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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
name the side effects of antimuscarinics
classic anticholincergic-based
26
name the four drug classes indicated for constipation
1. laxative and cathartics 2. peripheral opioid agonists 3. guanylate-cyclase-C agonists 4. selectice chloride (C2) channel activators
27
name the drug class, and drugs within the class MOA: peripheral mu-opioid receptor antagonists
peripheral opioid receptor antagonists 1. methylnaltrexone 2. naloxegol 3. alvimopan
28
when are peripheral opioid receptor antagonists indicated?
OIC (and unable to come off opioid) note: alvimopan is in this class but indicated for prevention of post-op ileus only
29
when is the peripheral opioid antagonist alvimopan indicated?
prevention of postoperative ileus (accelerates time to GI recovery following bowel resection surgery with primary anastomosis; only used in the hospital) **yellow**
30
name the side effects of the peripheral opioid antagnoists
GI-related
31
alvimopan carries a risk of...
MI REMS program requires use only in approved institutions for max of 15 doses
32
name the drug MOA: selective; results in secretion of Cl-/HCO3 into intestinal lumen via activation of CFTR ion channel
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
when is linactolide indicated?
IBS-C | CIC (chronic idiopathic constipation)
34
name the side effects of linactolide
GI-related
35
name the drug MOA: PGE-1 derivative, increases intestinal fluid secretion by activating GI-specific chloride channels (ClC2) in luminal cells of intestinal epithelium
lubiprostone
36
name the indications for lubiprostone
IBS-C (women) CIC OIC
37
name the side effects of lubiprostone
GI-related | CNS-related
38
name the five subclasses of laxatives and cathartics
1. stimulants 2. osmotics 2. salines 4. bulk forming 5. stool softeners
39
name the four agents in the bulk forming/hydrophilic colloidal subclass
1. dietary fiber/bran 2. psyllium 3. methylcellulose / carboxymethylcellulose 4. calcium polycarobphil
40
this subclass works to increase bulk-volume and water content, thereby increasing GI motility efficacy is seen within 2-4+ days
bulk forming/hydrophilic colloidal agents fiber can also support colonic bacteria, fermentation, and digestion
41
name the adverse effects of bulk forming/hydrophilic colloidal agents
bloating and obstruction - drink fluids but be cautious in renal failure DDIs -- LOTS
42
stool softeners are also known as...
surfactant or emollient laxatives
43
name the stool softener agents
docusate salts | mineral oil
44
name the subclass MOA: anionic surfactants which soften/lubricate feces efficacy seen in 1-3+ days, minimal laxative effect
stool softeners increases fluid secretion into GI tract decreases fluid reabsorption from GI tract; mineral oil penetrates stool to soften
45
name the adverse effects of stool softeners
GI-releated
46
name the five agents in the stimulants subclass of laxatives and cathartics
1. senna 2. bisacodyl 3. castor oil 4. glycerin 5. sodium picosulfate
47
what is the pre-colonoscopy bowel prep?
sodium picosulfate ``` in stimulants subclass but is also osmotic mg citrate - mg oxide/anhydrous citric acid being metabolically concerted to mg citrate ```
48
name the subclass MOA: stimulate peristalsis through: irritation of enterocytes, water and electrolyte accumulation, and osmotic and lubrication efficacy within 12-36 hours
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
name the adverse effects of stimulants
``` abdominal cramping urine discoloration (yellow-brown/red-pink) -- senna fluid/electrolyte disturbances (long use) ```
50
name the contraindications of stimulants
GI obstruction, ileus, impaction
51
castor oil is hydrolyzed to...
ricinoleic acid
52
which GI stimulant causes yellow-brown/red-pink urine?
senna
53
name the two saline agents
1. magnesium salts | 2. sodium phosphate
54
name the subclass MOA: poorly absorbed; hyperosmolar solutions, osmotically retain water in GI tract greater volume shortens transit time
saline agents
55
saline agents have DDI with...
diuretics (electrolyte balance)
56
when are saline agents cautioned?
1. renal disease (electrolytes) | 2. CHF / HTN (sodium)
57
name the four osmotic agents
1. lactuose 2. magnesium citrate 3. sorbitol 4. polyethylene glycol (PEG-3350)
58
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
osmotic agents
59
what osmotic agent is used for severe liver disease (hyperammonemia) patients?
lactulose change in pH traps ammonia in GI **STAR**
60
name the adverse effects of osmotic agents
electrolyte disturbances -- watch closely in at-risk patient pops. GI-related
61
large doses of what osmotic agent are used for bowel prep prior to GI scopes, radiological procedures, or surgery small doses used for constipation
polyethylene glycol (PEG-3350) **STAR**
62
efficacy of osmotic agents is seen within...
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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