Pq6 Lower Gi Tract Disorders

Front 1

What is Primary constipation?

Back 1

normal-transit, slow-transit, outlet obstx

Front 2

What is secondary constipation?

Back 2

GI tract disorders, lifestyle factors, endocrine/metabolic disorders, neurologic disorders, select med use, systemic conditions, psychological disorders, conditions affecting women

Front 3

What is the ROME III criteria?

Back 3

>2 sx for 3mo and sx onset >6mo prior to dx

Front 4

What are the sx in the ROME III criteria?

Back 4

>25% of defecations:

straining

lumpy or hard stool

sensation of incomplete evacuation

sensation of anorectal ostx

manual maneuvers to facilitate

< 3 defecations per week

Front 5

What is the MOA of of bulk-forming laxatives?

Back 5

fiber draws liquid into fecal mass and increases bulk, bulk stimulates evacuation

Front 6

What are ADR of bulk-forming laxatives?

Back 6

abdm cramping

GI plug ging

distention

flatulence

Front 7

onset of action for bulk-forming laxative?

Back 7

12-72h

Front 8

What is the class drug of bulk-forming laxatives?

Back 8

psyllium (Metamucil)

Front 9

MOA of detergent laxative?

Back 9

detergent action allows mint of water into fecal mass

Front 10

ADR of detergent laxative?

Back 10

rare

diarrhea, abdm cramping

Front 11

onset of action for detergent laxative?

Back 11

12h-5d

Front 12

Class drug for detergent laxative?

Back 12

docusate sodium (Colace)

Front 13

What is MOA of of lubricant laxative?

Back 13

soften fecal material by coating it thereby preventing colonic absorption of fecal water

Front 14

ADR of lubricant laxative?

Back 14

lipid PNA, anal prurits and other conditions related to oil leakage, dehydration, incontinence

Front 15

onset for lubricant laxative?

Back 15

oral 6-8h

rectal 5-15m

Front 16

class drug for lubricant laxative?

Back 16

mineral oil

Front 17

MOA of stimulant laxative?

Back 17

irritation of musculature or colonic intramural plexus; stimulation of secretion of water and electrolytes

Front 18

ADR of stimulant laxatives?

Back 18

perianal irritation

severe cramping

incontinence

malabsorption

electrolyte/fluid disturbance

Front 19

onset of action of stimulant laxatives?

Back 19

oral 6-10h

rectal 15-60m

Front 20

class drug for stimulant laxatives?

Back 20

bisacodyl (Dulcolax)

senna (Senokot-S)

Front 21

MOA of hyperosmolars

Back 21

hyperosmolar solution resulting in "pull" and retention of large amts of fluid to and within the gut lumen

Front 22

ADR of hyperosmolars

Back 22

abdm cramping

bloating

flatulence

rectal irritation

incontinence

Front 23

onset of action of hyperosmolars

Back 23

oral 48-96h

Front 24

class drug for hyperosmolars

Back 24

polyethylene glycol (Miralax)

Front 25

MOA of saline laxatives

Back 25

highly osmotic ions draw water into intestine, increases intraluminal pressure, mechanical stimulus to increase intestinal motility

Front 26

ADR of saline laxatives

Back 26

excessive diuresis

n/v

dehydration

incontinence

electrolyte disturbances

Front 27

onset of action of saline laxatives

Back 27

oral 3-6h (don't use bc can OD and kill)

rectal 2-5m

Front 28

class drug for saline laxatives

Back 28

di/monobasic sodium phosphate (Fleets Enema)

Front 29

MOA of chloride channel activator laxatives

Back 29

locally acting chloride channel activator that increases intestine fluid secretion

Front 30

ADR of chloride channel activator laxatives

Back 30

n/d

HA

Front 31

onset of action of chloride channel activator laxatives

Back 31

oral 1d

Front 32

class drug for chloride channel activator laxatives

Back 32

lubiprostone (Amitiza)

linaclotide (Linzess)

Front 33

When can use chloride channel activator laxative?

Back 33

chronic idiopathic constipation

opioid induced constipation

IBS

only for WOMEN

Front 34

MOA of gluanyl cyclase-c agonist laxative?

Back 34

local action that increase levels of cyclic CMP

Front 35

ADR of gluanyl cyclase-c agonist laxative

Back 35

severe diarrhea

Front 36

when is gluanyl cyclase-c agonist laxative contraindication?

Back 36

known or suspected mechanical GI obstx

Front 37

class drug for gluanyl cyclase-c agonist laxative

Back 37

linaclotide (Linzess)

Front 38

What can you use gluanyl cyclase-c agonist laxative for?

Back 38

CIC, IBC

Front 39

What is an injectable laxative?

Back 39

Methylnaltrexone (Relistor)

Front 40

What is Relistor used for?

Back 40

opioid induced constipation

Front 41

dosing for Docusate sodium

Back 41

Colace

100mg

one capsule BID

Front 42

dosing for milk of magnesia

Back 42

hyperosmolar laxative

30ml take qd for relief of constipation

Front 43

What the 3 drugs approved for antidiarrheals?

Back 43

bismuth subsalicylate (PeptoBismol)

loperamide (Imodium, etc.)

kaolin (a component of Kaopectate)

Front 44

MOA of bismuth salts

Back 44

antisecretory effects (the salicylate) and antimicrobial effect (the bismuth)

Front 45

ADR of bismuth salts

Back 45

absorption of salicylate is close to 90% (close to aspirin)

risk of Reye's syndrome in kids <12 y/o

Front 46

class drug for bismuth salts

Back 46

bismuth subsalicylate (PeptoBismol)

30mL q hour

Front 47

MOA of opiates

Back 47

decrease in digestive secretions

increase in GI muscle tone

Front 48

ADR of opiates

Back 48

drowsiness, dizziness

respiratory depression

n/v

HOTN

Front 49

class drug for opiates

Back 49

opium tincture

paregoric

diphenoxylate with atropine

Front 50

MOA of opioid-like agent

Back 50

decreased motility of GI tract thru a depressant effete on the longitudinal and circular muscles the intestinal wall

Front 51

ADR of opioid-like agent

Back 51

CNS effects are rare at very high doses (60mg) watch ped use

dry mouth

hypersensitivity rxns

constipation

Front 52

class dose of opioid-ike agent

Back 52

Loperamide (Imodium)

Front 53

What do we use Polycarbonphil (Fibercon) for?

Back 53

tx of diarrhea or constipation

works thru bulking in the intestinal tract

Front 54

What do you use Octreotide (Sandostatin) for?

Back 54

carcinoid tumors and VIPomas

ADR notable so only for severe cases

Front 55

dose of anti-diarrheal

Back 55

Loperamide (Imodium)

4mg now and take 2mg after each loose bowel mint up to 16mg qd

Front 56

What is inflm bowel disease?

Back 56

ulcerative colitis

crohn's disease

Front 57

tx for inflm bowel disease

Back 57

aminosalicylates

corticosteriods

Front 58

MOA of anti-inflammatory for inflm bowel disease

Back 58

unknown

Front 59

ADR of anti-inflammatory for inflm bowel disease

Back 59

GI intolerance

rare cases of renal damage

Front 60

class drug for anti-inflammatory for inflm bowel disease

Back 60

mesalamine (Pentasa, Asacol)

Front 61

MOA of corticosteriods for inflm bowel disease

Back 61

decreased formation, release and activity of kinins, histamine, lysosomal enzymes, PGs, and leukotrienes

Front 62

ADR of corticosteriods for inflm bowel disease

Back 62

HA

respiratory infx

nausea

Front 63

class drug for corticosteriods for inflm bowel disease

Back 63

budesonide (Entocort EC)

Front 64

MOA of immunosuppressants for inflm bowel disease

Back 64

disruption of SNA synthesis (interruption of purine synthesis) resulting in lowering of WBC, RBC, plts

Front 65

ADR for immunosuppressants for inflm bowel disease

Back 65

liver impariment

n/v

loss of appetite

Front 66

class drug for immunosuppressants for inflm bowel disease

Back 66

azathioprine

6-mercaptopurine

methotrexate

Front 67

What tests do you need to check when using immunosuppressants for inflm bowel disease

Back 67

liver tests q 3mo

CBC q 2mo

Front 68

MOA of abx for inflm bowel disease

Back 68

change in luminal flora and diminishing activation of mucosal immune system

Front 69

abc drugs for inflm bowel disease

Back 69

metronidazole

ciprofloxacin

Front 70

MOA of TNFa antibodies for inflm bowel disease

Back 70

monoclonal antibody binds to membrane-bound tumor necrosis factor-alphal

induces cell lysis

Front 71

ADR of TNFa antibodies for inflm bowel disease

Back 71

well tolerated

PNA and respiratory tract infx

hepatotoxicity (CHECK)

Front 72

Class drug for TNF a antibodies for inflm bowel disease

Back 72

infliximab (Remicade)

Front 73

What are some probiotics (live organisms) given to pts with inflm bowel disease

Back 73

lactobacilli

bifidobacteria

Saccharomyces boulardi

nonpathogenic E. coli

nissle 1917

VSL-3

Front 74

Why do we think IBS occurs?

Back 74

enteric nervous system that alters bowel motility and sensation

abdm pain and alteration of bowel habits

Front 75

nonpharm approaches to IBS

Back 75

avoid dietary excesses, caffeine, dietary triggers

moderation of fat intake

diarrhea- lactose intolerance bc of excess fruit or sorbitol intake

constipation- avoid beans, cabbage, uncooked broccoli and cauliflower

exercise

Front 76

pharm approaches for IBS

Back 76

constipation- Mg salts, polyethylene glycol-based laxatives are effective when used on scheduled basis

diarrhea- loperamide

Front 77

MOA of antispasmodics for IBS

Back 77

relaxation of smooth muscle of the gut or reduce its contractility

decreases pain but no effect on diarrhea or constipation

Front 78

ADR of Bentyl

Back 78

mild and reversible

dry mouth

blurred vision

urinary hesitancy

Front 79

class drug for antispasmodics

Back 79

dicyclomine (Bentyl)

hyoscyamine (Levsin)

Front 80

ADR of Levsin

Back 80

cardiovascular: bradycardia, tachycardia

CNS: dizziness, confusion

Front 81

What would you use Alosetron (Lotronex) for in pts with IBS

Back 81

major sx is diarrhea

Front 82

What would you use Tegaserod maleate (Zelnorm) for in pts with IBS

Back 82

major sx is constipation

Front 83

MOA of serotonin antagonist

Back 83

selective serotonin receptor antagonist (5-HT3) at enteric neuron sites in GI tract causing reduced pain sensation/bowel function

Front 84

ADR of serotonin antagonists

Back 84

constipation

nausea

Front 85

class drug for serotonin antagonist

Back 85

alosetron (Lotronex)

Front 86

Why do we not use serotonin antagonist much?

Back 86

bc they can cause ischemic colitis and people can die

Front 87

MOA of serotonin agonist

Back 87

activates the HT4 receptor site to stimulate peristaltic mvnt

Front 88

ADR of serotonin agonist

Back 88

diarrhea

Front 89

Contraindication for serotonin agonist

Back 89

severe renal or hepatic impairment of hx of bowel obstx

Front 90

class drug for serotonin agonist

Back 90

tegaserod maleate (Zelnorm)

Front 91

What would use use if a pt had IBS and too much bacteria?

Back 91

abx therapy: Rofaximin (Xifaxan)- unapproved, non-absorable, broad spectrum

Front 92

What would use use if a pt had IBS and too little bacteria?

Back 92

microbiome restoration: Lactobacillus or Bifidobacterium infantis 35624

Front 93

What is a natural remedy for IBS?

Back 93

peppermint oil

Front 94

What would you give someone who had an external hemorrhoid that was bleeding?

Back 94

fiber supplement

Front 95

What would you give someone who had an external hemorrhoid that was itchy?

Back 95

corticosteriod cream

Front 96

What would you do for someone who had a hemorrhoid and was thrombosed?

Back 96

surgery is the only immediate relief

alternatives: oral or topical analgesics, stool softeners, nitroglycerin 0.5% ointment

Front 97

What is the active ingredient in Preparation H and what does it do?

Back 97

phenylephrine 0.25% ointment or suppository

it is related to ATCH and causes vasoconstriction