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GI (2nd year) > Treatments for Diarrhea, Abdominal Pain and Constipation > Flashcards

Treatments for Diarrhea, Abdominal Pain and Constipation Flashcards

1
Q

What drug classes are indicated for diarrhea?

A
  • prostaglandin inhibitors
  • opioid agonists
  • serotonin (5HT3) antagonists
  • chloride channel inhibitors
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2
Q

What drugs are in the prostaglandin inhibitor class?

A

bismuth

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3
Q

What drugs are in the opioid agonist class?

A
  • Loperamide
  • Eluxadoline
  • Diphenoxylate
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4
Q

What drugs are in the serotonin (5HT3) antagonist class?

A
  • alosetron
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5
Q

What drugs are in the chloride channel inhibitor class?

A
  • Crofelemer
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6
Q

What drug classes are indicated for abdominal pain?

A
  • antimuscarinic agents

(hyoscamine, dicyclomine)

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7
Q

What drugs are in the anti-muscarinic class?

A
  • hyoscyamine

- dicyclomine

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8
Q

What drug classes are indicated for constipation?

A
  • peripheral opioid antagonists
  • guanylate cyclase-C agonists
  • selective chloride (C2) channel activators
  • laxatives and cathartics
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9
Q

What drugs are in the peripheral opioid antagonist class?

A
  • Methylnaltrexone
  • Alvimopan
  • Naloxegol
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10
Q

What drugs are in the guanylate cyclase-C agonist class?

A
  • Linaclotide
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11
Q

What drugs are in the selective chloride (C2) channel activators?

A
  • Lubriprostone
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12
Q

What drug classes are in the laxative and cathartic agents?

A
  • stimulants
  • osmotics
  • salines
  • bulk forming
  • stool softeners
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13
Q

What drugs are classified as stimulants?

A
  • Bisacodyl
  • Castor oil
  • Glycerin
  • Senna
  • Na+ Picosulfate
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14
Q

What drugs are classified as osmotics?

A
  • Lactulose
  • Magnesium Citrate
  • Polyethylene glycol
  • Sorbitol
  • Glycerin
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15
Q

What drugs are classified as salines?

A
  • Magnesium hydroxide

- Na+ phosphate

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16
Q

What drugs are classified as bulk-forming?

A
  • Diet (fiber/bran)
  • Psyllium
  • methylcellulose
  • carboxymethylcellulose
  • calcium polycarbophil
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17
Q

What drugs are classified as stool softeners?

A
  • docusate

- mineral oil

18
Q

Loperamide

MOA, side effects

A

MOA:

  • chemically related to opioids but no analgesic effects
  • interferes w/peristalsis

Side effects:

  • cardiac toxicities
  • anticholinergic toxicities
19
Q

Diphenoxylate

MOA, side effects

A

MOA:

  • synthetic opiate agonist + some atropine to prevent abuse/overdose
  • inhibit GI motility via local & central effect on GI smooth muscle

Side effects:
- anticholinergic toxicity + atropine toxicity

20
Q

Eluxadoline

MOA, side effects

A

MOA:

  • agonist of opioid mu & kappa; slow peristalsis
  • antagonist of opioid delta; decrease GI secretions

Side effects:

  • IBS, diarrhea-predominant (IBS-D)
  • hepatic/pancreatic toxicities (higher if no gallbladder)
21
Q

What is Eluxadoline contraindicated in?

A
  • biliary duct obstruction
  • alcoholism
  • hx of pancreatitis
  • severe hepatic impairment
22
Q

When should you stop Eluxadoline?

A

if you get severe constipation and it lasts 4+ days

23
Q

Alosetron

MOA, side effects

A

MOA:

  • selectively block GI 5HT3 receptors
  • inhibit GI secretions

Side effects:
- ischemic colitis (BLACK BOX)

24
Q

What is Alosetron indicated for?

A

chronic/severe IBS-D that is unresponsive to other therapies

- only for women

25
Q

Crofelemer

MOA, side effects

A

MOA:
- block cAMP-stimulated CFTR and CaCC to inhibit Cl- secretion

Side effects:

  • abdominal distention
  • elevated AST/ALT/bilirubin
26
Q

What is Crofelemer indicated for?

A

non-infectious diarrhea in HIV/AIDS

pts on anti-retroviral therapy

27
Q

Hyoscamine, Dicyclomine

MOA, side effects

A

MOA:
- competitive muscarinic antagonists

Side effects:
- anticholinergic toxicity

28
Q

Methylnaltrexone, Naloxegol, Alvimopan

MOA

A

MOA:

  • peripheral mu-opioid receptor antagonists
  • stimulate GI progression
29
Q

Which peripheral opioid antagonist is indicated for hospital-use only?

A

Alvimopan

prevention of post-op ileus, bowel resection surgery

30
Q

Which peripheral opioid antagonists are indicated for opioid-induced constipation?

A
  • methylnaltrexone

- naloxegol

31
Q

What is the one warning for Alvimopan?

A
  • risk of MI

- do not exceed 15 doses

32
Q

Linaclotide

MOA, indication

A

MOA:

  • guanylate cyclase-C agonist (increase cGMP)
  • stimulate secretion of Cl & HCO3 into lumen via CFTR activation

Indication:

  • IBS-C
  • chronic idiopathic constipation (CIC)
33
Q

Lubiprostone

MOA, indications

A

MOA:
- PGE-1 derivative, increase intestinal fluid secretion by activating GI-specific chloride channels (CIC-2)

Indications:

  • IBS-C (non-pregnant women)
  • CIC
  • OIC
34
Q

Bulk-forming/hydrophilic colloidal agents

MOA, efficacy

A

MOA:
- increase bulk volume and water content, increases GI motility

Efficacy:
- 2-4+ days

35
Q

Stool softeners

MOA, efficacy

A

MOA:

  • increase fluid secretion into GI tract
  • decrease fluid reabsorption in GI tract

Efficacy:
- 1-3+ days

36
Q

Stimulants ***

MOA, efficacy

A

MOA:

  • irritate enterocytes
  • Na/K ATPase inhibition
  • increase prostaglandin secretion

Efficacy:
- 12-36 hours

37
Q

Adverse effects of stimulants?

A
  • abdominal cramping

- urine discoloration with use of Senna (yellow/brown to red/pink)

38
Q

Saline agents

MOA

A

MOA:

- hyperosmolar, keeps water in GI tract

39
Q

What should you be cautious about when using saline agents?

A
  • renal disease

- CHF/HTN (sodium)

40
Q

Osmotic agents

MOA, efficacy

A

MOA:
- attract/retain water in GI tract

Efficacy:
- 1-2+ days (1-3 hrs if large dose)

41
Q

What is a special use of lactulose?

A

severe liver disease

- causes hyperammonemia in GI tract

42
Q

What is the special use of polyethylene glycol?

A

bowel prep for GI scopes/surgery

large doses

GI (2nd year) (4 decks)

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