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GI/GU II Exam 1 > Tx for Abd pain, Diarrhea, Constipation > Flashcards

Tx for Abd pain, Diarrhea, Constipation Flashcards

1
Q

What are indications & SE of Linaclotide

A

IBS-Constipation pre dom subtype & chronic idiopathic constipation

SE: GI-related

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2
Q

what are indications and SEs of lubiprostone

A

IBS-C (women), chronic idiopathic constipation, opioid-induced constipation

SE: GI &/or CNS related

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3
Q

what is the efficacy of osmotic agents

A

large dose = 1-3 hrs

small dose= 0.5-3 days

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4
Q

What are the indications & SE for methylnaltrexone & naloxegol

A

opiod-induced constipation

SE - GI-related

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5
Q

what is loperamide

A

Chemically-_related_ to opiods

BUT does NOT exhibit analgesic/opiate-like effects/produce physical dependence

FDA issued drug safety communication –> cardiac toxicities leading to death

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6
Q

what can be used for pre-colonoscopy bowel prep

A

Na+ Picosulfate

Polyethylene glycol in large doses

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7
Q

What are stool softners

A

aka surfactant/emollient

docusate salts: Na+, Ca2+, K+

mineral oil

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8
Q

what are the indications, SE and warnings for alvimopan

A

ONLY for accelerating time to GI recovery after bowel resection SRG w/ primary anastomsis (prevention of post-op ileus_)_

SE: GI-related

Warning: risk of MI w/ use - REMS program; hospital only; max of 15 doses

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9
Q

what are MOA, indications and SE for antimuscarinics for GI

A

MOA: competitively (-) automonic, post-ganglionic cholinergic receptors

indications- Abd pain/spasm

SE: classic anticholinergic based (mad, blind, red, hot, dry)

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10
Q

what is Lactulose used for

A

severe liver dz (hyperammonemia) - change in pH traps ammonia in GI

adverse effect: electolyte disturbances ; GI related

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11
Q

What is diphenoxylate

A

synthetic opiate agonist (similar to meperidine)

class V

small quantity of atropine added to discourage deliberate abuse/OD

opiod effects at very high doses

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12
Q

what is the MOA for peripheral opiod antagonists

A

peripheral mu-opiod receptor antagonists

methylnaltrexone, naloxegol, alvimopan

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13
Q

what is the only indication of eluxadoline

A

IBS-D

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14
Q

What is the MOA of Linaclotide

A

selective guanylate cyclase-C agonist

bind on luminal surface of intestinal epithelium –> increase intracel/extracel concentration of cGMP –> (+) Cl-/HCO3- into intestinal lumen via CFTR

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15
Q

What are the classifications of Laxative & Cathartic agents

A

stimulants: bisacodyl, castor oil, glycerin, senna, Na+ picosulfate

osmotics: lactulose, Mg2+ citrate, PEF, sorbitol

saline: Mg2+ hydroxide, Na+ phosphate

bulk forming: dietary (fiber, bran, fruit, grain, cereal), psyllium, methylcellulose, carboxymethylcellulose, Ca2+ polycarbophil

stool softner: docusate, mineral oil

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16
Q

What is the MOA of Alosetron

A

selectively block GI-based 5-HT3 receptor –> modulate regulation of visceral pain, colonic transit & GI secretion

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17
Q

what are indications and SE of Crofelemer

A

Non-infxs diarrhea in HIV/AID (pt on ART)

SE: GI related (abd distension, elevated AST/ALT/bilirubin

infxn: resp/urinary

18
Q

what classes of drugs can be used for Diarrhea

A

PG inhibitor: bismuth

Opioid agonists: loperamide, diphenoxylate, eluxadoline

5HT3 antagonists: alosteron

Cl- channel inhibitor: crofelemer

19
Q

what are the adverse effects and drug interactions of bulk-forming/hydrophilic colloidal agents

A

bloating/obstruction (drink fluids - so caution in renal failure)

interactions= LOTS

20
Q

what is the MOA and side effect of loperamide

A

MOA; interfere w/ peristalsis (slows transmit time); direct axn on circular/longitudinal Ms of intestinal wall –> slow motility –> allow fluid/electrolyte reabs & increase bulk/density of feces

SE: anticholinergic effects: “mad, blind, red, hot, dry”

21
Q

What are the antimuscarinic agents that are used for abd pain

A

hyoscyamine

dicyclomine

22
Q

How do anionic surfactants work

A

soften/lubricate feces

increase fluid secretion into GI tract

decrease fluid reabs from GI tract (mineral oils penetrate stool to soften)

23
Q

What is PEG-3350

A

polytheylene glycol

large dose = bowel prep prior to GI scope, radiological procedures or SRG

small dose = constipation

24
Q

what are saline agents

A

Mg2+ salts: Mg2+ sulfate & Mg2+ hydroxide

Na+ phosphate

poorly abs-ed –> hyperosmolar sol’ns & osmotically retain water in GI tract

greater vol shortens transit time

25
Q

What are the classes of drugs used for constipation

A

laxative & cathartic agents

peripheral opiod antagonists- methylnaltrexone, naloxegol, alvimopan

guanylate cyclase-c agonist; linaclotide

selective Cl- (C2) channel activators: lubiprostone

26
Q

what are osmotic agents

how does it work and what is the efficacy

A

lactulose

Mg2+ citrate

sorbitol

Polyethylene glycol (PEG)

=osmotically attract & retain increased water in colon–> increasing moisture, softness & vol/bulk

effect = 1-2+ days w/ laxative dose & large dose = catharsis

27
Q

What are the safety protocols for prescribing alosetron

A

physician must enroll in prescribing program

pt & physicians must sign a risk-benefit statement & agree to adhere to therapy plans

additional self-training & testing by physicians to learn to appropriately Dx IBS required

no refills w/o a follow-up exam

28
Q

what is the efficacy of stool softners

what are adverse effects

A

efficacy = 1-3+ days minimal laxative effect; softening mainly

adverse effects = GI-Related

29
Q

what is the efficacy of stimulants?

what are adverse effects & contraindications

A

efficacy = 12-36 hrs

adverse effects: abd cramps; _Senna-_urine discolor (yellow-brown/red-pink); fluid/electrolyte distrubance

contraindication: GI obstruction/ileus/impaction

30
Q

how do stimulants work

A

irritant to enterocytes, GI Sm. M leading to inflam –> Na/K ATPase inhibition &/or increase in PG synthesis/secretion (via cAMP/cGMP)

promote water/electrolyte accumulation in GI - castor oil is hydrolyzed to ricinoleic acid

stimulate peristalsis

31
Q

How do bulk-forming/hydrophilic colloidal agents work

what is the efficacy

A

work to increase bulk-volume & water content –> increase GI motility

fiber can support colonic bacteria, fermentation & digestion

efficacy in 2-4+ days

32
Q

what are drug interactions & cautions of saline agents

A

interaction = diuretics (electrolyte balance)

cautions: renal dz (electrolyte) & CHF/HTN (Na+)

33
Q

What are indications for Alosetron

A

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

severe IBS-D = diarrhea, freq/severe abd pain, freq bowel urgency/fecal incontinence, restriction of daily activity due to IBS

(exclude anatomic/biochem GI abnormalities before prescribing)

34
Q

what do you use as a stimulant for infants who cant defecate

A

glycerin

tri-hydroxyl alcohol - fxn as irritant, osmotic, lubricant agents

35
Q

What are examples of stimulants

A

senna

bisacodyl

castor oil

glycerin

Na+ picosulfate

36
Q

What are SE and contraindications of alosetron

A

GI related

black box: ischemic colitis

-> containdication =

  1. GI obstruction, perforation, stricture/adhesion, toxic megacolon
  2. diverticulitis, crohns, UC
  3. impaired instestinal circulation, thrombophlebitis or hypercoag state
  4. severe constipation: D/C immediately if develops on alosetron therapy
37
Q

What is the MOA of eluxadoline

A

agonist at opioid mu & kappa receptor in GI (slow peristalsis/delays digestion)

AND antagonist at delta receptor in GI (stomach, pancreas, biliary secretions decreased)

38
Q

What are contraindications for eluxadoline

A

biliary duct obstruction

alcoholism

Hx of pancreatitis

severe hepatic impairment

ALSO - stop if severe constipation develops & lasts 4+days & conitnue after bowels return to normal

39
Q

what is the MOA and SE of diphenoxylate

A

MOA: exert effect locally & centrally on GI Sm M cells –> inhibit GI motility –> slow excess GI propulsion

SE: anticholinergic; atropine “mad, blind, hot, red, dry”

40
Q

what are the SEs of Eluxadoline

A

hepatic/pancreatic toxicity (increased enzymes) ==> pancreatitis high risk pts w/o a gallbladder; FDA warning - death

CNS-related - sedation/euphoria/impaired cognition

41
Q

What is the MOA of Lubiprostone

A

a PGE-1 derivative –> increase intestinal fluid secretion by activating GI specific Cl- channel (CIC-2) in luminal cells of interstional epithelium

42
Q

What is Crofelemer & what is its MOA

A

derived from dark red sap of Croton lechleri tree (botanical pharm)

(-) Cl- secretion by blocking cAMP stimulated CFTR & Ca-activated Cl-channel

channels regulate fluid secretion by intestinal epithelial cells

GI/GU II Exam 1 (16 decks)

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