Small Bowel Pharm Flashcards
Give and example of bulk-forming agents that can help to relieve constipation and diarrhea.
psyllium husk
carboxy mthylcellulose
polycarbophil (cardboard)
other anti-diarrheal: kaolin clay
Name some basic over the counter anti-diarrheal aids
bismuth subsalicylate (black tongue) loperamide: Imodium
(diphenoxylate with atropine, opioid agonist- lomotil)
What’s the limiting factor in using opioids as anti-diarrheals?
they have a lot of side effects (and also potential for addiction)
How do bile salt binding resins address diarrhea?
build salt binding resigns like cholestyramine bind leaking bile that can cause diarrhea
What is the MOA of alostron and its precautions?
5-HT-3 antagonist, is very powerful, used in women only for IBS-D
may cause colon ischemia, cannot be taken in patients with a clotting disorder
Octreotide is known as “a ____ ____ on the GI tract.”
a somatostatin analog known as “a wet blanket on the GI tract”
it is expensive and difficult to tolerate, used in treating portal hypertension and diarrhea
Name the most significant side effects of methotrexate.
hepatotoxicity
bone marrow suppression
pulmonary toxicity
teratogenic
** FUN FACT patients should also be taking a folate supplement with this drug
Name the treatment for mild, moderate and severe Crohn’s
mild: aminosalicylates (mesalamine) and corticosteroids (budesonide)
moderate-severe: immunodulators(slow) (azithoprine, methotrexate), anti TNF (infliximab, adalimumab), other biologics (natalizumab, vediolizumab
Briefly differentiate between mild, moderate and severe crohn’s disease.
mild: ambulatory; 4 stool
severe: persistent symptoms on corticosteroids or high fever, rebound or abscess >10 stool
Describe some of the significant side effects of axathioprine
bone marrow suppression, drug induced liver injury (must check liver AST/ALT every 3mo), fever, pancreatitis, non melanoma skin cancer, lymphoma
A patient on TNF inhibitors is at risk for reactivation of what two infections?
latent TB
occult Hep B
What are indications for colectomy?
toxic megacolon
severe hemorrhage
lack of response to therapy
cancer or dysplasia
Differentiate constipation predominant IBS and chronic constipation.
constipation predominant IBS includes pain, chronic constipation does not
Name examples of stool softeners.
Decussate sodium ('mucus in a pill') mineral oil (emollient)
What is the mechanism to treating constipation by non absorbed sugars and salts like magnesium hydroxide and lactulose/sorbitol?
produces an osmotic diarrhea that can be accompanied by cramping/gas/bloating