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Flashcards in GI Motility 3 Deck (26)
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1

Definition of what?

  • A chronic functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits in the absence of an organic disease

IBS

2

What are the 5 sxs of IBS?

  • Abdominal pain
  • Distention
  • Bloating
  • Indigestion
  • defecation sx

3

What are the 3 "subcategories" of IBS?

  • pain associated with diarrhea (IBS-D)
  • pain associated with constipation (IBS-C)
  • pain and diarrhea alternating with constipation (IBS-M)

4

Tx of IBC-C

  • 1st: soluble fiber: Psyllium/ispaghula
  • 2nd: PEG

5

Which drug?

  • Improves constipation, but not abdominal pain
  • ADE: bloading and abd discomfort

PEG

6

Which drug?

  • stimulates the type 2 chloride channel (ClC-2) in the small intestine: inc. chloride-rich fluid secretion into the intestine

Lubiprostone (Amitiza)

7

What type of pt would you use Lubiprostone with? 

approved for tx of women >18 yo w/IBS-C

8

In what types of pts should Lubiprostone be avoided? 

 

women of child-bearing age 

Category C for preggos

9

Which drug?

Stimulates intestinal fluid secretion and transit time

-significant improvement in abdominal pain and discomfort

MC side effect = diarrhea

 

Linaclotide 

 

10

Which drug?

•Significant improvement in secondary endpoints of abdominal pain/discomfort, bloating, straining, stool consistency, number of CSBMs (complete & spontaneous bowel movements) per week, compared with placebo

 Linaclotide (Linzess)

( Guanylate Cyclase-C Agonist )

11

What is the box warning on Plecanatide? 

risk of serious dehydration in pediatric pts

12

What does Plecanatide tx?

IBS-C (Chronic idiopathic constipation)

13

Which drug?

Increased # of CV deaths observed 

voluntarily removed from the market except in emergencies

emergency tx of IBS-C in women <55

Tegaserod

 

14

What is the initial therapy for IBS-D (diarrhea)

Loperamide

15

- dec. stool frequency and consistency, but NOT bloating or abdominal discomfort

- Take before a meal


Which drug? 

Loperamide (IBS-D) 

16

Which drug?

•A mixed  mu-opioid receptor agonist, delta-opioid receptor antagonist and kappa opioid receptor agonist

Eluxadoline 

(tx for IBS-D)

17

Which drug?

•Acts locally to reduce abdominal pain and diarrhea

- NO constipating side effects

- abuse potential 

Eluxadoline (IBS-D) 

18

What is 2nd line therapy for IBS-D? (3 drugs)

Bile acid sequestrants 

  • Cholestyramine
  • Colestipol
  • Colesevelam

19

What are the 4 SE of Bile Acid Sequestrants 

(2nd line therapy for IBS-D)

Gastrointestinal SEs

  • Bloating
  • Flatulance 
  • Abdominal discomfort
  • Constipation

20

Name the 4 5-HT3 Antagonists

  • Ondanetron
  • Granisetron
  • Dolasetron
  • Palonosetron

21

can cause fatal ischemic colitis 

restricted to women with IBS-D who haven not responded to conventional therapies 

requires FDA approved restricted-use program 

Which drug? 

Alosetron

22

Tx of chronic abdominal pain in IBS

  • Which treatment is helpful?

Tricyclic antidepressants

(Amitriptyline or Desipramine)

23

Which drug? 

  • may alter central processing of visceral afferent information
  • (anticholinergic properties)
  •  alters receptors for enteric neurotransmitters such as serotonin

Tricyclic Antidepressants

(Amitriptyline or Desipramine)

For chronic abdominal pain 

24

What are the 2 commonly used antispasmodics?

  • Dicyclomine
  • Hyoscymine

25

Antispasmodics work primarily through which activities?

(For IBS)

Anticholinergic activities

26

Higher doses of Antispasmodics (dicyclomine & hyoscymaine) have additional effects such as what? (4)

Significant additional anticholinergic effects

  • dry mouth
  • visual disturbances
  • urinary retention
  • constipation