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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
What are the classes of drugs used for constipation
**laxative & cathartic agents** **peripheral opiod antagonists**- methylnaltrexone, naloxegol, alvimopan **guanylate cyclase-c agonist**; linaclotide **selective Cl- (C2) channel activators:** lubiprostone
26
what are osmotic agents how does it work and what is the efficacy
**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
What are the safety protocols for prescribing alosetron
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
what is the efficacy of stool softners what are adverse effects
efficacy = 1-3+ days minimal laxative effect; softening mainly adverse effects = GI-Related
29
what is the efficacy of stimulants? what are adverse effects & contraindications
efficacy = 12-36 hrs _adverse effects:_ abd cramps; _**Senna**-_urine discolor (yellow-brown/red-pink); fluid/electrolyte distrubance contraindication: **GI obstruction/ileus/impaction**
30
how do stimulants work
**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
How do bulk-forming/hydrophilic colloidal agents work what is the efficacy
work to increase bulk-volume & water content --\> increase GI motility fiber can support colonic bacteria, fermentation & digestion _efficacy in 2-4+ days_
32
what are drug interactions & cautions of saline agents
interaction = **diuretics** (_**electrolyte** balance_) cautions: **renal dz** (_electrolyte_) & **CHF/HTN** (_Na+_)
33
What are indications for Alosetron
**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
what do you use as a stimulant for infants who cant defecate
**glycerin** tri-hydroxyl alcohol - fxn as irritant, osmotic, lubricant agents
35
What are examples of stimulants
senna bisacodyl castor oil glycerin Na+ picosulfate
36
What are SE and contraindications of alosetron
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
What is the MOA of eluxadoline
**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
What are contraindications for eluxadoline
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
what is the MOA and SE of diphenoxylate
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
what are the SEs of Eluxadoline
**hepatic/pancreatic** toxicity (increased enzymes) ==\> **pancreatitis high risk pts w/o a gallbladder; FDA warning - death** CNS-related - sedation/euphoria/impaired cognition
41
What is the MOA of Lubiprostone
a **PGE-1 derivative** --\> increase intestinal fluid secretion by _activating_ GI specific Cl- channel (CIC-2) in luminal cells of interstional epithelium
42
What is Crofelemer & what is its MOA
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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