Pharm: Small And Lg Bowel D/os

Front 1

What are prokinetic agents?

Back 1

Drugs that increase contractile force and accelerate intraluminal transit, thus enhancing coordinated GI motility.

Front 2

What are the receptors that ACh binds to on GI smooth muscle, stimulating propulsion?

Back 2

M2 (more abundant)
M3 (more important)

Front 3

Bethanecol: MOA

Back 3

"Call Beth if you want to stimulate your bowels and bladder"

cholinergic agonist: selectively stimulates muscarinic receptors without any effect on nicotinic receptors.

Longer duration than Ach.

Front 4

Neostigmine: MOA

Back 4

AChE inhibitor.

Allows accumulation of ACh at sites of release. Does not stimulate muscle directly.

Front 5

Metoclopramide: MOA

Back 5

Dopamine receptor antagonist.

DA inhibits motility, mostly in upper GI.

Inhibition of D2 receptors can enhance prokinetic actiity.

Front 6

What is metoclopramide used for?

Back 6

Mostly used to lessen N/V caused by GI dysmotility syndromes.

1) GERD: increases LES tone
2) Gastric stasis: stimulates gastric motility
3) Diabetic gastroparesis: stimulates antral motility
4) Decreases small intestinal transit time by stimulating peristalsis

Front 7

What is tegaserod maleate?

Back 7

Partial 5HT4 agonist.

Accelerates GI transit.

Efficacy shown mainly in female patients with constipation-predominant IBS.

Front 8

Important side fx of tegaserod maleate

Back 8

CV adverse events, including angina, heart attacks, stroke.

Front 9

Macrolides and Erythromycin work how?

Back 9

Motilin agonists.

Motilin is a potent contractile agent.

Front 10

What are luminally active laxatives?

Back 10

They increase retention of intraluminal fluid by hydrophilic or osmotic mech, decrease net absorption of fluid by effecting electrolyte transport, and alter motility by inhibition of segmental contractions and enhance peristaltic contractions.

Front 11

What are bulk producing laxatives?

Back 11

psyllium and bran fiber that undergo bacterial fermation to make short chain fatty acids.

These are trophic to colonic epithelium, stimulate an increase in bacterial mass to increase stool volume.

They attract water to increase stool bulk.

Front 12

What are osmotically active laxatives?

Back 12

Non-absorbable inorganic salts or sugars. Exert effect by osmotically mediated water retention which then stimulates peristalsis.

Front 13

impaired relaxation of the LES with defective peristalsis

Back 13

achalasia

Front 14

metoclopramide: adverse fx

Back 14

Extrapyrimidal effects and parkinsonian like symptoms. Increase serum prolactin.

Front 15

Heterogenous disorder characterized by difficulty in passage of stools and infrequent defecation pattern.

Back 15

constipation

Front 16

What are saline laxatines? How do they work?

Back 16

Contain Mg or Phosphate. Laxative effect is from osmotically mediated water retention in lumen that stimulates peristalsis.

These include Mg salts

Front 17

Glycerin and lactulose are what type of laxative?

Back 17

Non-digestible alcohols and sugars

Front 18

Hygroscopic agent and lubricant

Only administered rectally by suppository or applicator

Back 18

Glycerin

Front 19

What laxative is also used to treat hepatic encephalopathy and why?

Back 19

Lactulose.
Patients with severe liver disease have
Impaired capacity to detoxify ammonia from the colon: SCFA from lactulose –
Traps ammonia by converting to ammonium ion

Front 20

What are the polyethylene glycol electrolyte solutions?

What are they used for primarily?

Back 20

Long chain PEGs that are poorly absorbed and caused retention of water by high osmotic effect.

They're used to cleanse the bowel prior to GI exam.

Front 21

What are the stool-wetting agents and emollients?

Back 21

Anionic surfactants that lower surface tension of stool and allow mixing of aqueous and fatty substances. Softens the stool and permits easier defecation.

Front 22

What is docusate sodium?

Back 22

Stool softener - anionic surfactant.

Front 23

T/F Mineral oil (indigestible mix of aliphatic hydrocarbons that penetrates and softens the stools) is widely used yet only marginally effective.

Back 23

T

Front 24

Stimulant/Irritant Laxatives: How do they work?

Back 24

Probably induce low grade inflammation that promotes accumulation of water and electrolytes and stimulate intestinal motility. Includes activation of cAMP and cGMP pathways.

Front 25

Bisacodyl: what class of laxative?

Back 25

stimulant/irritatve.

OD leads to fluid and electrolyte deficit.

Front 26

Anthraquinone: what class of laxative?

Back 26

stimulant, irritative.

Produce giant migrating colonic contracts, induce water and electrolyte secretion.

Front 27

Lubiprostone : What is it?

Back 27

Laxative that works as a chloride channel activator, stimulating fluid secretion and enhances mobility.

Front 28

Lubiprostone : what is it approved to treat?

Back 28

chronic idiopathic constipation and in a lower dose for women with IBS with constipation.

Front 29

What are two drugs to treat opioid-associated constipation?

Back 29

methylnaltrexone; alvimopan

Front 30

Consequences of chronic untreated diarrhea

Back 30

1. Electrolyte imbalances—esp. Na+, K+, Mg++

2. Dehydration

3. Inadequate absorption of nutrients

Front 31

What are indications for use of anti-diarrheal drugs?

Back 31

1) Acute self-limited diarrhea
2) Symptomatic tx of chronic diarrhea until underlying cause can be found and cured

Front 32

Bismuth Subsalicylate : MOA

Back 32

bulk-forming and hydroscopic agents.

Bismuth may have direct antibacterial effect.

Front 33

Diphenoxylate with Atropine : MOA

Back 33

Opiate with atropine added to discourage abuse.

Used as anti-diarrheal.

Front 34

Loperamide: effects

Back 34

opiate that doesn't cross bbb.

Slows intestinal motility by direct inhibition of circular and longitudinal SM.

Front 35

In severe cases of diarrhea, ___ and ____ are the principle
risk in infants, children and frail elderly patients.

Back 35

dehydration and electrolyte imbalances

Front 36

Treatment of Diarrhea due to cases of E. coli, shigella or salmonella

Back 36

Antibiotics: specifically trimethoprim and sulfamethoxazole

Front 37

used to prevent “Travelers Diarrhea” commonly
caused by enterotoxigenic E. coli.

Back 37

doxycycline

Front 38

Recurrent abdominal pain associated with altered bowel movements.

Back 38

Irritable bowel syndrome

Front 39

Patients with mild IBS symptoms are usually started on what med?

Back 39

fiber supplements

Front 40

Alosetron: MOA and use

Back 40

antagonist action on the 5-HT3 receptors of the enteric nervous system of the gastrointestinal tract. Slows movement of fecal material thru colon.

Only used in women with severe diarrhea-predominant IBS.

Front 41

What are hyosyamine and methscopolamine?

Back 41

Anticholinergics used to tx diarrhea predominant IBS

Front 42

Tricyclic antidepressants: nortryptiline - also used for what?

Back 42

Diarrhea-predominant IBS

Front 43

Mixture of beneficial lyophilized bacteria given orally
Enhance barrier function, modulation of the mucosal immune system, alteration of intestinal microflora

Back 43

probiotics

Front 44

First line therapy for IBD (crohn's and UC)

Back 44

Aminosalicylates

Front 45

What is the active ingredient that is desirable to be delivered to colon?

Back 45

5-ASA (mesalamine)

Front 46

Prototypical aminosalicylate

Back 46

sulphasalazine

Front 47

What do the aminosalicyclates end in?

Back 47

-salazine

Front 48

What MUST be ruled out before treating for IBD?

Back 48

C. difficile pseudomembranous colitis.
This is because the presentation for IBD and C difficile is similar, but the treatment is exactly the opposite (immunosuppression vs ABX).

Front 49

Second line therapy for IBD

Back 49

Corticosteroids - Budesonide

Front 50

Budesonide: what is it and what is it used for?

Back 50

It's a corticosteroid used to treat IBD

Front 51

MOA of aminosalicylates (mostly 5-ASA) in IBD

Back 51

Acts locally in colon to decrease the inflammatory response and systemically inhibits prostaglandin and leukotriene synthesis.

Inhibits 5-lipoxygenase pathways of arachidonic acid metabolism
1. Reduces LTB4 and 5-HETE levels (assoc. with chemotaxis)
2. Reduces neutrophil, macrophage and lymphocyte chemotaxis

Front 52

Side effects of aminosalicylates

Back 52

Side effects mainly by sulfapyridine include fever, dizziness, headache, rash, itching, nausea, vomiting (10-45% of pts). Many pts are on the newer agents

Front 53

What is used as remission maintenance therapy in IBD?

Back 53

Mesalamine

Front 54

T/F Corticosteroids are used as remission maintenance therapy in IBD.

Back 54

F. They have many adverse effects if use is prolonged.

Front 55

Methylprednisolone : MOA

Back 55

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Front 56

When are corticosteroids best used?

Back 56

During a major flare up, acute exacerbations, severe disease, etc. NOT good for remission therapy.

Front 57

Why are short-acting corticosteroids preferred?

Back 57

They depress cortisol much less than long acting corticosteroids and thus some side effects can be prevented/minimized.

Front 58

3 short acting corticosteroids

Back 58

budesonide
beclomethasone
fluticasone

Front 59

Azathioprine (prodrug converted to 6-Mercaptopurine): MOA

Back 59

1) Inhibits nucleic acid synthesis
2) Suppresses lymphocyte proliferation
3) Anti-inflam effects
4) Suppression of NK cell cytotoxicity

Front 60

Azathioprine (prodrug converted to 6-Mercaptopurine): indications

Back 60

severe refractory IBD. Used for long-term treatment or for patients who do not respond to 5-aminosalicylate or corticosteroids.

Front 61

Infliximab : MOA

Back 61

MAB that neutralizes TNFα, thus Reduces infiltration of inflammatory cells, reduces proportion of
mononuclear cells from the lamina propia able to express TNF
and interferon.

Front 62

When are ABX used in IBD?

Back 62

Are usually administered on an empirical basis in patients with severe colitis in addition to steroids.
Antibiotics help treat complications (e.g., abscesses and fistulas) caused by bacteria that leak from
the intestine. Broad-spectrum antibiotics are often used in hospitalized patients with extremely
active IBD, especially if a fever is present.

Front 63

Two common ABX used in IBD

Back 63

metronidazole, ciprofloxacin