Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
treatment goals of diarrhea
|
-prevent fluid and electrolyte imbalances and dehydration
-treat curable causes -manage diet -symptomatic relief |
|
|
Rehydration therapy
|
-IV therapy reserved for mod to severe dehydration especially if accompanied by protracted vomiting, fever and shocky clinical pic
-should contain glucose, water and balance of electrolytes: WHO-ORs, Pedialytes, Infalyte, Rehydralyte -drink small amts, slowly |
|
|
Opiates/opiods
|
MOA: delay transit time, inc gut capacity
-Loperamide (immodium)-OTC- peripheral acting opiate (only acts outside CNS) which also acts as an antisecretory agent -not for pts with high fever or bloody diarrhea -may be used for travelers diarrhea -AW: rare; dizziness and constipation |
|
|
Dipenoxylate (lomodal)
|
-opiate combined with atropine to discourage abuse
-used for acute and chronic diarrhea not due to severe inflamm infections -AE: dry mouth, blurred vision, urinary hesitancy |
|
|
Bismuth subsalicylate (peptobismal)
|
-antisecretory, anti-inflamm and antibacterial effects
-used for travelers diarrhea -dec transit time -salicylate component, so may affect anticoagulants -bismuth can interfere with tetracycline absorption -liquid or tablet form -AE: darkening of tongue and stools |
|
|
Adsorbents
|
-Polycarbophil (Fibercon)-OTC
-MOA: absorbs 60 times its wt in water and can be used to treat both constipation and diarrhea -drink a lot of fluids -AE: bloating and flatulence |
|
|
Travelers diarrhea
|
-Bismuth subsalicylate
-Rifaximin (Kifaxan): noninvasive E.coli -Fluoroquinolone: cipro, leveofloxacin 3 day course --> severe illness/dysentery, >6 stools/24hr, fever, bloody stool |
|
|
Constipation
|
-straining at stool at least 25% of the time, hard stools, feeling of incomplete evacuation, 2 less BM per week
-common in elderly women -many causes: GI, drugs, diet, pregnancy, neuro |
|
|
Classificaion of Agents for constipation tx
|
1. Luminally active agents: hyrophylic colloids, bulk forming agents; osmotic agents; stool-wetting agents and emollients
2. Stimulants or irritants (not used on a reg basis): effects on motility and fluid secretion; castor oil, senna (directly irritates nerve plexi in bowel) and cascara 3. Prokinetic agents |
|
|
Classification by when the agents produce a BM
|
1. 1-3 days cause softening of stool: Lactulose, mineral oil sorbitol, bulk-forming agents and docusate salts (colace- good for preventing)
2. 6-12 hrs cause soft and semiliquid stool: Cascara, senna, bisacodyl 3. 1-6 hours causes watery stools: magnesium salts, sodium phosphates, bisacodyl, polethlyene glycol-electrolyte preps |
|
|
Bulk formers
|
-work in 1-3 days
-dietary fiber adds bulk to stool, has prokinetic effects on the colon -encourage at least 10g of fiber/day, inc fluids 1. Psyllium (metamucil) 2. Methylcellulose (citrucel)-most delicate 3. Polycarbophils (Fibercon) -start slowely and inc as tolerated to avoid bloating and cramping |
|
|
Emollient Laxatives
|
-Docusate salts (colace)
-stool softener -facilitates mixing of water and fatty mineral with stool -better for prevention and for chronic constipation -also avail as enema -well-tolerated -Glycerin suppositories are mild and good for relied of acute constipation-very effective, work w/in 15-20 min |
|
|
Lactulose and Sorbitol
|
-osmotic agents (small sugars) that draw fluid into colon
-Lactulose also metabolized by colon bacteria and lower pH --> inc peristalsis; also used for chronic liver failure, hepatic encephalopathy -Sorbitol used for chronic constipation; AE: flatulence or cramps |
|
|
Anthraquinon Derivatices
|
-Cascara and Senna
-directly stimulate nerve plexi -metabolized by gut bacteria and irritate colon causing contractions and secretion of water/lytes -NOT for daily use, they may lead to laxative dependence and abnl colon function -AE: cramps, diarrhea, laxative dependence and senna can change stool color |
|
|
Bisacodyl
|
-irritant to colon mucosa and should be used for short term relief of constipation ONLY
-enteric coated 10-15mg po at bedtime -AE: cramping |
|
|
Saline laxatives
|
-Osmotic action--> draws water into colon lumen which stimulates peristalsis
-Magnesium salts (sulfate, hydroxide, citrate) bitter so take with citrus juices (MOM) -Sodium phosphate (Fleet phospho-soda, osmoPrep tabs) -caution with renal pts -catharic effects which produce watery stools in 1-3 hrs -used for bowel cleansing prior to certain procedures -enema formulation of sodium phosphate |
|
|
Polyethylene glycol- (PEG) Electrolyte Solutions
|
-Colyte, Golytely, Nulytely, Miralax
-osmotic cathartic agent -used for bowl cleansing prior to Ba enema or colonoscopy -drink 4 liters until fecal discharge is clear -powder packets -AE: N/V, anal irritation,cramps |
|
|
Glycerin suppositories
|
-provide immediate relief of constipation by exerting osmotic action in the rectum causing evacuation within 30 min
-safe and effective in kids |
|
|
Amitiza (lubiprostone)
|
-MOA: activates CIC-2 chloride channels locally in the SI to inc intestinal fluid secretion. It is the first selective chloride channel activator
-AE: nausea |
|
|
Probiotics
|
-live, friendly organisms in the intesting
-Bifidobacteria, Lactobacillus, Saccaromyces -avail as culture in yogurts, capsules, tablets, packets -may help IBS, IBD, certain diarrhea and recurrent yeast infections |
|
|
IBS-Anticholinergics --> Antispasmotics
|
1. Hyoscyamine sulfate (Levsin): anticholinergic agent
AE: drowsiness, anticholinergic effects 2. Librax: anticholinergic and benzodiazepine -pt should not drive 3. Dicyclomine hydrochloride (Bentyl): decreases fecal urgency and pain -CI in glaucoma and GI or GU obstruction! |
|
|
Serotonin drugs for IBS
|
in the GI tract 5HT is a powerful stimulator of smooth muscle causing a prokinetic effect
-vomiting reflex |
|
|
therapies for IBD
|
1. Aminosalicylates--> 5ASA
2. glucocorticocoids 3. Immunosuppresants |
|
|
5-ASA compounds
|
- 5-aminosalicylic acid cmpds: topical anti-inflamm action in intesting
-role: mild to mod UC -5-ASA is bound by an azo bond to inert molecule or another 5-ASA molecule to reduce rapid absorption in SI -Sulfasalazine, balsalazid, olsalazine: for UC -Mesalamine (5 asa is linked to inert carriers to delay release)- for Crohns and UC |
|
|
AE of 5-ASA compounds
|
-Sulfazalazine is linked to sulfapyridine which is main cause of its AE
-N/GI upset, HA, arthralgias, myalgies and bone marrow suppression, hypersensitivity -other 5 ASA formulations are well tolerated: diarrhea, skin rash and HA |
|
|
Glucocortosteroids and IBD
|
-role: severe exacerbation of IBD (IV and po)
-Oral prednisone: 40mg induce remission in 60-90% of cases withint 5 days to 6 wks -enemas such as hydrocortisone retention enema deliver local action ot rectum, sigmoid and distal colon -budesonide: less systemic and more topical action for Crohns |
|
|
Immunosuppressive agents
|
-Role: second line agents for severe disease and those who are steroid resistant or dependent
-Thioguanin derivatives: 6-Mercaptopurine, azathioprine (takes 3 months ) -Methotrexate for steroid dependent Crohns -slow onset of action but effective in reducing requirements for steroids -AE:bone marrow suppression |
|
|
Infliximab
|
-immunoglobulin that binds to TNF
-used for mod to severe Crohns -given as an IV infusion and may require multiple infusions -short term safety: more frequent URI, delayed hypersensitivity rxns are more common, infxs?? (TB and Hep B) |
