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spear GI exam 2
| CLASS | DRUG | MOA | ADRS | NOTES |
|---|---|---|---|---|
| Bulk forming laxatives - constipation | Plant derived: Metamucil (psyllium), methylcellulose (citrucel), Synthetic: polycarbophil (fibercon) | indigestible, hydrophilic colliods that absorb water to form a gel that slides down the colon | esophageal/GI obstruction | takes days to work, no used for rapid relief, must maintain hydration to avoid obstruction, calcium formations decrease drug absorption |
| Stool softeners (surfactant agents) - constipation | Docustate (colace), Mineral oil (milkinol) | Docusate- increase water and lipids to penetrate colon Mineral oil- lubes poop both make it easier to go and cause less straining | cramping, diarrhea, nausea | Docusate - relief within days, used for prophylaxis, DO NOT USE in pts under 2 y/o Mineral oil - relief within hours, has risk of aspirations (pill into lungs), so avoid laying down |
| Osmotic laxitives - constipation | Mag hydroxide (MoM), mag citrate, sod phosphate (fleet edema), PEG (MiraLAX), lactulose, lacitol (pizensy) | soluble, non-absorbable compounds that draw water into stool PEG/sodium phosphate can be used for cleaning | Severe flatulence, electrolyte disturbance (Mg/Na products), CAUTION with CV risk, pregnant and pts under 2 years old MoM: risk of hypermag in renal insuff. pts not in PEG | works fast, within hours, |
| Stimulant laxatives - constipation | Natural: Senna (Ex-lax, senokot), castor oil, Synthetic: Bisacodyl (dulcolax) | Increase water and electrolytes in small intestine fluid, decrease water pulled from stool in large intestine | Antacids may diminish therapeutic efficacy of bisacodyl | Brown pigmentation of the colon with long term use of natural products |
| Chloride channel activator - constipation/IBS-C | Lubiprostone (amitiza) | mimics prostglandin, activates type-2 chloride channels, secreting more Cl into intestines, cause bowl movement within 24 hours | delayed gastric emptying | IBS-C women |
| Guanylate cyclase - C agonists - constipation/IBS-C | Linaclotide (linzess), peclanatide | agonists at guenylate cyclase - C to increase cGMP, activating CTFR to releae mroe CL into intestines | BOWED WARNING: dehydration in pediatric pts | increase bowels movements per week by 1-2 , IBS-C adults in general |
| Opioid receptor antagonists - constipation | Alvimopan (entereg), methylnaltrexone, naloxegol, naldemedine | Intestinal opioid receptor antagonists, decrease water absorption in intestines | Alvimopan BOXED WARNING: Myocardial infarction | Alvimopan: caution with renal or hepatic dysfunction |
| Opioid agonists - diarrhea | Loperamide (Diamode; Imodium), Diphenoxylate + atropine (Lomotil), Difenoxin + atropine (Motofen) | Decreases Ach and 5HT release, prolongs transit time, increase intestines fluid absorption, increase anal sphincter tone ATROPINE: antimuscarinic (anticholiniergic GI effect) anti SLUD (DUMBELLS) | constipation, cramps, nausea | No analgesic effects, CNS effects with high doses and prolonged use has addiction risk |
| Colloid bismuth compounds - diarrhea -antisecretory | Bismuth subsalicylate (pepto), bismuth subcitrate potassium (aspirin allergy) | Protective layer against acid and pepsin, inhibits intestinal prostaglandin and chloride secretion (opposite of our consitpation drug), improves consistency | harmless blackening of tongue of stool, tinnitus | avoid in pts with renal insufficiency |
| Octretide - antisecretory - diarrhea | Octreotide (sandostatin) | somatostatin analog -inhibits gastrin secretion low doses reduce small bowel motility and delay emptying time high doses inhibit gastric emptying and colonic motility | fat soluble vitamin deficiency, abdominal pain, nausea, flatulence, gallstones, bradycardia, hormone imbalance with prolonged treatment | once monthly IM depot, SQ 6-12 hours half life, IV 1.5 hours |
| Bile salt-binding resins - bile acid sequestrants - diarrhrea | Cholestyramine (Prevalite; Questran), Colestipol (Colestid), Colesevelam (Welchol) | sequestrants that trap bile inside the intestine via charged interactions, increase excretion of bile acids | fecal impaction, const, flat, bloat lower serum cholesterol, | may bind and reduce absorption/availability of many other drugs |
| Anticholinergics/antispasmodics - IBS | Dicyclomine (Bentyl), Hyoscyamine (Levsin) | muscarinic ACh receptor antagonists in smooth muscle | high doses, antiSLUD effects (they are anticholinergics) | used to treat IBS stomach (abdominal) pain |
| Serotonin-3 receptor antagonists - IBS | Alosetron (lotronex) (other 5-HT3 are only anytinausea) | Potent selective 5-HT3 receptor antagonists, inhibition of visceral afferent pain sensation, inhibits colon motility | BOXED WARNINGS for GI toxicities, constipation and ischemic colitis CI: in severe hepatic impairment | used for severe IBS-D in women |
| Opioid agonists - IBS - D | Eluxadoline | MOR/KOR agonists, reduces abdominal pain and prolong transit time | constipation, ab cramps, pancreaitis | used for IBS-D in adults and children |
| Sodium/hydrogen exchanger 3 inhibitor | Tenapanor (Ibsrela) | NHE3 inhibitor, decrease GI absorption of Na, increase gut Na and water to loosen stool | BOXED WARNING: dehydration risk in pediatric patients, avoid in patients younger than 12, CI below 6 | used or IBS-C in adults |
Created by:
beezy41