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Flashcards in GI Motility 1 Deck (35)
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1

Drugs stimulating GI motility

  • What is the name of the agent that can selectively  stimulate gut motor function?

Prokinetic

2

Submucosal IPANs activate the enteric neurons responsible for what 2 activities? 

  • Peristaltic & Secretory reflex activity

3

Stimulation of 5-HT4 receptors on presynaptic terminals of IPANs enhances release of what 2 substances, therefore promoting reflex activity?

  • acetylcholine (ACh)
  • Calcitonin gene related peptide (CGRP)

4

What 3 drugs stimulate GI motility? 

  • Cholinomimetic Agents (cholingergic or anticholinesterase)
  • Metoclopramide (dopamine & serotonin antagonist)
  • Macrolides (erythromycin antibiotic) motilin receptor

5

What are the 2 Cholinomimetic Agents? 

  • Bethanechol
  • Neostigmine

6

Which Cholinomimetic Agent? 

  • Stimulates muscarinic M3 receptors on muscle cells and at myenteric plexus synapses
  • History of use in the treatment of GERD and gastroparesis

Bethanechol

7

Which Cholinomimetic Agent? 

  • Ach inhibitor
    • enhance gastric, small intestine, and colonic emptying

Neostigmine

8

What are the 5 ADEs of Cholinomimetic Agents?

(Drugs stimulating GI motility)

(Cholinergic effects)

  1. Excessive salivation
  2. Nausea
  3. Vomiting
  4. Diarrhea
  5. Bradycardia

9

4 uses of Cholinomimetic Agents

  • GERD
  • Impaired gastric emptying
  • Non-ulcer Dyspepsia
  • Prevention of vomiting

10

Which medication is used to tx the following:

  • treatment of symptomatic GERD
  • not effective in patients with erosive esophagitis
  • use prokinetic agents + antisecretory agents in pts with regurgitation or refractory heartburn

Cholinomimetic Agents

(Bethanechol & Neostigmine)

11

Which medication is used to tx the following:

Impaired Gastric Emptying

  • delayed gastric emptying due to postsurgical disorders (vagotomy, antrectomy)
  • diabetic gastroparesis

Cholinomimetic Agents

  • Bethanechol
  • Neostigmine

12

Which medication is used to tx the following:

  • Symptomatic improvement in a small number of patients with chronic dyspepsia

Cholinomimetic Agents

  • Bethanechol
  • Neostigmine

13

T/F

  • Cholinomimetic agents are approved by FDA and available in the US for postpartum lactation stimulation

False

  • NOT approved by FDA or available in the US for this purpose

14

Which medication?

- Blocks dopamine D2 receptors in CTZ

- increases esophageal peristalsis

- enhances gastric emptying 

Metoclopramide

15

ADEs of Metoclopramide

Extrapyramidal effects: 

- dystonia, akathisia,

- Tardive dyskinesia 

- elevated prolactin levels: galactorrhea, gynecomastia, impotence, menstrual d/o. 

**avoid long term uses especially in the elderly 

16

Which drug?

  • Directly stimulate motilin receptors on GI smooth muscle 
  • Tolerance rapidly develops
  • Used in patients with acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy

Erythromycin

(Cholinomimetic Agents - Macrolides)

17

4 medications which cause Constipation

  • Opiates
  • Calcium Carbonate Antacids
  • Diuretics
  • Iron preparations

18

Laxatives

  • Intermittent constipation is best prevented with what 4 things?

  • High fiber diet
  • Adequate fluid intake
  • Regular exercise
  • Pooping when you need to

19

If the patient suffers from constipation due to a secondary cause/disease, what is first line tx?

Treat the underlying cause

20

If a patient suffers from constipation and has no underlying diagnosis, how should you treat? (5)

Choose symptomatic therapy

1. add bulking agents to diet

2. If no relief with bulking agents: add Osmotic laxative (PEG)

3. If no relief with osmotic laxative: add stimulant laxative (Bisacodyl) 

4. If none of the above work, use: Lubiprostone or Linaclotide trial

5. Opioid receptor antagonist (if opioid induced)

21

What types of laxatives are these?

  • Non-absorbable sugars or salts
  • polyethylene glycol

Osmotic Laxatives

22

What are the 2 stimulant laxatives? 

 

Anthraquinone Derivatives (senna, cascara)

Diphenylmethane Derivatives (Bisacodyl)

23

What type of Laxative?

  • Lubiprostone

Chloride Channel Activator

24

Which type of laxative?

  • Linaclotide
  • Plecanatide 

Guanylate Cyclase C Agonists

25

What do these agents do?

  • Magnesium citrate
  • Magnesium hydroxide
  • Magnesium sulfate (high dose)
  • Sodium phosphates
  • Bisacodyl
  • Polyethylene glycol-electrolyte preparation

Cause watery evacuation in 1 - 6 hours

26

Which laxative?

  • Indigestible, hydrophilic colloids that absorb water, forming a bulky, emollient gel that distends the colon and promotes peristalsis

Bulk-Forming Laxatives

(Psyllium & Methylcellulose)

27

What is the name of the bulk forming laxative made w/ synthetic fibers?

Polycarbophil

28

What are the 2 names of the common preparations of bulk forming laxatives which include natural plant products?

  • Psyllium
  • Methylcellulose

29

Bulk Forming Laxatives

  • Bacterial digestion of plant fibers within the colon may lead to an increase in what 2 sxs?

  • bloating
  • flatus

30

Which laxative?

  • mixing of aqueous and fatty materials within the intestinal tract
  • agent include: docusate (oral or enema)

Stool Surfactant Agents (Softeners)