Treatments for Abd pain, diarrhea, and constipation

Question 1

Opioid agonists for diarrhea

Answer 1

Loperamide, dephenoxylate, eluxadoline

Question 2

Loperamide MOA

Answer 2

interferes with peristalsis and slows transit time, acts directly on circular and longitudinal muscles

Question 3

Side effects of loperamide

Answer 3

anticholinergic

Question 4

Diphenoxylate MOA

Answer 4

inhibits GI motility and slows excess GI propulsion

Question 5

Side effects of diphenoxylate

Answer 5

anticholinergic

Question 6

Eluxadoline MOA

Answer 6

agonist at mu and kappa receptors in GI (slows peristalsis), antagonist at delta opioid receptors (decrease GI secretions)

Question 7

Indications for eluxadoline

Answer 7

irritable bowel syndrome, diarrhea-precominant subtyoe

Question 8

Side effects eluxadoline

Answer 8

hepatic/pancreatic toxicity (increased enzymes), CNS-related (sedation, euphoria)

Question 9

Contraindications eluxadoline

Answer 9

biliary duct obstruction, alcoholism, history of pancreatitis, severe hepatic impairment

Question 10

Alosetron MOA

Answer 10

selectively blockd GI-based 5HT3 receptors

Question 11

Indications for Alosetron

Answer 11

chronic, severe IBS-D not responsive to other therapies

Question 12

Side effects alosetron

Answer 12

GI-related, ischemic cholitis

Question 13

Ischemic colitis (Black Box Warning)

Answer 13

physicians must enroll in a prescribing program, patients and physicians must sign a risk-benefit statement, additional training by physicians required, follow up for refills

Question 14

Alosetron contraindications

Answer 14

GI obstruction, perforation, stricture, toxic mega colon, diverticulitis, IBD, impaired intestinal circulation, severe constipation

Question 15

Crofelemer MOA

Answer 15

inhibits Cl ion secretion by blocking cAMP-CFTR and CaCC (regulate fluid secretion by intestinal epithelial cells)

Question 16

Indications for Crofelemor

Answer 16

non-infectious diarrhea in HIV/AIDS

Question 17

Side effects crofelemor

Answer 17

GI-related, infections

Question 18

Drugs used for abdominal pain

Answer 18

antimuscarinic agents - hyoscyamine and dicycloamine

Question 19

Antimuscarinics for Abd Pain MOA

Answer 19

competitively-inhibit autonomic, post-ganglionic cholinergic receptors

Question 20

Side effects for antimuscarinics for abd pain

Answer 20

anticholinergic-based

Question 21

Drugs in peripheral opioid antagonists class

Answer 21

methylnaltrexone, naloxegol, alvimopan

Question 22

MOA peripheral opioid antagonist class

Answer 22

antagonist of mu-opioid receptor

Question 23

Indications for methylnaltrexone, naloxegol, and alivmopan

Answer 23

opioid-induced constipation; alvimopan used for accelerating GI recovery time and prevent postop ileus

Question 24

Side effects peripheral opioid antagonist

Answer 24

GI-related

Question 25

Alvimopan warnings

Answer 25

risk of MI

Question 26

Linaclotide MOA

Answer 26

selective gunylate cyclase-C agonist, increases cGMP, stimulates secretion of Cl and HCO3 via activation of CFTR

Question 27

Indications for linaclotide

Answer 27

IBS-C, chronic idiopathic constipation

Question 28

Lubiprostone MOA

Answer 28

PGE1 derivative, increases intestinal fluid secretion by activating GI-specific Cl channels

Question 29

Indications for lubiprostone

Answer 29

IBS-C, chronic and opioid-induced constipation

Question 30

Bulk-forming/Hydrophilic Colloidal Agents

Answer 30

fiber/bran, psyllium, cellulose, polycarbophil

Question 31

MOA hydrophilic colloidal agents

Answer 31

increase bulk-volume and water content, increasing GI motility

Question 32

AE hydrophilic colloidal agents

Answer 32

bloating/obstruction, lots of drug interactions

Question 33

Examples of stool softeners

Answer 33

surfactant, emollient laxatives (Docusate, mineral oil)

Question 34

MOA anionic surfactants

Answer 34

soften/lubricate feces by increasing fluid secretion and decrease fluid reabsorption from GI tract

Question 35

Efficacy of stool softeners

Answer 35

1-3 days

Question 36

Examples of GI stimulants

Answer 36

senna, bisacodyl, castor oil, glycerin, sodium picosulfate

Question 37

MOA GI stimulants

Answer 37

irritant to enterocytes, promote water/electrolyte accumulation in GI tract

Question 38

Efficacy of GI stimulants

Answer 38

12-36 hours

Question 39

AE stimulants

Answer 39

abdominal cramping, urine discoloration, fluid/electrolyte disturbances

Question 40

Saline agents used for constipation

Answer 40

Magnesium salts, sodium phosphate

Question 41

MOA saline agents for constipation

Answer 41

Mg/PO4 ions poorly absorbed, creates hyperosmolar solutions and osmotically retains water in GI tract

Question 42

Saline agent drug interactions

Answer 42

diuretics, causes an electrolyte imbalance

Question 43

Cautions for use of saline agents

Answer 43

pts with renal disease and CHF/HTN should not use

Question 44

Osmotic agents used for constipation

Answer 44

lactulose, mag citreate, sorbitol, PEG

Question 45

MOA osmotic agents for constipation

Answer 45

attract and retain increased water in colon increasing moisture, softness, and volume

Question 46

Efficacy of osmotic agents

Answer 46

1-2 days, 1-3 hours if large volume administered

Question 47

Other uses of lactulose

Answer 47

severe liver disease (hyperammonemia)

Question 48

AE osmotic agents

Answer 48

electrolyte disturbances, GI-related

Question 49

PEG is used for...

Answer 49

bowel prep prior to GI scopes, radiological procedures or surgery, smaller doses for constipation