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79 Cards in this Set

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Psyllium (Metamucil)
Methylcellulose (Citrucel)
Bulk-forming Laxative
MgSO4 (Epsom salt)
Mg(OH)2 (Milk of Magnesia)
Saline Laxatives:
Lactulose (Chronulac, Cephulac)
Osmotic Laxatives:
Bisacodyl (Dulcolax)
Sennosides (Senokot)
Stimulant Laxatives:
Docusate Na+ (Colace)
Docusate K+ (Dialose)
2 other laxitives
Mineral Oil
Tegaserod (Zelnorm)
Diphenoxylate + atropine (Lomitil)
Loperamide (Imodium)
Opioids Antidiarrheals
Sulfasalazine (Azulfidine);
Olsalazine (Dipentum)
Mesalamine (5-ASA, Asacol)
Rxs for Diarrhea with IBD & AIDS:
Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Alosetron (Lotrenox)
Antiemetics--5-HT3 Antagonists
Chloropromazine (Thorazine)
Promethazine (generic)
Droperidol (Inapsine)
D2 Antagonists:
-- Diphenhydramine (Benadryl)
-- Meclizine (Antivan)
-- Cyclizine (Marezine)
Antiemetics: Antihistamines
Chloropromazine (Thorazine)
Promethazine (generic)
Droperidol (Inapsine)
D2 Antagonist Antiemetics
Diphenhydramine (Benadryl)
Meclizine (Antivan)
Cyclizine (Marezine)
Antihistamine Antiemetics
Scopolamine (Transderm-Scop)
Anticholinergic Antiemetics
Dronabinol (Marinol)
Cannbinoid Antiemetics
Aprepitant (Emend)
Substance P Receptor Antagonists Antiemetics
Avoid these if taking tetracycline
Bulk-Forming Laxatives
Nonabsorbable, indigestible & hydrophilic colloids that absorb water & expand → softening & ↑ bulk→ intestinal distention & promotes peristalsis
Bulk-Forming Laxatives
safest & most physiologic laxitives
Bulk-Forming Laxatives
Onset of this is 12-24 hrs after administration
Bulk-Forming Laxatives
this drug causes ↓ plasma cholesterol. it binds bile acids → ↑ their excretion
Adverse reactions:
Impaction, intestinal obstruction
Bulk-Forming Laxatives
Avoid in obstructive bowel ds or Crohn’s Ds.
Bulk-Forming Laxatives
↓ intestinal absorption of many Rx (e.g. salicylates, digoxin)
Bulk-Forming Laxatives
Oral onset of these laxitives is within 4 hrs; Rectal is within 5-30 minutes.
Saline Laxatives
MOA of this group of laxitives is osmotic. They trap fluid in lumen → softening & distention → peristalsis
b. Mg 2+ stimulates CCK release → ↑ GI secretion & motility
Saline Laxatives
Clinical Uses of these laxitives is to empty bowel prior to surgery or radiologic or colonscopic procedures
Saline Laxatives
Chronic of these laxitives use can cause HYPERmagnesemia → lethargy, muscle weakness, respiratory paralysis, EKG changes, confusion
MgSO4 (Epsom salt)
Mg(OH)2 (Milk of Magnesia)
Adverse reactions of this laxitive include edema & CHF
and hyperphosphatemia which can lead to hypocalcemia in children
This laxitive acts osmoticly to trap water, softening stool. It is metabolized to lactate , acetate & formate by colonic bacteria. This decreases luminal pH and ↑ secretion & motility
Lactulose (Chronulac, Cephulac
onset of this laxitive is 1-3 days
Lactulose (Chronulac, Cephulac
This drug also tx hepatic encephalopathy: Associated with ↑ plasma NH3→ lethargy, stupor, coma; behavior changes & tremor by ↓ plasma NH 3
Adverse reactions of this laxitive includes
- Fatulence & cramping (20%)
- NVD, loss of fluid & K+
1. MOA:
a. Directly stimulates intestinal motility.
b. Inhibits Na+-K+ATPase → fluid/electrolyte accumulation in lumen
c. ↑ synthesis of PGs & cAMP → ↑ fluid/ electrolyte secretion
Stimulant Laxatives (Irritants)
OTC laxative & use to evacuate bowel before diagnostic tests.
Prodrug – activated to desacetyl metabolite
Onset is > 6 hrs
Bisacodyl (Dulcolax)-
Prodrug- reduced by colonic bacteria to active form. Onset~ 6-12 hrs. Chronic use can→ Melanosis Coli –dark pigmentation of colonic mucosa. Benign & reversible, but suggests abuse. Also discolor urine into yellowish brown & red.
Sennosides (Senokot)
Adverse reactions: Abdominal cramps. Chronic misuse → cathartic colon (atony & dilation) - Can be Habit-Forming. Chronic use→ loss of normal bowel functions,electrolyte imbalance, malabsorption & wt. loss.
Stimulant Laxatives
These drugs are anionic surfactants; softening stool → allow water & lipids to penetrate.
Docusates: Stool softeners
These drugs are weakly laxative; onset : 1-3 days
Docusates: Stool softeners
These drugs may ↑ absorption of other Rxs → ↑ Rx toxicity
Docusates: Stool softeners
Mixture of liquid hydrocarbons obtained from petroleum--indigestible.
MOA: Penetrates & softens the stool; may ↓ absorption of water.
NOT for routine use because:
↓ absorption of fat-soluble vitamins.
Lipid pneumonia if aspirated.
Seepage of oil past anal sphrincter.
Avoid use with docusates → ↑ absorption → Hepatotoxic
Mineral Oil
A 5-HT4 partial agonist; stimulates 5-HT4 receptors on GI mucosa ↑ peristalsis & intestinal secretions.
Tegaserod (Zelnorm)
Used for chronic constipation & irritable bowel syndrome with constipation
Tegaserod (Zelnorm)
SE include diarrhea & headache
Tegaserod (Zelnorm)
These 2 sets of laxitives act by softening feces and usually act within 1-3 days
Bulk forming laxitives
Surfactant laxitives
These laxitives produce soft or semifluid stool and act within 6-8 hours
Stimulent laxitives
These laxitives produce watert evacuation and act within 1-3 hours
osmotic laxitives
The _______ are the most effective & prompt acting nonspecific antidiarrheal agents.
These drugs act by binding opioid receptors on myenteric & submucosal neurons
→ Presynaptic ↓ ACH release → ↓ propulsive, peristaltic contractions
↓ GI secretions→delays passage of bowel contents & ↑ absorption of water → constipation
Side effects: Constipation; high doses → CNS effects & ANTI -SLUD
Young children
Inflammatory bowel disease – Excessive dilation & fecal retention
→ Toxic Megacolon
→ ↑ perforation
Kaolin/pectin (Kapectolin) is an ________ laxitive
Used empirically for diarrhea; can interfere w/ Rx absorption
(Kaolin/pectin (Kapectolin))
MOA: Hydrolyzed by intestinal coliforms to:
a. bismuth oxychloride = bactericidal
b. salicylate = antisecretory & anti-inflammatory
Bismuth Subsalicylate (PeptoBismol)
For nonspecific diarrhea & Travelers’ diarrhea.

Caution: Turns tongue & stool black Impaction in infants & elderly
Bismuth Subsalicylate
MOA: Cleaved by colonic bacteria to:
- 5-aminosalicylic acid – inhibits PG synthesis → anti-inflammatory
- sulfapyridine – toxicity
Sulfasalazine (Azulfidine):
Side effects:
- NV, headache, GI upset, malaise
- Allergic rn, including blood dyscrasias, folate deficiency
Sulfasalazine (Azulfidine):
- Inhibits secretion of VIP→ ↓ GI secretion
- Inhibits GI motility & gallbladder contract.
Octreotide (Sandostatin)
Used for AIDS-related diarrhea. Diarrhea associated w/ IBD & dumping syndrome.
Octreotide (Sandostatin)
May cause NVD, abdominal pain, fat malabsorption w/ gallstones
Octreotide (Sandostatin)
These drugs block stimulation of the CTZ in the area postrema or signals from the GI tract & vestibular system in inner ear to the vomiting center.
Involves 5-HT3, D2, H1 and muscarinic mechanisms
MOA: Peripheral 5HT3 R blockade on the GI vagal afferents + Central 5HT3 R blockade in CTZ
5-HT3 Antagonist antiemetics
These drugs work best when used with Dexamethasone (Decadron)
5-HT3 Antagonist antiemetics
Adverse reactions:
- Headache (10-20%), dizziness, constipation, prolonged QT-interval
Antiemetic 5-HT3 Antagonists
ONLY indicated for women w/ severe diarrhea predominant IBS resistant to other tx.
Alosetron (Lotrenex)
Adverse reactions: Constipation (30%); serious GI side effects (ischemic colitis, etc.) →hospitalization, surgery & death.
Metoclopramide (Reglan) is a _______________
Mixed D2/5HT3 Antagonists
-Antiemetic-blocks D2 R in CTZ.
- Prokinetic agent that↑ GI motility→ gastric emptying by ↑ ACh release.
Metoclopramide (Reglan)
Uses: Chemo/radiation-induced emesis & nausea with pregnancy
Prokinetic: Esophageal reflux (GERD)
Impaired gastric emptying after surgery
Facilitate GI intubation
Caution: Can prolong Q-T interval --> Torsades
D2 antagonist Antiemetics
Adverse reactions:
Extrapyramidal reactions
Orthostatic hypotension (α- block)
Sedation, drowsiness
D2 Antagonist Antiemetic
For NV due to Motion Sickness & vertigo
Antihistamine antiemetic
MOA: ↓ impulse from vestibular apparatus
Antiemetic Antihistamine
Best for motion sickness
Scopolamine (Transderm-Scop)
MOA: ↓ impulse conduction from the vestibular system to the emetic center.
Scopolamine (Transderm-Scop)
Anti-SLUD side-effects
sedation, dry mouth, urinary retention, etc.
Scopolamine (Transderm-Scop)
Synthetic ∆9-THC; unknown MOA
Scheduled II controlled substance; NOT first-line; for refractory cases
Dysphoria, hallucinations, sedation -- limit use.
Dronabinol (Marinol)
↑ effects of other Rxs.
A centrally acting antagonist of Sub P/NK1 receptor; present in vagal afferent fibres innervating the STN and area postrema.

Used in conjunction with 5-HT3 antagonists and a corticosteroid.

Metabolized by hepatic CYP3A4; may interact with dexamethasone & warfarin.
Aprepitant (Emend)