Pharm2 4 GI Drugs pt3 Flashcards
What do Opiods/Anticholingergics do?
They are anti-diarrheals.
Slows transit time in the bowel: this lets you absorb more water out of the feces, and you go from a watery diarrhea to a firmer stool.
Example of opioids/anticholinergics (antidiarrheal)
Diphenoxylate hydrochloride and atropine sulfate
Diphenoxylate hydrochloride and atropine sulfate (antidiarrheal)
Who gets it? How?
Never take more than _. why?
If it’s so bad that they crapped themselves on their way to see you at the clinic. Take 1, if you are no longer soiling yourself (but you still have diarrhea) then that’s fine. Otherwise take another (no more than 4) because…
Do not take more than they need to! It will wor, but afterwards you will not have a bowel movement for 3-5 days, and you’ll have bubble bubble toil an trouble bowel noises.
Diphenoxylate hydrochloride and atropine sulfate (antidiarrheal) is never given to who? Why?
YOU WILL NOT WRITE THIS IN THE PEDIATRIC POPULATION: dramatic likelyhood of increasing risk of a bowel perforation in the peds population, especially under age 5.
Diphenoxylate hydrochloride and atropine sulfate (Lomotol®)
Side fx: (6)
drowsiness, dizziness, headache, tiredness, blurred vision, dry mouth, and anorexia (you wouldn’t want to eat if you can’t move bowels for 5 days)
Diphenoxylate hydrochloride and atropine sulfate (Lomotol®)
CI
Preg
Diphenoxylate hydrochloride is chemically related to meperidine, use w/ MAOs may precipitate hypertensive crisis
Contraindications: acute ulcerative colitis, invasive gastroenteritis (toxigenic E. coli, Salmonella, etc.), pseudomembranous colitis [C diff] associated with broad-spectrum antibiotics
Pregnancy: Cat. C
___ is a Schedule V controlled substance, it is chemically related to meperidine, use w/ MAOs may precipitate hypertensive crisis
Diphenoxylate hydrochloride and atropine sulfate (Lomotol®)
__ are the primary anti-inflammatory drugs used to treat UC
Aminosalicylates
everything he said about biologics/monoclonal antibodies:
Biologics are drugs w/ weird names…most end with –mab, they are monoclonal antibodies – they are almost NEVER prescribed in the primary setting, ALMOST EXCLUSIVELY prescribed by gastroenterologists.
Big side note, Not these drugs: monoclonal antibodies
Biologics – monoclonal antibodies - are used in rheumatoid arthritis ulcerative colitis, and IBD. Not used in primary care b/c they require a ton of prior authorizations. And they’re very expensive - $20,000-$40,000 per year.
they have a decreased immune system – patient must be aware, if they come down with an infection that they need to come in. Before that, they need to get a bunch of tests and vaccines – screened to make sure you don’t have TB (Quantiferon gold), make sure they have Hep B vaccine & no history of it which could be reactivated. And last, if they have lived in certain areas they need to be tested for fungal infections (Rocky Mountain fever). After vaccines wait 4 weeks. Give them a flu vaccine every year (not the live vaccine). This makes them immunocompromised.
Ex of Salicylates
Indications
An off-label use:
Sulfasalazine
FDA-approved in adults and children ≥ 2 yoa for treatment of inflammatory bowel disease, including UC and Crohn’s disease
Used off-labels for the treatment of chronic alcoholics to reverse the scarring associated with cirrhosis of the liver
Sulfasalazine
CI, Cautions, Preg, side/adverse fx
Contraindications: intestinal or urinary obstruction
Cautions: hepatic or renal dysfunction, asthma, G6PD deficiency, monitor LFTs
Pregnancy: Cat. B
Side effects/Adverse Events: anorexia, headache, GI upset, pruritis, rash, fever, hemolytic anemia, urine, tear, and/or skin discoloration
Constipation – Stool Softeners work how?
These act in the large and small intestine to cause water and fats to penetrate the stool, easing stool movement
but you Quickly produce a tolerance effect and so become ineffective with prolonged use
ex of stool softener
Caution
Preg category
Also feels good on the bum for who?
Docusate Sodium (Colace®)
Cautions: discontinue if no bowel movement or rectal bleeding occurs
Pregnancy: Cat. B
makes patients with anal fissures more comfortable too.
Constipation – Bulk forming agents.
How do they work?
How intense/gentle are they?
What are they used for?
Work in the small and large intestine cause the stool to be bulkier and to retain more water, as well as forming an emoliant gel, easing perstaltic action
These have the gentlest of effects among laxatives and can be taken long-term for maintaining regular bowel movements
ex of Bulk-forming agent for constipation
approved for how old?
indications
FDA-approved for adults and children ≥ 6 yoa for the treatment of constipation, and an adjunct in diverticular disease and irritable bowel syndrome constipation (IBC-C).
Methylcellulose (Citrucel®)
Contraindications
Cautions
Contraindications: signs/symptoms of appendicitis, intestinal obstruction, fecal impaction
Cautions: discontinue if no bowel movement or rectal bleeding occurs
Bowel Preps
Ex:
MoA
polyethylene glycol
rapidly alters colonic osmosis by retaining water in the colon, lowering colonic pH and DRAMATICALLY increasing colonic peristalsis and emptying
What’s Commonly used in ED for ppl who have been poisoned?
give ‘em activated charcoal to absorb the poison and propylethylene glycol to increase the speed of removal.
2 cautions to look out for with propylethylene glycol
*This causes huuuuuuuge osmotic electrolyte shifts. Especially in the elderly, it can cause cardiac arrhytmias.
Polyethylene Glycol (GoLytely®) CI, Preg category
Contraindications: GI obstruction or perforation, toxic colitis/megacolon, ileius
Pregnancy: Cat. C
Polyethylene Glycol (GoLytely®) Side effects/Adverse Events: (4)
nausea, vomiting, abdominal cramping (to say the least), fluid and/or electrolyte disturbances, dehydration (so much water is put out through the colon)
What’s the class of drugs for symptomatic relief of and to treat painful or pruritic internal and external rectal hemorrhoids, anal fissues, proctitis, terminal ulcerative colitis, pruritus ani, and other inflammatory conditions of the rectum or anus (colorectal agents)
Anesthetic/Steroid
ex of an anesthetic/steroid
Pramoxine/hydrocortisone topical
Pramoxine/hydrocortisone topical (Proctofoam-HC®)
MoA
mucoadhesive analgesic and anti-inflammatory foam provides direct effect as an anti-inflammatory and topical anesthetic
Pramoxine/hydrocortisone topical (Proctofoam-HC®)
CI, Preg category
Contraindications: infective dermatoses, tuberculosis, diverticulitis
Pregnancy: Cat. C
