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79 Cards in this Set
- Front
- Back
Bran
Psyllium (Metamucil) Methylcellulose (Citrucel) |
Bulk-forming Laxative
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MgSO4 (Epsom salt)
Mg(OH)2 (Milk of Magnesia) |
Saline Laxatives:
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Lactulose (Chronulac, Cephulac)
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Osmotic Laxatives:
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Bisacodyl (Dulcolax)
Sennosides (Senokot) |
Stimulant Laxatives:
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Docusate Na+ (Colace)
Docusate K+ (Dialose) |
Surfactants:
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2 other laxitives
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Mineral Oil
Tegaserod (Zelnorm) |
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Diphenoxylate + atropine (Lomitil)
Loperamide (Imodium) |
Opioids Antidiarrheals
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Sulfasalazine (Azulfidine);
Olsalazine (Dipentum) Mesalamine (5-ASA, Asacol) |
Rxs for Diarrhea with IBD & AIDS:
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Ondansetron (Zofran)
Granisetron (Kytril) Dolasetron (Anzemet) Alosetron (Lotrenox) |
Antiemetics--5-HT3 Antagonists
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Chloropromazine (Thorazine)
Promethazine (generic) Droperidol (Inapsine) |
Antiemetics
D2 Antagonists: |
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-- Diphenhydramine (Benadryl)
-- Meclizine (Antivan) -- Cyclizine (Marezine) |
Antiemetics: Antihistamines
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Chloropromazine (Thorazine)
Promethazine (generic) Droperidol (Inapsine) |
D2 Antagonist Antiemetics
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Diphenhydramine (Benadryl)
Meclizine (Antivan) Cyclizine (Marezine) |
Antihistamine Antiemetics
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Scopolamine (Transderm-Scop)
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Anticholinergic Antiemetics
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Dronabinol (Marinol)
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Cannbinoid Antiemetics
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Aprepitant (Emend)
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Substance P Receptor Antagonists Antiemetics
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Avoid these if taking tetracycline
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Bulk-Forming Laxatives
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MOA:
Nonabsorbable, indigestible & hydrophilic colloids that absorb water & expand → softening & ↑ bulk→ intestinal distention & promotes peristalsis |
Bulk-Forming Laxatives
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safest & most physiologic laxitives
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Bulk-Forming Laxatives
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Onset of this is 12-24 hrs after administration
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Bulk-Forming Laxatives
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this drug causes ↓ plasma cholesterol. it binds bile acids → ↑ their excretion
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psyllium
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Adverse reactions:
Impaction, intestinal obstruction |
Bulk-Forming Laxatives
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Avoid in obstructive bowel ds or Crohn’s Ds.
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Bulk-Forming Laxatives
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↓ intestinal absorption of many Rx (e.g. salicylates, digoxin)
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Bulk-Forming Laxatives
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Oral onset of these laxitives is within 4 hrs; Rectal is within 5-30 minutes.
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Saline Laxatives
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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
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Clinical Uses of these laxitives is to empty bowel prior to surgery or radiologic or colonscopic procedures
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Saline Laxatives
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Chronic of these laxitives use can cause HYPERmagnesemia → lethargy, muscle weakness, respiratory paralysis, EKG changes, confusion
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MgSO4 (Epsom salt)
Mg(OH)2 (Milk of Magnesia) |
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Adverse reactions of this laxitive include edema & CHF
and hyperphosphatemia which can lead to hypocalcemia in children |
Na+Phosphate/Biphosphate
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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
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Lactulose (Chronulac, Cephulac
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onset of this laxitive is 1-3 days
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Lactulose (Chronulac, Cephulac
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This drug also tx hepatic encephalopathy: Associated with ↑ plasma NH3→ lethargy, stupor, coma; behavior changes & tremor by ↓ plasma NH 3
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Lactulose
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Adverse reactions of this laxitive includes
- Fatulence & cramping (20%) - NVD, loss of fluid & K+ |
lactulose
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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)
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OTC laxative & use to evacuate bowel before diagnostic tests.
Prodrug – activated to desacetyl metabolite Onset is > 6 hrs |
Bisacodyl (Dulcolax)-
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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.
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Sennosides (Senokot)
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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.
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Stimulant Laxatives
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These drugs are anionic surfactants; softening stool → allow water & lipids to penetrate.
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Docusates: Stool softeners
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These drugs are weakly laxative; onset : 1-3 days
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Docusates: Stool softeners
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These drugs may ↑ absorption of other Rxs → ↑ Rx toxicity
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Docusates: Stool softeners
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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
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A 5-HT4 partial agonist; stimulates 5-HT4 receptors on GI mucosa ↑ peristalsis & intestinal secretions.
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Tegaserod (Zelnorm)
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Used for chronic constipation & irritable bowel syndrome with constipation
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Tegaserod (Zelnorm)
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SE include diarrhea & headache
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Tegaserod (Zelnorm)
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These 2 sets of laxitives act by softening feces and usually act within 1-3 days
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Bulk forming laxitives
Surfactant laxitives |
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These laxitives produce soft or semifluid stool and act within 6-8 hours
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Stimulent laxitives
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These laxitives produce watert evacuation and act within 1-3 hours
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osmotic laxitives
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The _______ are the most effective & prompt acting nonspecific antidiarrheal agents.
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opioids
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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 |
Opioids
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Side effects: Constipation; high doses → CNS effects & ANTI -SLUD
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Opioids
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Contraindications:
Young children Inflammatory bowel disease – Excessive dilation & fecal retention → Toxic Megacolon → ↑ perforation |
Opioids
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Kaolin/pectin (Kapectolin) is an ________ laxitive
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Adsorbent
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Used empirically for diarrhea; can interfere w/ Rx absorption
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Adsorbent
(Kaolin/pectin (Kapectolin)) |
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MOA: Hydrolyzed by intestinal coliforms to:
a. bismuth oxychloride = bactericidal b. salicylate = antisecretory & anti-inflammatory |
Bismuth Subsalicylate (PeptoBismol)
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For nonspecific diarrhea & Travelers’ diarrhea.
Caution: Turns tongue & stool black Impaction in infants & elderly |
Bismuth Subsalicylate
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MOA: Cleaved by colonic bacteria to:
- 5-aminosalicylic acid – inhibits PG synthesis → anti-inflammatory - sulfapyridine – toxicity |
Sulfasalazine (Azulfidine):
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Side effects:
- NV, headache, GI upset, malaise - Allergic rn, including blood dyscrasias, folate deficiency |
Sulfasalazine (Azulfidine):
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MOA:
- Inhibits secretion of VIP→ ↓ GI secretion - Inhibits GI motility & gallbladder contract. |
Octreotide (Sandostatin)
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Used for AIDS-related diarrhea. Diarrhea associated w/ IBD & dumping syndrome.
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Octreotide (Sandostatin)
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May cause NVD, abdominal pain, fat malabsorption w/ gallstones
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Octreotide (Sandostatin)
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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 |
Antiemetics
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MOA: Peripheral 5HT3 R blockade on the GI vagal afferents + Central 5HT3 R blockade in CTZ
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5-HT3 Antagonist antiemetics
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These drugs work best when used with Dexamethasone (Decadron)
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5-HT3 Antagonist antiemetics
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Adverse reactions:
- Headache (10-20%), dizziness, constipation, prolonged QT-interval |
Antiemetic 5-HT3 Antagonists
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ONLY indicated for women w/ severe diarrhea predominant IBS resistant to other tx.
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Alosetron (Lotrenex)
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Adverse reactions: Constipation (30%); serious GI side effects (ischemic colitis, etc.) →hospitalization, surgery & death.
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Alosetron
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Metoclopramide (Reglan) is a _______________
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Mixed D2/5HT3 Antagonists
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MOA:
-Antiemetic-blocks D2 R in CTZ. - Prokinetic agent that↑ GI motility→ gastric emptying by ↑ ACh release. |
Metoclopramide (Reglan)
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Uses: Chemo/radiation-induced emesis & nausea with pregnancy
Prokinetic: Esophageal reflux (GERD) Impaired gastric emptying after surgery Facilitate GI intubation |
Metoclopramide
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Caution: Can prolong Q-T interval --> Torsades
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D2 antagonist Antiemetics
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Adverse reactions:
Extrapyramidal reactions Orthostatic hypotension (α- block) Sedation, drowsiness |
D2 Antagonist Antiemetic
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For NV due to Motion Sickness & vertigo
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Antihistamine antiemetic
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MOA: ↓ impulse from vestibular apparatus
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Antiemetic Antihistamine
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Best for motion sickness
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Scopolamine (Transderm-Scop)
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MOA: ↓ impulse conduction from the vestibular system to the emetic center.
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Scopolamine (Transderm-Scop)
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Anti-SLUD side-effects
sedation, dry mouth, urinary retention, etc. |
Scopolamine (Transderm-Scop)
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Synthetic ∆9-THC; unknown MOA
Scheduled II controlled substance; NOT first-line; for refractory cases Dysphoria, hallucinations, sedation -- limit use. |
Dronabinol (Marinol)
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↑ effects of other Rxs.
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Benzodiazepines
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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)
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