Term
| How much of the 9 L (2L from diet 7 from secretions) that is presented to the intestines is reabsorbed? |
|
Definition
|
|
Term
| What things can casue diarrhea |
|
Definition
| increased osmotic load, excessive secretion of electrolytes and water, exudation of protein and fluid from mucosa, altered intestinal motility... basically, a failure to reabsorb |
|
|
Term
| What are the 3 classifications of intraluminal agents that are anti-diarrheal? |
|
Definition
| Hydroscopic agents, Bile acid resins, and Bismuth Subsalicylate |
|
|
Term
| What are the 3 Hydroscopic agents? |
|
Definition
| psyllium, kallin, and pectin |
|
|
Term
| What is the MOA of Hydroscopic agents? |
|
Definition
| absorb water and increase stool bulk, may also bind bacterial toxins |
|
|
Term
| What are the 2 Bile acid resins used as anti-diarrheals? |
|
Definition
| Cholestyramine and Colestipol |
|
|
Term
| What is the MOA of Bile acid resins used as anti-diarrheals? |
|
Definition
| They bind bile acids and are useful in bile salt-induced diarrhea and may also bind bacterial toxins |
|
|
Term
| What is a drawback of Bile acid resin use for anti-diarrhea treatment? |
|
Definition
| sequester thyroxin, digoxin and vitamins. decreased bioavailability of those drugs |
|
|
Term
| What drug is found in Peptobismol and is used as an anti-diarrheal? |
|
Definition
|
|
Term
| WHat is the MOA of Bismuth Subsalicylate? |
|
Definition
| forms bismuth oxychloride which is not absorbed and salicylic acid that is absorbed |
|
|
Term
| What is the action of Bismuth |
|
Definition
| sepcifically, from Bismuth Subsalicylate?,it is anti-secretroy, anti-inflammatroy, and anti-microbial |
|
|
Term
| What is the action of Salicylic acid |
|
Definition
| from Bismuth Subsalicylate, specifically?,it is anti-inflammatory |
|
|
Term
| What is a side effect of Bismuth Subsalicylate and what is it due to? |
|
Definition
| It can turn the tongue and stool black. It is due to Bismuth Sulfide. |
|
|
Term
| What are the two opioids used as Anti-diarrheals? |
|
Definition
| Loperamide and Diphenoxylate |
|
|
Term
| What is the MOA of opioids as antidiarrheals? |
|
Definition
| activate intestinal mu receptors, causing tonic contraction. They also activate mu and delta receptors for absorption. |
|
|
Term
| What is the potency of Loperamide and Diphenoxylate as antidiarrheals |
|
Definition
| as compared to Morphine?,more potent than morphine for anti-diarrheal activity. |
|
|
Term
| What is the big difference in the two opioids that are used as anti-diarrheals? |
|
Definition
| Their ability to cross the BBB |
|
|
Term
| What are loperamide's actions? |
|
Definition
| penetrates the CNS poorly, increases rectal sphincter tone, disrupts peristalsis |
|
|
Term
| What are the actions of Diphenoxylate? |
|
Definition
| can penetrate the CNS causing respiratory depression |
|
|
Term
| What do preparations of Diphenoxylate include? |
|
Definition
| atropine, to reduce secretion and motility and to discourage abuse |
|
|
Term
| WHat is the main side effect of Opioids used as anti-diarrheals? |
|
Definition
|
|
Term
| What is the MOA of Clonidine as an anti-diarrheal? |
|
Definition
| alpha-2 agonist; it activates receptors that stimulate absorption, inhibit secretion, and increase intestinal transit time |
|
|
Term
| What is the main use of Clonidine as an anti-diarrheal? |
|
Definition
| USed to treat diabetics with chronic diarrhea due to autonomic neuropathy |
|
|
Term
| What is the MOA of Octretotide as an anti-diarrheal? |
|
Definition
| it is an inhibitory analog of Somatostatin. It inhibits secretion, decreases contractility |
|
|
Term
| What is the potency and duration of action of Octeotride compared to Somatostatin? |
|
Definition
| much more potent and longer half life |
|
|
Term
| How is Octreotide administered? |
|
Definition
|
|
Term
| What are the indications for Octreotide use for diarrhea? |
|
Definition
| Carcinoid Syndrome, VIPoma, AIDS, Diabetes |
|
|
Term
| What is the side effect of Octreotide? |
|
Definition
|
|
Term
| What are the 5 classifications of laxative mechanism? |
|
Definition
| Bulk laxatives, Lubricating agents, Stimulant laxatives, Osmotic agents, Neuromuscular agents |
|
|
Term
| WHat are the 2 Bulk laxatives? |
|
Definition
| psyllium and methylcellulose |
|
|
Term
| What are some drawbacks of Bulk laxatives? |
|
Definition
| can undergo bacterial degradation in the colon and cause bloating and flatulence, unpleaseant to swallow, can bing drugs such as digoxin and thyroid hormone |
|
|
Term
| What is the speed of action of bulk laxatives? |
|
Definition
|
|
Term
| What are the effects of bulk laxatives? |
|
Definition
| increase stool bulk and shorten intestinal transit time |
|
|
Term
| What is a lubricating agent used as a laxative which softens stool over 2-3 days? |
|
Definition
|
|
Term
| What does Mineral oil interfere with? |
|
Definition
| it is indigestable, so it interferes with aborption of fat soluble things |
|
|
Term
| What are adverse effects of Mineral oil? |
|
Definition
| interruption of fat soluble substance absorption, anal sphincter oil leakage and oil aspiration in childrena nd elderly |
|
|
Term
| What are the 4 stimulant laxatives? |
|
Definition
| docusate, bisacodyl, senna, and castor oil |
|
|
Term
| What is the MOA of Docusate? |
|
Definition
| it is a SURFACE-acting agent that softens the stool, but also increases electrolyte and water secretion into the intestinal lumen |
|
|
Term
| What do all stimulant laxatives work to do? |
|
Definition
| they cause a PG-mediatedincrease in cAMP but also inhibit Na/K ATPase, leading to electrolyte and water secretion and also cause low grade inflammation |
|
|
Term
| What do stimulant laxatives induce in the small and large bowel? |
|
Definition
|
|
Term
| WHen is Docusate used as a stimulant laxative? |
|
Definition
| following colorectal surgery and post-MI to reduce strain |
|
|
Term
| How is Bisacodyl administered and how does it act? |
|
Definition
| enteric-coated capsules; works just like Docusate by causing increased electrolyte and water secretion by a PG-mediated increase in cAMP and inhibition of Na/K ATPase |
|
|
Term
| What are the anthroquinones that are used as stimulant laxatives? |
|
Definition
|
|
Term
| What is the onset of action of Anthroquinones and what do they produce? |
|
Definition
| delayed; produce giant migrating colonic contractions |
|
|
Term
| How does Castor oil work as a stimulant laxative? |
|
Definition
| causes low grade inflammation in the small bowel, causing water and electrolyte secretion. |
|
|
Term
| What are the Osmotic agents taht are used as laxatives? |
|
Definition
| Saline laxatives, poorly absorbed sugars, PEG, lubiprostone |
|
|
Term
| What are the saline laxatives? |
|
Definition
| Magnesium Hydroxide, Sodium Phosphate, Magnesium Citrate |
|
|
Term
| WHen is Magnesium Hydroxide used? |
|
Definition
| for acute and chronic constipation |
|
|
Term
| When is Magnesium citrate used? |
|
Definition
|
|
Term
| What are the poorly absrobed sugars used as laxatives? |
|
Definition
| lactulose, sorbitol, mannitol |
|
|
Term
| what is the MOA of poorly metabolized sugars (lactulose |
|
Definition
| sorbitol, mannitol) as laxatives?,They are hydrolyzed by intestinal bacteria, acidified, and create osmotic drag |
|
|
Term
| What laxatives are used before bowel procedures? |
|
Definition
| Polyethylene glycol-electrolyte containing solutions |
|
|
Term
| What is the MOA of PEG containt solutions? |
|
Definition
| They are poorly absorbed and cause water retention in the colon |
|
|
Term
| What is a fatty acid metabolite of PGE1 that activates Cl- channels in the GI epithelium? |
|
Definition
|
|
Term
| What is the effect of Lubiprostone activation of Cl- channels in the GI epithelium? |
|
Definition
| stimulates intestinal fluid secretion and decreases intestinal transit time |
|
|
Term
| What is Lubiprostone used for? |
|
Definition
| chronic idiopathic constipation in adults and constipation a/w IBS |
|
|
Term
| What are the side effects of Lubiprostone? |
|
Definition
|
|
Term
| What are examples of Neuromuscular agents that are used as laxatives? |
|
Definition
| 5HT4 agonists, Misoprostol (PG), cholinergics (bethanechol-direct, Neostigmine-indirect), opiate antagonists |
|
|
Term
| What is a selective mu receptor antagonist that is used for opioid induced constipation |
|
Definition
|
|
Term
| When is Methylnaltrexone used? |
|
Definition
| In patients with advanced illness that are receiving opioid pain meds, which induce constipation. |
|
|
Term
| WHy is Methylnltrexone used in patients on opioid analgesics? |
|
Definition
| Because it blocks GI mu receptors without affecting analgesic effects of other mu receptors |
|
|
Term
| What are the 2 divisions of Inflammatory Bowel DISEASE? |
|
Definition
| Ulcerative Colitis and Chron's |
|
|
Term
| What 6 calsses of drugs are used for Inflammatory Bowel Dz treatment? |
|
Definition
|
|
Term
| What are the 2 components of Sulfasalazine? |
|
Definition
| Mesalamine and Sulfapyridine |
|
|
Term
| What is the MOA of Mesalamine? |
|
Definition
| It inhibits COX and Lipoxygenase, reducing LTB4 and 5_HETE levels |
|
|
Term
| Which component of Sulfasalazine is responsible for most of the side effects |
|
Definition
| the Mesalamine or Sulfapyridine? |
|
|
Term
| What are the uses of Sulfasalazine? |
|
Definition
| acute and maintenance therapy of Ulcerative Colitis |
|
|
Term
| What are the side effects of Sulfasalazine |
|
Definition
| which are mediated by the Sulfapyridine component?,Fever, malaise, headache, skin rash, bone marrow suppression. |
|
|
Term
|
Definition
| It is more effective for Tx of Chron's and it is used in acute and maintenance therapy for Ulcerative Colitis |
|
|
Term
| What are the side effects of Mesalamine like compared to Sulfasalazine and what are they? |
|
Definition
| Muche less. They include headache, rash, and diarrhea |
|
|
Term
| Why are Glucocorticoids indicated in Treatment of Inflammatory Bowel Disease? |
|
Definition
| for their anti-inflammatory actions |
|
|
Term
| What are the systemic side effects of oral Prednisone? |
|
Definition
| HTN, Hypoglycemia, cataracts, mood change |
|
|
Term
| What are the 4 Immunomodulators used for Treatment of Inflammatory Bowel disease? |
|
Definition
| Mercaptopurine, Azathioprine, Methotrexate, cyclosporine |
|
|
Term
| How do Meracptopurine and Azathioprine work as immunomodulators? |
|
Definition
| Mercaptopurine suppresses Lymphocyte proliferation; Azathioprine is converted to Mercaptopurine |
|
|
Term
| How does Methotrexate work as an immunomodulator? |
|
Definition
| It is a DHFR inhibitor with anti-inflammatory and immunosuppressive activity |
|
|
Term
| How does Cylcosporine work as an immunomodulator? |
|
Definition
| It inhibits T cell activation |
|
|
Term
| What are the biological agents used in the treatment of Inflammatory Bowel Disease? |
|
Definition
| Infliximab, Adalimumab, Certolizumab, Natalizumab |
|
|
Term
| What is the MOA of Infliximab? |
|
Definition
| monoclonal Ab to TNF-alpha |
|
|
Term
| What is the MOA of Adalimumab? |
|
Definition
| humanized Ab to TNF-alpha |
|
|
Term
|
Definition
| besides Inflammatory Bowel Dz, is Adalimumab used to treat?,R.A. |
|
|
Term
| What is the MOA of Certolizumab? |
|
Definition
| It is a Fab fragment to TNF alpha |
|
|
Term
| What is the MOA of Natalizumab? |
|
Definition
| It is a monoclonal Ab to alpha4 integrins, which are key in leukocyte trafficking and cell-cell communication during inflammation |
|
|
Term
| Which 2 antibiotics are used in the Treatment of Inflammatory Bowel Disease? |
|
Definition
| Metronidazole and Ciprofloxacin |
|
|
Term
| What is a 5HT4 agonist used for the treatment of constipation a/w Inflammatory Bowel Dz? |
|
Definition
|
|
Term
| What is a 5HT3 antagonist used for treatment of diarrhea associated with Inflammatory Bowel Dz? |
|
Definition
|
|
Term
| What are the anti-spasmodics used for bloating a/w Inflammatory Bowel Dz? (a general class of drugs) |
|
Definition
|
|
Term
| What 3 classes of drugs are used for the treatment of abdominal pain a/w Inflammatory Bowel Dz? |
|
Definition
| anti-cholinergics, TCA's, SSRI's |
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