[Pharm] Diarrhea, Abdominal pain, Constipation Flashcards
What are the 4 classes of drugs you would prescribe for DIARRHEA?
Prostaglandin inhibitors
Opioid agonists
Serotonin antagonists
Chloride channel inhibitors
What is the prostaglandin inhibitor you would prescribe for DIARRHEA?
Bismuth
What are the (3) opioid agonists that you would prescribe for DIARRHEA?
Loperamide
Diphenoxylate
Eluxadoline
What is the (1) serotonin antagonist you would prescribe for DIARRHEA?
Alosetron
What is the (1) chloride channel inhibitor you would prescribe for DIARRHEA?
Crofelemer
What is the GENERAL MOA of opioid agonists for treating diarrhea?
Anti-propulsive
What is one of the clever designs put into diphenoxylate to prevent opioid abuse?
Diphenoxylate (opioid agonist) has a small quantity of ATROPINE added to discourage deliberate abuse/over-dosage of drug
What is the one drug that has a unique indication within the opioid agonist category?
What is that indication?
Eluxadoline
Irritable bowel syndrome, diarrhea predominant subtype [IBS-D]
What is the major side effect of eluxadoline?
Pancreatitis!!!!
MOA of alosetron?
Selectively blocks GI BASED 5HT3 receptors
Indication for alosetron?
Chronic, severe IBS-D that are NOT RESPONSIVE to other conventional therapies in WOMEN
What are the major side effects associated with ALOSETRON?
GI related = dyspepsia
BLACK BOX = ISCHEMIC COLITIS
MOA of crofelemer?
Inhibits
chloride ion secretion
by
blocking cAMP stimulated CFTR* and *calcium activated chloride channels
What is the super unique indication for CROFELEMER?
Non infectious diarrhea in HIV/AIDS pts that are on ANTI-RETROVIRAL THERAPY
What is the ONE class of drugs used for abdominal pain?
Antimuscarinic agents
What are the (3) antimuscarinic agents used in treatment of abdominal pain?
Hyoscyamine
Dicyclomine
Clidinium/Chlordiazepoxide
Side effects of antimuscarinics?
Classic anticholinergic based
Dry mouth
Urinary retention
Constipation
Drowsiness
Mental confusion
Blurred vision
What are the (4) classes of drugs used for treating CONSTIPATION?
Peripheral opioid antagonists
Guanylate Cyclase-C Agonists
Selective Chloride (C2) Channel Activators
Laxative and Cathartic Agents
MOA of LINACLOTHIDE?
Selective guanylate cyclase-C (GC-C) agonist
Stimulates secretion of chloride/bicarb into the intestinal lumen, this results in increased intestinal fluid and accelerated transit
What are the indications for LINACLOTIDE?
Irritable bowel syndrome-constipation predominant subtype [IBS-C]
Chronic idiopathic constipation [CIC]
MOA of LUPIPROSTONE?
Prostaglandin E1 derivative
Increases intestinal fluid secretion by activating GI specific CHLORIDE CHANNELS (CIC-2) in the luminal cells of intestinal epithelium
What is the “claim to fame” indication for LUBIPROSTONE?
Opioid induced constipation (OIC)
(*also treats IBS-C and CIC)
MOA of Methylnaltrexone?
Peripheral MU-OPIOD receptor ANTAGONIST
(MethylnaltrexOne) blocks Mu-Opioid
Indications for methylnaltrexone?
Opioid induced constipation (OIC)
What is the ONE indication for ALVIMOPAN?
PREVENTION OF POST OPERATIVE ILEUS
What is the BLACK BOX WARNING of ALVIMOPAN?
RISK OF MI
Must enter a risk mitigation systmic process (REMS) in order to prescribe
What would be a great class of drugs to prescribe for your patient that complains of:
“I poop once every other day, but when I do…MAN it’s hard and painful to pass…”
Help me
STOOL SOFTENER
What is the one stimulant given pre-colonoscopy for bowel prep?
Sodium picosulfate
What is the MOA of stimulants (irritants)?
IRRITANT to enterocytes, GI smooth muscle which leads to INFLAMMATION
This inflammation leads to an increase in prostaglandin synthesis
Contraindications of stimulants?
GI obstruction/Ileus/Impaction
What is the MOA of saline agents?
Mg/Phosphate ions poorly absorbed…
Osmotically retain water in GI tract
What OSMOTIC agent is used for severe liver disease?
Lactulose
What is the osmotic agent that when given at HIGH DOSES is used for bowel prep prior to GI scopes?
Polyethylene glycol (PEG-3350)
What are the two drugs given for pre-colonoscopy bowel prep?
State what type of drug and dose
Sodium Picosulfate (low dose, stimulant)
Polyethylene glycol (high dose; osmotic)
