Therapeutics Exam 3 (Foster/Scott) Flashcards
UC (Ulcerative colitis) or CD (Crohns Disease):
mucosal inflammation confined to rectum to colon
UC
UC (Ulcerative colitis) or CD (Crohns Disease):
transmural inflammation
CD (deeper = transmural)
UC (Ulcerative colitis) or CD (Crohns Disease):
inflammation of GI tract (can affect any part from mouth to anus)
CD
6 Possible Causes of IBD
immunologic microbial genetic Psychological environmental Drug related causes
UC (Ulcerative colitis) or CD (Crohns Disease):
is more superficial than the other one
UC
What are some local complications of UC
hemorrhoids
anal fissures
perirectal abscesses
what is a systemic complication of UC
toxic megacolon!
systemic toxicity — could be fatal – fever/tachycardia/elevated WBCs/abdominal distension
UC leads to a decrease or increase in colorectal cancer risk?
increase AF!
colonoscopies + biopsies should be done q 1 - 2 years…
UC (Ulcerative colitis) or CD (Crohns Disease):
will have a cobblestone appearance
CD
UC (Ulcerative colitis) or CD (Crohns Disease):
is often discontinuous (normal bowel parts separating disease bowel)
CD
UC (Ulcerative colitis) or CD (Crohns Disease):
which one has bleeding being more common?
UC
UC (Ulcerative colitis) or CD (Crohns Disease):
which one has a greater risk of colorectal cancer/carcinoma
UC
Complications of CD?
small bowel stricture/obstruction
fistula common
nutritional deficiencies
Extraintestinal Manifestations of IBD
Hepatobiliary Ocular Bone/joint (ARTHRITIS and Osteoporosis) Hematologic Coagulation (INCREASED RISK FOR VTE) Dermatologic and Mucocutaneous
Extraintestinal Manifestations of IBD
Pts may experience arthritis—
it is asymmetrical or symmetrical
asymmetrical
Extraintestinal Manifestations of IBD
Arthritis seen a lot during _______
and is hard to treat why?
seen during FLARES (control disease = control arthritis)
hard to treat - because we can’t just give NSAIDs!
Extraintestinal Manifestations of IBD
Patients are at an increased risk of ______ – higher risk during flares - CONSIDER PROHPYLAXIS for this!!
risk VTE —- ahhhh
Clinical Presentation of UC and its disease extent/location:
if it is distal – that means the disease is where?
distal = left sided
= distal to splenic flexure
Clinical Presentation of UC and its disease extent/location:
if it is extensive – that means the disease is where?
extending proximal to the splenic flexure
Clinical Presentation of UC and its disease extent/location:
if it is proctitis – that means the disease is where?
involving the rectal area
Clinical Presentation of UC and its disease extent/location:
if it is proctosigmoiditis – that means the disease is where?
involves rectum and sigmoid colon
Clinical Presentation of UC and its disease extent/location:
if it is pancolitis– that means the disease is where?
majority of colon is involved
Disease Classification of UC:
what are the 4 categories of severity?
mild
moderate
severe
fulminant
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
< 4 stools / day
mild
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 4 stools/day
moderate
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 6 stools/day
severe
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
> 10 stools/day
fulminant
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
no systemic disturbance; normal ESR; normal fecal calprotectin and lactoferrin
mild (with < 4 stools +/- blood)
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
minimal systemic disturbance
moderate (also > 4 stools/day)
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
evidence of systemic disturbance (fever, tachycardia, anemia, or ESR > 30 mm/h)
Severe (> 6 stools/day)
Disease Classification of UC:
Mild, Moderate, Severe, or Fulminant?
continuous bleeding with stools, toxicity - severe systemic disturbances; abdominal tenderness; need for transfusion; colonic dilation
fulminant (> 10 stools/day)
Lab Tests to look at for CD?
Hgb/Hct
CRP, ESR, WBCs
+ anti-saccharamycses cervisiae antibodies!!!! (diff from UC!!!0
fecal calprotectin and lactoferrin
UC (Ulcerative colitis) or CD (Crohns Disease):
will have skip lesions
Crohns
UC (Ulcerative colitis) or CD (Crohns Disease):
cigarette smoking is actually protective
UC
UC (Ulcerative colitis) or CD (Crohns Disease):
fistulas and strictures are uncommon
UC
UC (Ulcerative colitis) or CD (Crohns Disease):
cigarette smoking is a risk factor
CD
IBD Treatment:
what is the best diet to be beneficial?
none to be known!!!
people have own specific trigger foods
UC (Ulcerative colitis) or CD (Crohns Disease):
Surgery/colectomy seen to be used more
UC
T or F: There are only a couple agents to cure IBD
false! there are NONE!
No agents are curative!!
Pharm options for IBD:
5 main classes?
ASAs Corticosteroids Immunomodulators/immunosuppresives Biologics Antimicrobials
what drugs are ASA agents for tx IBD
sulfasalazine
mesalamine
what is 5-ASA
mesalamine
what is the active component in sulfasalazine
and what is the inactive part that causes ADE’s
active: 5-ASA
inactive + ADEs = sulfapyridine
UC (Ulcerative colitis) or CD (Crohns Disease):
which one has (+) perinuclear antineutrophil cytoplasmic antibodies
UC
what drugs are ASAs for IBD therapy
sulfasalazine
mesalamine
what drugs are immunomodulators for IBD therapy
azathioprine
mercaptopurine
cyclosporine
methotrexate
Sulfasalazine MOA:
_____ by colonic bacteria to release _______ and _____
cleaved; release sulfapyridine; 5-ASA
You can administer mesalamine alone - but why do we not?
rapidly and completely absorbed in small intestine but NOT colon (booooo)
Mesalamine topical is a good option:
use enemas for _______
use suppository for ______
(use them for when the disease is where)
enemas - when LEFT sided disease
suppositories: proctitis
Mesalamine:
which one is typically more effective - topical or oral?
topical!
A lot of oral mesalamine drugs are either ____ or ____ related
pH or ER/DR
what are the oral mesalamine options
Apriso Lialda Pentasa Asacol HD/Delzicol Osalazine Balasalazide
(“BOA PAL”)
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Apriso work in?
colon
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Lialda work in?
terminal ileum
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Pentasa work in?
duodenum, ileum
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Asacol HD/Delzicol work in?
terminal ileum
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Osalazine work in?
colon
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
where does Balsalazide work in?
colon
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
which ones work in the colon?
Apriso
Osalazine
Balsalazide
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
which ones work in the terminal ileum?
Lialda
Asacol HD/Delzicol
The Oral mesalamine drugs acting in different parts of the GI tract due to pH or ER stuff —
which ones work in the duodenum/ileum
Pentasa
Drug Interactions for sulfasalazine vs mesalamine
BOTH: since ASA agents - anticoag/antiplatelets/NSAIDs
but mesalamine is affected by acid reducing agents!!
Monitor CBCs and LFTs in sulfasalazine why?
bc pneumoitis/lymphma/anemia/thrombocytopenia risk
also hepatoxicity
Sulfasalazine can lead to a ______ reaction if allergy
hypersensitivity/rash
Mesalamine derivs:
which one commonly causes diarrhea
Olsalazine
Budesonide:
Given PO for up to ______
ok to give because of ______ = less systemic exposure
8 - 16 weeks!
first pass metab
Budesonide:
drug interactions?
CYP3A4 inhibitors – since heavy first pass!!!
AZA/6-MP:
which one is the prodrug of the other
AZA = prodrug of 6-MP
AZA/6-MP:
ADEs?
(remember it is chemo!) Bone marrow suppression N/V/D Stomatitis pancreatitis hepatoxicity
what monitoring to do for AZA/6-MP:
TPMT!!!!! (homozygous mutation – hell no to these drugs)
CBC - bc bone marrow
LFTs - bc hepatotoxicity
Cyclosporine:good for (induction or maintenance) of remission
induction!!
NOT for long term use!!/just bridge therapy
Cyclosporine ADEs?
metabolic - HTN, hyperlipidemia, hyperglycemia
nephro and neurotoxicity
gingival hyperplasia/hirsutism
Cyclosporine : good for _____
MTX: good for ____
(UC or CD)
Cyclo: UC
MTX: CD
MOA of the Biologic:
Infliximab
anti TNF-a antibody
MOA of the Biologic:
adalimumab
anti TNF-a antibody
MOA of the Biologic:
golimumab
anti TNF-a antibody
MOA of the Biologic:
certolizumab
anti TNF-a antibody
MOA of the Biologic:
Natalizumab
anti integrins/prevent leukocyte adhesion
MOA of the Biologic:
Ustekinumab
IL12/IL23 antagonist
MOA of the Biologic:
Tofacitinib
janus kinase inhibitor
Indicated for UC or CD or both:
Infliximab
CD/UC
Indicated for UC or CD or both:
adulimumab
CD/UC
mod - severe; steroid dependent or fistulizing disease
Indicated for UC or CD or both:
Golimumab
UC
Indicated for UC or CD or both:
Certolizumab
CD
Indicated for UC or CD or both:
Natalizumab
CD
Indicated for UC or CD or both:
Vedolizumab
CD/UC
Indicated for UC or CD or both:
ustekinumab
CD
Indicated for UC or CD or both:
tofacitinib
UC
Indicated for UC or CD or both:
tofacitinib
UC
ADRs of TNF-a inhibitors:
increase risk of infections, demyelinating disease, and malignancy (also HSTCL risk)
inj site rxns
For TNF-a inhibitors must check for what things prior to therapy
if up to date on vaccines
for tuberculosis and hep B/C
Contraindication with TNF a inhibitors (what other biologic)
live vaccines!during tx and 3 mos after
All TNF a inhibitors are given _____ route except infliximab is given ______
all given SQ
inflix: is IV!
what is HSTCL
hepatosplenic T cell lymphoma
How to prevent ADA’s with Infliximab
take immunomodulators too! (Aza)
what are ADAs
anti drug antibodies
T or F:
all TNF a inhibitors are for induction and maintenance
TRUE!
all anti-TNFs are!!
what drug has risk of PML (bc of JC virus that lies dormant)
Natalizumab
what drug is similar to Natalizumab but does NOT have PML/JC virus issue
Vedolizumab
all NON TNF a inhibitors are IV except which one
Ustekinumab! induction is IV but maintenance is SQ
TDM of Biologics and Strategy:
typically check therapeutic levels when?
when loss of response to an anti-TNF agent
TDM of Biologics and Strategy:
if pt loss of response to an anti-TNF agent AND pt has subtherapeutic level with no/low ADA – do what
increase dose or dosing interval! (dose just isnt high enough!)
can add immunomodulator
TDM of Biologics and Strategy:
if pt loss of response to an anti-TNF agent AND levels are at therapeutic level – do what
switch to vedolizumab with or w/out immunomodulator (drug just wont work in this pt)
TDM of Biologics and Strategy:
if pt loss of response to an anti-TNF agent AND pt has subtherapeutic level with high ADA – do what
switch within the class (pt has built immunity against this drug)
what drugs for UC/CD treatment should NOT be used contaminantly with immunosuppressants
Natalizumab (NO Aza/6-MP)
Tofacitinib - NO Aza or biologics with it!!!
T or F: Tofacitnib is best as monotherapy
true because it should NOT be used with immunosuppressants or biologics!!
ADE’s of tofacitnib
NEUTROPENIA!!
increased risk of infections/tuberculin test/ avoid if active infection
Tofacitinib and Neutropenia - how to deal with it
do NOT give drug if ANC < 500
if 500 - 1000 (dose reduce if 10 mg BID or d/c 5 mg BID until ANC > 1000)
Antimicrobial options for UC/CD —
cipro and metronidazole
ADRs of antimicrobials for UC/CD
resistance and C.DIFF!!!
Antimicrobials are used in (UC or CD) if it is associated with fistulas/abscesses
CD!
N/V during pregnancy:
Usually worst during what time of the day
and usually limited to what trimester?
morning
first
N/V during pregnancy:
Non-pharm options
ginger root/gum Peppermint oil (Best for mild cases!)
Morning Sickness “magic” = ginger + vitamin B6 +folic acid
N/V during pregnancy: Pharm options?
Diclegis or Bonjesta
all have Pyridoxine (vit. B6) TID or Doxylamine TID
Diclegis or Bonjesta?
is 1 tab BID
bonjesta
Diclegis or Bonjesta?
is 2 tabs qhs +/- 1 tab in AM and noon
diclegis
what antiemetic drugs during pregnancy have minimal risk to the fetus and which one is used but has less data to support its safety to fetuses?
safe: antihistamines; phenothiazines, metoclopramide
not a lot of data: ondansetron!
what are some rx drugs that can be used for N/V during pregnancy?
metoclopramide ondansetron meclizine dimenhydrinate promethazine prochlorperazine
PONV stands for?
post op nausea/vomiting
Risk factors for PONV
F ___ M
_____ status
Hx of _____ or _____
F > M
non-smoking status (smoking = protective!)
hx of PONV or motion sickness
Risk factors for PONV – Anesthetic Risk Factors:
intra-operative use of _____ but less with ______
use of ______
Type of _____
use of volatile anesthetics; less with propofol
use of nitrous oxide
what surgeries increase peoples risk of PONV
laparoscopy
craniotomy
ENT
Treating PONV:
N/V is seen ______ surgery so give the agents when?
seen AFTER surgery; give agents at the end of the procedure
for treating PONV:
use # agent(s) for when propofol is used
1
for treating PONV:
for treating mod - high risk -
______ are drug of choice
5-HT3 antagonisists
for treating PONV:
for highest risk
always use # agents
what are possible agents?
2 agents!
5-HT3 + metoclopramide or aprepitant
for treating PONV:
low risk if # of risk factors
mod - high risk if # of risk factors
high risk if # of risk factors
low: 0 -1
mod - high: 2+
high: 3+ or if prior hx of PONV
for treating PONV:
aprepitant: give how?
40 mg 1 -3 hours prior to induction of anesthesia
definition of constipation?
decreased frequency PLUS signs/sx > 25% of the time
need 2 or more of the symptoms to chronic constipation – what are the symptoms
straining lumpy/hard stools sensation of incomplete evacuation sensation of obstruction/blockage manual maneuvers to facilitate defecations <3 defecations per week
Peristalsis is mediated predominantly thru _______
serotonin transmitter
when food/stool distends the gut walls, _____ cells will release _____ (will cause colonic motility)
enterochromaffin cells; release 5HT3
mouth - anus transit time?
20 - 72 hours
Acute Constipation:
less than __#__ bowel movements per week
Chronic Constipation:
sxs lasting > ____
Acute: 3
chronic: 6 weeks
Common Causes of Constipation?
Elderly – things are just slower
Dietary (poor fluid intake)
Disease states that slow down GI motility
lack of privacy - long term care facilities
opioids
what disease states can slow down GI motility?
diabetes
parkinsons
CNS injury/disease
MS
Antacid ingredients that wil cause constipation?
Aluminim/Calcium
______ scale to asses poops
Bristol Stool
Bristol Stool:
Type 1 - 7
which end means slow transit time and which one means fast transit
type 1: slow
7: fast
Adding fiber to diet to promote regular bowel habits:
Add fiber ______
____ g of fiber per day
SLOWLY
20 - 30 g/day
Adding fiber to diet to promote regular bowel habits:
increase fiber over ____ days
7 - 10
why are prunes awesome for bowel habits:
lots of sorbitol (sugar)
12 g of fiber
and has dihydrophenylsatin (natural laxative)
pts should defecate when colonic activity is greatest - this is when?
first thing in the morning!
within 30 minutes after meals
Bulk Laxatives:
advantages and disadvantages
advantages: soften stool better than docusate/well tolerated
disadvantages: must have adequate fluid intake!! impact on drug absorption
examples of bulk laxatives
psyllium
methylcellulose
calcium polycarbophil
T or F: stool softeners are great to increase peristalsis
hell no—- not effective for creating peristalsis (NOT good for active constipation)
examples of a lubricant laxative
mineral oil
example of surfactant/emollient
docusate
examples of saline laxatives
Milk of magnesia/ Mg Citrate
examples of hyperosmotic laxatives/agents
sorbitol (karo corn syrup)
lactulose
PEG!!
glycerin
advantages of hyperosmotic laxatives/agents
and disadvantages of hyperosmotic laxatives/agents
advantages: well tolerated; softens and stimulates BM
great for CHRONIC constipation!!
Disadvantages takes 1-3 days for onset at usual doses &
minor nausea/cramping
stimulant laxative choices?
senna
bisacodyl
castor oil
advantages for stimulant laxatives
6 - 12 hours onset
Drug of choice for pts on opioids
works well if pts have motility disorders
disadvantages for stimulant laxatives
risk of nausea/cramping;
avoid long term continuous use in pts with normal GI motility
Lubiprostone MOA
Cl- channel activator
linaclotide MOA
Guanylate cyclase C receptor
if treating acute constipation and pt wants relief in 6 - 24 hours - what can they do
MOM
std. dose of PEG
bisacodyl or senna tablets
if treating acute constipation and pt wants relief in 0.5 - 3 hours - what can they do
large doses of PEG
magnesium citrate
if treating acute constipation and pt wants relief in 0.5 - 1 hours - what can they do
enemas
or suppositories
Follow up when? for constipation:
if acute: _____
if chronic constipation: ______
acute: 1 -2 DAYS
chronic: 1 -2 WEEKS
Chronic Constipation Treatment:
step 1?
dietary interventions have been tried
Chronic Constipation Treatment:
step 2?
bulk forming laxative + adequate fluid intake
Chronic Constipation Treatment:
step 3?
sorbitol/lactulose/PEG
Chronic Constipation Treatment:
step 4?
stimulant laxative
Chronic Constipation Treatment:
step 5?
lubiprostone
linactolide
pregnancy pts that are constipated should use what?
diet, fiber, and docusate
spinal cord injury pts and laxative use?
since they have damage to nerves they do not have adequate function for peristalsis — will use routine use of bowel stimulants
when a patient is taking an opioid medication – what kind of laxative medication should they avoid?
bulk!!! not going to help (will make it worse)
they need stimulant laxatives
what is the perk of methylnaltrexone and naloxegol?
they are mu opioid receptor antagonist — to be used for opioid induced constipation
methylnaltrexone vs naloxegol
which one is SC and which one is PO
SC = methylnaltrexone naloxegol = PO
what disease states are worrisome with bowel prep regimens?
heart failure
renal disease
electrolyte abnormalities
Classifying Diarrhea:
Acute?
< 14 days (usually an infection process caused this)
Classifying Diarrhea:
Persistent
> 14 days
Classifying Diarrhea:
Chronic?
> 30 days
Classifying Diarrhea:
Chronic Idiopathic
> 4 weeks w/out identifiable cause
How diarrhea happens:
The _____ intestine water absorptive capacity is exceeded and _____ overloads the colon = diarrhea
small intestine
chyme overloads
What is chyme?
thick semifluid mass of partially digested food and digest secretions formed in stomach/intestine during digestion
where does most of the fluid that gets to the small intestine come from?
our diet/intake or GI secretions
GI secretions (fluids from stomach, bile, pancreas, salivary glands, and intestines)
How diarrhea happens:
________ typically delay passage and mix of intestinal contents which allows for greater absorption
*ppl w/ diarrhea often have fewer of these
segmenting contractions
How diarrhea happens:
(decrease or increase) in intestinal osmolarity leads to diarrhea
increase! (more Cl- in lumen = water and Na+ follow!!)
4 pathopys causes of diarrhea
secretory
osmotic
exudative
altered intestinal transit
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
is a change in active ion transport (either decreased Na+ absorption or increase in Cl- secretion)
secretory
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Sxs will NOT be helped if the patients stops eating
secretory
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
caused when poorly absorbed substances are retained in the intestinal fluids
osmotic
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Sxs will be improved if the patient stops eating
osmotic
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
Seen in lactose intolerance
osmotic
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
seen with pancreatic tumors/unabsorbed fat/laxatives
secretory
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
seen with consumption of poorly soluble CHOs (lactulose/sorbitol)
osmotic
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
is actually a subset of secretory
exudative
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
characterized by large stool volumes
and
mucus/protein/blood is in the gut — pts will need work up if UC or CD
exudative
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
decrease time of exposure b/w intestinal epithelium and chyme = irregular absorption/secretion
altered intestinal transit
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
typically caused by bowel resection or pro-motility meds
altered intestinal transit
Secretory, osmotic, exudative, or altered intestinal transit diarrhea?
altered motility due to neuropathy in diabetes
altered intestinal transit
common medications that can cause diarrhea
cholinergic meds Mg+ containing medications chemo (irinotecan!!) Monoclonal ABs ACEIs misoprostol colchicine sorbitol containing meds metformin (Laxatives, motility agents)
how to evaluate if a pt is dehydrated
skin turgor test/skin tenting dry mucous membranes (tongue) dizziness when standing orthostatic hypotension concentrated urine
Diarrhea Treatment – Diet management:
More important in ______ diarrhea (need to remove causative agent)
____ diet
osmotic
BRAT
T or F:
Do not stop feedings in children w/ bacterial diarrhea
true!!
Pharm Treatment goals of Diarrhea:
(decrease or increase) fluid accum. in the lumen
(decrease or increase) propulsive contractions
(decrease or increase) mixing contractions
decrease
decrease
increase
Treating Acute Diarrhea:
First check if the have ______
fever or systemic symptoms
Treating Acute Diarrhea:
If NO fever/systemic symptoms – how to treat?
Symptomatic Therapy
fluid/electroylyte replacement
loperamide/diphenoxylate or absorbet
diet
Treating Acute Diarrhea:
If they do have fever/systemic symptom- what to check next?
check feces for WBC/RBC/and parasites
Treating Acute Diarrhea:
If they do have fever/systemic symptom and negative for things when checked feces – do what?
symptomatic therapy
fluid/electroylyte replacement
loperamide/diphenoxylate or absorbet
diet
Treating Acute Diarrhea:
If they do have fever/systemic symptom and positive for things when checked feces – do what?
use appropriate abx and symptomatic therapy
Chronic Diarrhea:
T or F: always refer to doctor
True!!
Possible Causes of Chronic Diarrhea?
intestinal infection IBD malabsorption secretory hormonal tumor drug induced motility disturbance
How to prevent travelers diarrhea
drink bottled water/drinks
wash fresh fruits/veggies
consider pepto 1 - 4 x daily
what drugs are antimotility agents used for diarrhea
diphenoxylate (+atropine) difenoxin (+atropine) loperamide paregoric tincture of opium
for diphenoyxlate + atropine - do not exceed ______ /day
20 mg
for loperamide - do not exceed ______ / day
16 mg (8 tabs)
for difenoxin + atropine do not exceed ____ /day
8 tabs
which anti motility agent is OTC diphenoxylate (+atropine) difenoxin (+atropine) loperamide paregoric tincture of opium
loperamide
which anti motilty agents should not be used in kids < 2 bc of high sensitivity => toxic megacolon
diphenyoxylate and difenoxin
Antimotility agents:
activate the ____ receptors on smooth muscle of the bowel to reduce ______ and increase _____
activate mu opioid receptors; reduce peristalsis; increase segementation
what are examples of absorbents for treating diarrhea
polycarbophil/fibercon
attapulgite/kaopectate
what drugs are antisecreotry agents
bismuth subsalicylate (pepto)
enzymes - lactase
probiotics
octrotide
Pepto: max dose of?
8 doses in 24 hours
T or F: IBS has just as much inflammation as IBD does
false! (IBS does not have an inflammatory component)
IBS - irritable bowel syndrome
IBD = inflammatory
Subtypes of IBS?
IBS- C (constipation)
IBS-D (diarrhea)
IBS-M (mixed)
untyped IBS
which Subtype of IBS?
Hard/lumpy stools at least 25 % of the time
loose water stools less than 25% of the time
IBS-C
which Subtype of IBS?
Hard/lumpy stools less than 25 % of the time
loose water stools at least 25% of the time
IBS-D
which Subtype of IBS?
Hard/lumpy stools at least 25 % of the time
loose water stools at least 25% of the time
IBS-M
which Subtype of IBS?
Hard/lumpy stools less than 25 % of the time
loose water stools less than 25% of the time
untyped
4 non pharm options for IBS
diet - pts have a food sensitivity/trigger
low FODMAP diet
physical activity
cognitive behavioral therapy
what is the low FODMAP diet
fermentable, oligosaccharides, disaccharides, monosaccahrides, polyols — aka avoid poorly absorbed carbs
pathophys of IBS:
thought to be due to ______ and ______ of intestine
somatovisceral and motor dysfunction
what drugs are antispasmodics
hycosamine
dicyclomine
Antispasmodics:
use caution in what pts
and avoid in pts that have what things?
use caution in elderly — BEERS
avoid in pts w/ glaucoma, and IBS w/ constipation…
TCAs are helpful in what kind of IBS?
and
SSRIs have seen to be helpful in what IBS?
TCAs – for IBS-D pts
SSRIs - IBS-C
why are antidepressants helpful in IBS
reduce visceral sensitivity
Tx IBS- C:
what to do for diet?
increase fiber/fluid intake
avoid foods that increase sxs
gluten free
Low FODMAP diet
what drugs can be used for IBS-C?
add a bulk laxative!!
(maybe antispasmodic/anticholinerigcs to relieve painful bowel spasms)
consider Lubiprostone/linactolide: for constipation and abdom pain
TCA/SSRI for pain, anxiety, and depression
serotonin 4 antag - as last resort
what drugs are pro-secretory agents
lubiprsotone and linactolide
Contraindication for Lubiprostone?
if suspected intestinal block
black box warning for linaclotide
against use in kids under 17 (dehydration risk)
lubiprsotone and linactolide
which one to take with food/water
which one to take 30 ins before first meal
lubiprostone: take w/ food
linactolide: before first meal
MOA of teagserod:
stimulates peristalsis and GI secretions – 5Ht4 agonist
when is tegaserond used?
in emegency situations/under FDA investigaiton right now —
diet for IBS-D?
avoid lactose and caffeine
MOA of eluxadoline
multiple mu opioid receptor agonist
lubiprsotone and linactolide
which one should be avoided in pregancy
lubiprostone
