PAS 648 Constipation, Diarrhea, IBS and IBD Exam | Questions and Answers

PAS 648 Constipation, Diarrhea, IBS and IBD Exam | Questions and Answers What is in rehydration therapy for diarrhea? glucose, water and balance of electrolytes (Na+, K+, HCO3-) What is preferred rehydration therapy? Oral rehydration solution (ORS) What is the MOA of opiates? delay transit time, increase gut capacity What are the opiates for diarrhea? - Loperamide peripheral acting opiate (OTC) - Diphenoxylate (Rx) +atropine (LOMITIL) What are indications for opiates? - acute and chronic diarrhea not due to severe inflammatory infections - May be used for traveler's diarrhea What are the AE of opiates? - dizziness and constipation - Dry mouth, constipation, blurry vision w/ atropine When should opiates be avoided in diarrhea? fever and /or severe bloody diarrhea What is the antisecretory agent used for diarrhea? Bismuth subsalicylate (PeptoBismal) What is the MOA of Bismuth subsalicylate (PeptoBismal)? Antisecretory, anti-inflammatory and antibacterial effects What is the indication for Bismuth subsalicylate (PeptoBismal)? traveler's diarrhea What are AE of Bismuth subsalicylate (PeptoBismal)? darkening of tongue and stools with repeat administration What is the only FDA recommended OTC absorbent? Polycarbophil (Fibercon) What is MOA of Polycarbophil (Fibercon)? absorbs 60 times its weight in water and can be used to treat both constipation and diarrhea What are AE of Polycarbophil (Fibercon)? Bloating and flatulence What is used of traveler's diarrhea is severe and interferes with travel? - Azithromycin drug of choice - Rifaximin Who should Rifamaxin not be used in for traveler's diarrhea? fever or bloody diarrhea. What does dietary fiber add to stool? Bulk What are examples of dietary fiber? Wheat bran, cereals, fruits and vegetables What are commercial bulk forming agents? - Psyllium (Metamucil) - Methylcellulose (Citrucel) - Polycarbophils (Fibercon) - wheat dextrin (eg, Benefiber) Bulk forming agents must be taken with: Fluids What are indications for bulk forming agents? prevention and normalize BM What are the emollient laxatives? - Docusate salts (Colace) - Glycerin What is the MOA of emollient laxatives? Facilitate mixing of water and fatty materials with stool What is the indication for emollient laxatives? Better for prevention and for chronic constipation How is glycerin administered? Rectally What BM drugs soften stool and have an onset of 1-3 days? - Lactulose - mineral oil - sorbitol - bulk-forming agents - docusate salts - low dose PEG What BM drugs have an onset of 6-12 hours? - Senna - bisacodyl po What BM drugs cause watery stools and have an onset of 1-6 hours? - Magnesium salts (osmotic) - Sodium Phosphates (osmotic) - Bisacodyl (rectally) - Polyethylene glycol (PEG)-electrolyte preps (osmotic) What are osmotic agents for constipation? - lactulose - sorbitol What is the MOA of osmotic agents? (small sugars) that draw fluid into colon but are not absorbed What can lactulose be used for? - chronic constipation - chronic liver failure - hepatic encephalopathy What constipation medication can be used for chronic liver failure and hepatic encephalopathy? Lactulose What is the MOA of lactulose? metabolized by colon bacteria and lower pH -- increases peristalsis What are the AE of sorbitol? flatulence, cramps What are the Stimulant Laxatives Anthraquinone Derivatives? - Senna - Bisacodyl What is the MOA of senna? - Metabolized by gut bacteria and irritate colon causing contractions and secretion of water/lytes - Irritant/stimulant What are indications for senna? occasional constipation Senna __________ be used daily should not What are the AE of senna? - Cramps, diarrhea, laxative dependence and senna can change stool color - Contraindication pregnancy What is the MOA of bisacodyl? Irritant to colon mucosa and should be used for short term relief of constipation ONLY When should stimulant laxatives be used? short term constipation ONLY What are the AE of bisacodyl? abdominal cramping What are osmotic/saline laxatives? - Magnesium salts (sulfate, hydroxide, citrate) - Sodium picosulfate, magnesium oxide, and anhydrous citric -acid) - Sodium Phosphate (Fleet Phospho-Soda, OsmoPrep tabs) What is the MOA of osmotic/saline laxatives? - Osmotic actionà draws water into colon lumen which stimulates peristalsis - In large doses Cathartic effects, which produce watery stools in 1-3 hours What is the indication for osmotic/saline laxatives? - Occasional constipation (more rapid relief) - Used for bowel cleansing prior to certain procedures What are AE of osmotic/saline laxatives? May cause hypermagnesemia and hyperphosphatemia Which patients should you use caution when prescribing osmotic/saline laxatives? renal patients What are Osmotic Laxative Polyethylene glycol -Electrolyte (PEG) Solutions? - Colyte - Golytely - Nulytely - Miralax (PEG only) What is the MOA of Osmotic Laxative Polyethylene glycol -Electrolyte (PEG) Solutions? - Osmotic cathartic agent - formulated as solution that passes through the colon without net absorption or secretion What is indication for Osmotic Laxative Polyethylene glycol -Electrolyte (PEG) Solutions? bowel cleansing prior to Ba enema or colonoscopy What are AE of Osmotic Laxative Polyethylene glycol -Electrolyte (PEG) Solutions? N/V, anal irritation, cramps What is a safe and effective tx for constipated children? glycerin suppositories What are the chloride channel activators? Amitiza (Iubiprostone) What is the MOA of Amitiza (Iubiprostone)? activates CIC chloride channels to increase intestinal fluid secretion What is the indication for Amitiza (Iubiprostone)? Constipation What are the AE of Amitiza (Iubiprostone)? Nausea What is used for large volume bowel preps? PEG solutions What are the guanylate cyclase agonists? - Trulance (Plecanatide) - Linzess (Linaclotide) What is the MOA of Trulance (Plecanatide)? - Agonist guanylate cyclase-C - Intestinal fluid increases and GI transit time is accelerated. What is the indication for Trulance (Plecanatide)? - Treatment of chronic idiopathic constipation (CIC) in adults - IBS-C symptoms What are the AE of Trulance (Plecanatide)? GI, diarrhea Who is Trulance (Plecanatide) contraindicated in? Children What is the MOA of Linzess (Linaclotide)? guanylate cyclase-C agonist works locally on the intestinal epithelium causing secretion of Cl and HCO3 and decreases nociceptor activity What is the indication for Linzess (Linaclotide)? - chronic constipation - IBS with constipation What are the AE of Linzess (Linaclotide)? diarrhea and abd pain Who is Linzess (Linaclotide) CI in? children less than 6 years old due to risk of dehydration What is MOA of Prucalopride (Motegrity)? Serotonin 5-HT4 Receptor Agonist What is indication for Prucalopride (Motegrity)? chronic idiopathic constipation in adults What are AE of Prucalopride (Motegrity)? - HA, N/V and D are most common 10% - Increased risk for suicidal ideation and behavior I first few weeks (MONITOR!) What constipation drug has an increase risk for suicidal ideation and behavior? Prucalopride (Motegrity) What is the indication for Tenapanor (Ibsrela)? IBS with constipation refractory to other meds What is the MOA of Tenapanor (Ibsrela)? sodium/hydrogen exchanger 3 inhibitor, which acts locally to reduce sodium absorption from the small intestine and colon What are the AE of Tenapanor (Ibsrela)? Diarrhea Who is Tenapanor (Ibsrela) CI in? PED patients 6 years of age What are probiotics?