4
Q

list the serotonin antagonists used to treat diarrhea

A

alosetron

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5
Q

list the chloride channel inhibitors used to treat diarrhea

A

crofelemer

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6
Q

MOA loperamide

A

direct action on circular and longitudinal muscles of intestinal wall to interfere with peristalsis

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7
Q

side effects loperamide

A

dizziness, fatigue, drowsiness, urinary retention (anticholinergic)

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8
Q

why is atropine added to diphenoxylate

A

to discourage deliberate abuse/over-dosage

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9
Q

MOA diphenoxylate

A

exerts effects locally and centrally on GI smooth muscle cells to inhibit GI motility and slows excess GI propulsion

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10
Q

side effects diphenoxylate

A

dizziness, drowsiness, urinary retention (anticholinergic, atropine)

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11
Q

MOA eluxadoline

A

agonist at opioid mu and kappa receptors to slow peristalsis and delay digestion

antagonist at delta opioid receptors to decrease secretions

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12
Q

indications for eluxadoline

A

IBS with diarrhea (DIARRHEA ONLY)

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13
Q

side effects eluxadoline

A
  • GI related (n/v/d/abd pain)
  • hepatic/pancreatic toxicity (PANCREATITIS)
  • CNS related (dizziness, sedation, euphoria, impaired cognition)
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14
Q

contraindications eluxadoline

A
  • biliary duct obstruction
  • alcoholism
  • history of pancreatitis
  • hepatic impariment
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15
Q

when should you stop eluxadoline therapy

A

if severe constipation develops and lasts 4+ days

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16
Q

MOA alosetron

A

selectively blocks GI-based 5HT3 receptors (serotonin antagonist)

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17
Q

indications for alosetron

A

chronic, severe IBS with diarrhea (women)

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18
Q

female patient with severe IBS-D comes in and is not responsive to other conventional therapies, what should you give her

A

alosetron

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19
Q

side effects alosetron

A
  • GI: CONSTIPATION, dyspepsia, GERD, N/V

- ISCHEMIC COLITIS

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20
Q

which drug has ischemic colitis as a possible side effect

A

alosetron

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21
Q

what must occur in order to prescribe and refill alosetron

A
  • no refills w/o follow up exam
  • physicians must enroll in prescribing program
  • pts & physicians must sign risk-benefit statement
  • additional self-training and testing
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22
Q

contraindications to alosetron

A

history or active:

  • GI obstruction, perforation, stricture, adhesions, toxic megacolon
  • diverticulitis, crohn’s, UC
  • impaired intestinal circulation
  • severe constipation
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23
Q

MOA crofelemer

A

inhibits chloride ion secretion by blocking cAMP-stimulated CFTR and Ca2+ activated chloride channels

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24
Q

indications for crofelemer

A

NON-INFECTIOUS diarrhea in HIV/AIDS patients on RETROVIRAL THERAPY

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25
Q

what is the drug indicated for non-infectious diarrhea in HIV/AIDS patients on retroviral therapy

A

crofelemer

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26
Q

side effects crofelemer

A

GI: abd distention, elevated AST/ALT/bilirubin

Infections (pts are immunocompromised)

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27
Q

list the antimuscarinic agents used for abd pain in IBS

A
  • hyoscyamine
  • dicyclomine
  • clidinium/chloridazepoxide
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28
Q

MOA antimuscarinic agents for abd pain in IBS

A

competitively inhibit autonomic, post-ganglionic cholinergic receptors to decrease GI motility and spasms

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29
Q

indications for antimuscarinic agents in IBS

A

abdominal pain/spasms

30
Q

side effects of antimuscarinics for abd pain/spasms in IBS

A

classic anticholinergic effects

  • dry mouth
  • urinary retention
  • constipation
  • drowsiness
  • mental confusion
  • blurred vision
31
Q

list the peripheral opioid antagonists used for constipation

A
  • methylnaltrexone
  • naloxegol
  • alvimopan
32
Q

list the guanylate cylase-C agonists used for constipation

A

linaclotide

33
Q

list the selective chloride (C2) channel activators used for constipation

A

lubiprostone

34
Q

MOA linaclotide

A

binds to guanylate cyclase-C of intestinal epithelium and increases concentration of cGMP –> activation of CFTR –> stimulates secretion of Cl-/HCO3- into lumen

35
Q

indications for linaclotide

A
  • IBS-C
    (IBS constipation predominant subtype)
  • chronic idiopathic constipation (CIC)
36
Q

side effects linaclotide

A
  • diarrhea

- GERD/dyspepsia/N/V

37
Q

MOA lubiprostone

A

a prostaglandin E1 analog that increases intestinal fluid secretion by activating GI specific Cl- channels

38
Q

indications for lubiprostone

A
  • IBS-C (IBS constipation predominant subtype) - women
  • chronic idiopathic constipation (CIC)
  • OPIOID INDUCED CONSTIPATION
39
Q

side effects lubiprostone

A

nausea, dyspepsia, dizziness

40
Q

MOA methylnaltrexone

A

antagonizes peripheral mu-opioid receptors

41
Q

indications for methylnaltrexone

A
  • opioid induced constipation
42
Q

what drug is used as prevention against postoperative ileus

A

alvimopan

43
Q

indications for alvimopan

A

prevention of postoperative ileus

44
Q

side effects methylnaltrexone

A

abd pain, diarrhea, nausea, vomiting

45
Q

warnings for alvimopan and what are the REMS limitations

A

carries a risk of MI

REMS: requires use only in approved institutions for maximum of 15 doses

46
Q

list the stimulants of the laxative and cathartic agents

A
  • bisacodyl
  • castor oil
  • glycerin
  • senna
  • Na+ picosulfate
47
Q

list the osmotics of the laxative and cathartic agents

A
  • lactulose
  • mag citrate
  • polyethylene glycol
  • sorbitol
48
Q

list the salines of the laxative and cathartic agents

A

Magnesium hydroxide

Na+ phosphate

49
Q

list the bulk forming substances of the laxative and cathartic agents

A
  • dietary (fiber/bran)
  • fruits/grains/cereal
  • psyllium
  • methylcellulose/carboxymethylcellulose
  • calcium polycarbophil
50
Q

list the stool softeners of the laxative and cathartic agents

A
  • docusate

- mineral oil

51
Q

MOA of bulk forming agents used for constipation

A

work to increase bulk-volume and water content to increase GI motility

52
Q

adverse effects bulk forming agents

A

bloating/obstruction

53
Q

drug interactions with bulk forming agents

A

LOTS mainly with psyllium and the celluloses

54
Q

MOA stool softeners

A

anionic surfactants that soften/lubricate the feces

  • increase fluid secretion into GI tract
  • inhibit water reabsorption
  • mineral oil penetrates stool to soften
55
Q

how long does it take for stool softeners to take effect

A

1-3 days

56
Q

adverse effects of stool softeners

A

GI related

57
Q

when is sodium picosulfate used

A

pre-colonoscopy bowel prep

58
Q

MOA stimulants

A

Na+/K+ ATPase inhibition and/or increase in prostaglandins –> irritation and inflammation to enterocytes –> stimulates peristalsis

59
Q

how does castor oil promote water/electrolyte accumulation in the GI tract

A

it is hydrolyzed to ricinoleic acid

60
Q

how does glycerin act as a stimulant

A

it functions as an irritant, an osmotic agent, and a lubricating agent

61
Q

when do stimulants take effect

A

12-36 hours (sooner w/ glycerin)

62
Q

adverse effects stimulants

A
  • abd cramping
  • urine discoloration (with senna)
  • fluid/electrolyte disturbances
63
Q

what drug taking for constipation will discolor the urine

A

senna

64
Q

contraindications of stimulants

A

GI obstruction/ileus/impaction

65
Q

cautions for prescribing stimulants in pregnant women

A

several of the stimulants pass into the breast milk

66
Q

MOA saline agents

A

magnesium and phosphate ions are poorly absorbed in the GI tract so they osmotically retain water in the GI tract

67
Q

drug interactions w/ saline agents

A

diuretics

68
Q

cautions when prescribing saline agents

A

pts w/ renal disease and CHF/HTN

69
Q

MOA osmotic agents

A

work to osmotically attract and retain increased water in the colon

70
Q

other than constipation, what is lactulose used for

A

severe liver disease pts with hyperammonemia

71
Q

adverse effects osmotic agents

A

electrolyte disturbances, GI related issues

72
Q

other than constipation, what is polyethylene glycol used for

A

LARGE doses used for bowel prep prior to GI scopes, radiological procedures, or surgery

(small doses are for constipation)

Maddy - GI II Exam I - some pharm (23 decks)

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