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GI II > Treatments for Diarrhea, Abdominal Pain, and Constipation > Flashcards

Treatments for Diarrhea, Abdominal Pain, and Constipation Flashcards

1
Q

name the four drug classes for diarrhea

A
  1. prostaglandin inhibitors
  2. opioid agonists
  3. serotonin (5-HT3) antagonists
  4. chloride channel inhibitors
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2
Q

name the three opioid agonists

A
  1. loperamide (imodium)
  2. diphenoxylate (lomotil)
  3. eluxadoline (viberzi)
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3
Q

which opioid agonist is C-IV?

A

eluxadoline (viberzi)

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4
Q

name the drug

MOA: directly acts on muscles (circ and long) to decrease motility –> increases resorption time and bulk

A

loperamide

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5
Q

what are the side effects of loperamide?

A

classic anticholinergics

yellow

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6
Q

what opioid agonist has potential cardiac toxicities?

A

loperamide

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7
Q

name the drug

MOA: locally and centrally slows GI smooth muscle cells, inhibits motility and slows excess propulsion

A

diphenoxylate

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8
Q

which opioid agonist is C-V?

A

diphenoxylate / lomotil

a synthetic opiate agonist, chemically similar to meperidine

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9
Q

a small quantity of atropine is added to what drug, and why?

A

diphenoxylate / lomotil (opioid agonist)

added to discourage deliberate abuse/over-dosage

STAR

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10
Q

what are the side effects of diphenoxylate?

A

classic anticholinergic; atropine

yellow

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11
Q

name the drug

MOA: mu and kappa agonist, slows peristalsis

delta agonist, decreases secretions (pancreas, stomach, biliary)

A

eluxadoline

yellow

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12
Q

when is eluxadoline indicated?

A

IBS-D (diarrhea prominent)

STAR

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13
Q

what are the side effects of eluxadoline?

A

hepatic / pancreatic toxicity
5x normal amount of enzymes===> STOP

CNS - sedation/euphoria/impaired cognition

STAR

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14
Q

name the contraindications of eluxadoline

A

biliary duct obstruction
alcoholism
history of pancreatitis
severe hepatic impairment

stop therapy if severe constipation develops and lasts 4+ days

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15
Q

name the drug

MOA: selectively blocks GI-based 5-HT3 receptors, modulating regulation of visceral pain, colonic transit, and GI secretions

A

alosteron

this is the only 5-HT3 antagonist

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16
Q

when is alosetron indicated?

A

chronic, severe IBS-D that is not responsive to other therapies (women)

STAR

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17
Q

severe, diarrhea-predominant IBS includes diarrhea and…

A

one or more of the following:

  • frequent/severe abdominal pain
  • frequent bowel urgency or fecal incontinence
  • restriction of daily activities d/t IBS
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18
Q

what is the black box warning of alosetron?

A

ischemic colitis

other SE: GI-related

STAR

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19
Q

what are the contraindications of alosetron?

A

hx or current:

  • GI obstruction, perforation, stricture/adhesions, toxic megacolon
  • diverticulitis, crohn’s, ulcerative colitis
  • impairs intestinal circulation, thrombophlebitis or hypercoagulable state
  • severe constipation (d/c immediately if this develops)
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20
Q

name the drug

inhibits Cl- ion secretion by blocking cAMP-stimulated CFTR and CaCC

A

crofelemer

channels regulate fluid secretion by intestinal epithelial cells

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21
Q

when is crofelemer indicated?

A

non-infectious diarrhea in HIV/AIDS

aka mytesi ; cl-channel inhibitor

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22
Q

name the side effects of crofelemer

A
  • GI-related (abdominal distention, elevated AST/ALT/bili)

- infections (respiratory, urinary)

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23
Q

what drug class is indicated for abdominal pain? name the two drugs

A

antimuscarinic agents

  • hyoscyamine
  • dicyclomine
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24
Q

name the drug class

MOA: competitively inhibits autonomic, post-ganglionic cholinergic receptors (mx sites)

A

antimuscarinics

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25
Q

name the side effects of antimuscarinics

A

classic anticholincergic-based

26
Q

name the four drug classes indicated for constipation

A
  1. laxative and cathartics
  2. peripheral opioid agonists
  3. guanylate-cyclase-C agonists
  4. selectice chloride (C2) channel activators
27
Q

name the drug class, and drugs within the class

MOA: peripheral mu-opioid receptor antagonists

A

peripheral opioid receptor antagonists

  1. methylnaltrexone
  2. naloxegol
  3. alvimopan
28
Q

when are peripheral opioid receptor antagonists indicated?

A

OIC (and unable to come off opioid)

note: alvimopan is in this class but indicated for prevention of post-op ileus only

29
Q

when is the peripheral opioid antagonist alvimopan indicated?

A

prevention of postoperative ileus

(accelerates time to GI recovery following bowel resection surgery with primary anastomosis; only used in the hospital)

yellow

30
Q

name the side effects of the peripheral opioid antagnoists

A

GI-related

31
Q

alvimopan carries a risk of…

A

MI

REMS program requires use only in approved institutions for max of 15 doses

32
Q

name the drug

MOA: selective; results in secretion of Cl-/HCO3 into intestinal lumen via activation of CFTR ion channel

A

linactolide

full MOA: selecrtive guanylate cyclase-C (GC-C) agonist

  • binds to GC-C on luminal surface of intestinal epithelium and increases IC/EC cGMP
  • stimulates secretion of Cl-/HCO3 into intestinal lumen via activation of CFTR ion channel
33
Q

when is linactolide indicated?

A

IBS-C

CIC (chronic idiopathic constipation)

34
Q

name the side effects of linactolide

A

GI-related

35
Q

name the drug

MOA: PGE-1 derivative, increases intestinal fluid secretion by activating GI-specific chloride channels (ClC2) in luminal cells of intestinal epithelium

A

lubiprostone

36
Q

name the indications for lubiprostone

A

IBS-C (women)
CIC
OIC

37
Q

name the side effects of lubiprostone

A

GI-related

CNS-related

38
Q

name the five subclasses of laxatives and cathartics

A
  1. stimulants
  2. osmotics
  3. salines
  4. bulk forming
  5. stool softeners
39
Q

name the four agents in the bulk forming/hydrophilic colloidal subclass

A
  1. dietary fiber/bran
  2. psyllium
  3. methylcellulose / carboxymethylcellulose
  4. calcium polycarobphil
40
Q

this subclass works to increase bulk-volume and water content, thereby increasing GI motility

efficacy is seen within 2-4+ days

A

bulk forming/hydrophilic colloidal agents

fiber can also support colonic bacteria, fermentation, and digestion

41
Q

name the adverse effects of bulk forming/hydrophilic colloidal agents

A

bloating and obstruction
- drink fluids but be cautious in renal failure

DDIs – LOTS

42
Q

stool softeners are also known as…

A

surfactant or emollient laxatives

43
Q

name the stool softener agents

A

docusate salts

mineral oil

44
Q

name the subclass

MOA: anionic surfactants which soften/lubricate feces

efficacy seen in 1-3+ days, minimal laxative effect

A

stool softeners

increases fluid secretion into GI tract
decreases fluid reabsorption from GI tract; mineral oil penetrates stool to soften

45
Q

name the adverse effects of stool softeners

A

GI-releated

46
Q

name the five agents in the stimulants subclass of laxatives and cathartics

A
  1. senna
  2. bisacodyl
  3. castor oil
  4. glycerin
  5. sodium picosulfate
47
Q

what is the pre-colonoscopy bowel prep?

A

sodium picosulfate

in stimulants subclass but is also osmotic mg citrate
- mg oxide/anhydrous citric acid being metabolically concerted to mg citrate
48
Q

name the subclass

MOA: stimulate peristalsis through: irritation of enterocytes, water and electrolyte accumulation, and osmotic and lubrication

efficacy within 12-36 hours

A

stimulants / irritants

  • irritant to enterocytes, GI smooth muscle leading to inflammation – Na/K-ATPase inhibition, increase in PG synthesis and secretion
  • promote water/electrolyte accumulation in GI – castor oil hydrolyzed to ricinoleic acid
  • glycerin is tri-hydroxyl alcohol and functions as irritant, osmotic, and lubricant agent
49
Q

name the adverse effects of stimulants

A 
abdominal cramping
urine discoloration (yellow-brown/red-pink) -- senna
fluid/electrolyte disturbances (long use)
50
Q

name the contraindications of stimulants

A

GI obstruction, ileus, impaction

51
Q

castor oil is hydrolyzed to…

A

ricinoleic acid

52
Q

which GI stimulant causes yellow-brown/red-pink urine?

A

senna

53
Q

name the two saline agents

A
  1. magnesium salts

2. sodium phosphate

54
Q

name the subclass

MOA: poorly absorbed; hyperosmolar solutions, osmotically retain water in GI tract

greater volume shortens transit time

A

saline agents

55
Q

saline agents have DDI with…

A

diuretics (electrolyte balance)

56
Q

when are saline agents cautioned?

A
  1. renal disease (electrolytes)

2. CHF / HTN (sodium)

57
Q

name the four osmotic agents

A
  1. lactuose
  2. magnesium citrate
  3. sorbitol
  4. polyethylene glycol (PEG-3350)
58
Q

name the subclass

MOA: osmotically attract and retain increased water in colon, increasing moisture, softness and volume/bulk

effective within 1-2+ days with laxative doses; catharsis within hours at larger doses

A

osmotic agents

59
Q

what osmotic agent is used for severe liver disease (hyperammonemia) patients?

A

lactulose

change in pH traps ammonia in GI

STAR

60
Q

name the adverse effects of osmotic agents

A

electrolyte disturbances – watch closely in at-risk patient pops.

GI-related

61
Q

large doses of what osmotic agent are used for bowel prep prior to GI scopes, radiological procedures, or surgery

small doses used for constipation

A

polyethylene glycol (PEG-3350)

STAR

62
Q

efficacy of osmotic agents is seen within…

A

1-3 hours of large-volume distribution

smaller, daily doses provide effects within 1/2-3 days

GI II (5 decks)

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