Term
|
Definition
-overuse lead to thorough evacuation
-requires several days to accumulate bulk
-lag in defecation is interpreted as continued constipation
-take more laxative (vicious cycle)
-if continued, bowel becomes unresponsive |
|
|
Term
| The most satisfactory prophylactic and treatment for functional constipation is a _____________ coupled with ____________, proper daily exercies, and bowel training. |
|
Definition
| diet rich in fiber; sufficient fluid intake |
|
|
Term
| dietary fiber and bulk-forming laxatives |
|
Definition
bran
psyllium
methylcellulose |
|
|
Term
| polyethylene glycol-electrolyte solutions |
|
Definition
|
|
Term
| magnesium oxide (milk of magnesia) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| drug of choice for bowel prep |
|
Definition
| PEG-electrolyte solutions (Colyte, Golytely) |
|
|
Term
| specific use for lactulose |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why are PEG-electrolyte solutions better than older osmotic laxatives? |
|
Definition
| don't cause electrolyte imbalance |
|
|
Term
|
Definition
| surfactant stool softener |
|
|
Term
|
Definition
|
|
Term
|
Definition
| chloride channel activator (CIC-2) in the small intestine--increases motility (laxative) |
|
|
Term
| specific use for lubipristone |
|
Definition
| constipation associated with IBS |
|
|
Term
| _________ can cause nausea but is still a good laxative. |
|
Definition
|
|
Term
| Why do opioid analgesics cause constipation? |
|
Definition
| decreased intestinal motility via mu opioid receptors |
|
|
Term
| methylnaltrexone (Relistor) |
|
Definition
| peripherally active mu opioid antagonist |
|
|
Term
|
Definition
patients receiving palliative care
SQ every 2 days |
|
|
Term
|
Definition
| peripherally active mu opioid antagonist |
|
|
Term
|
Definition
decrease postop ileus in patients who have had bowel resection
limited to 7 days (PO) due to risk of CV toxicity |
|
|
Term
| What dictates the time available for reabsorption of water and solutes? |
|
Definition
|
|
Term
| Increased motility leads to ________; decreased motility leads to ____________. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| opioid mechanism of action in treating diarrhea |
|
Definition
| act at mu receptors in GI tract to decrease motility |
|
|
Term
| Why are loperamide, diphenoxylate, and diphenoxin good drugs to use for diarrhea? |
|
Definition
| poor CNS penetration (do not cross BBB), so less abuse liability |
|
|
Term
| How do you treat uncomplicated infectious diarrhea? |
|
Definition
| fluid replacement and bed rest |
|
|
Term
| ROME guidelines for diagnosis of IBS |
|
Definition
In 12 months, the patient must experience 12 weeks of abdominal pain and discomfort, with 2 of 3 features:
-defecation relieves symptoms
-change in stool frequency
-change in appearance of stool |
|
|
Term
| IBS is a structural/functional disorder. |
|
Definition
|
|
Term
|
Definition
| anticholinergic drug used for treatment of IBS |
|
|
Term
| anticholinergic mechanism of action in treating IBS |
|
Definition
decrease motility
-relax intestinal smooth muscle
-inhibit ACh-mediated release of serotonin
decrease secretions |
|
|
Term
| side effects of anticholinergics for treatment of IBS |
|
Definition
dry mouth
dry eye
tachycardia |
|
|
Term
|
Definition
anti-motility agent
5-HT3 receptor antagonist |
|
|
Term
| What drug is used for constipation-predominant IBS? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| TCA mechanism of action in treating IBS |
|
Definition
| may be anticholinergic actions and alteration of processing of visceral afferent information |
|
|
Term
| TCAs can be used for the treatment of what GI condition? |
|
Definition
|
|
Term
|
Definition
anticholinergic actions
orthostatic hypotension
overdose may lead to fatality |
|
|
Term
| goal of meds for the treatment of inflammatory bowel disease (ulcerative colitis and Crohn's disease) |
|
Definition
|
|
Term
| 5-aminosalicylic acid (5-ASA) |
|
Definition
aspirin derivative
active drug |
|
|
Term
|
Definition
|
|
Term
| ASA derivatives have local/systemic mechanisms of action |
|
Definition
|
|
Term
| Formulations of ASA derivatives are designed to deliver drug to _________ and _________. |
|
Definition
| distal small intestine; colon |
|
|
Term
| anti-inflammatory actions of 5-ASA |
|
Definition
-blockade of prostaglandin formation (cyclooxygenase)
-blockade of lipoxygenase pathway (many inflammatory mediators)
-inhibition of transcription factor NF-KB (important for cytokine production)
-may inhibit natural killer cells, mucosal lymphocytes, and macrophages
-may scavenge reactive oxygen species |
|
|
Term
|
Definition
induction and maintenance of remission in ulcerative colitis
efficacy less established in Crohn's disease |
|
|
Term
| The side effects of sulfasalazine are cause by what? |
|
Definition
|
|
Term
| sulfasalazine side effects |
|
Definition
-slow acetylators: can't be dosed sufficiently
-GI distress, nausea, headache
-arthralgia, myalgia, bone marrow suppression
-hypersensitivity (fever, dermatitis, pancreatitis, pneomonitis, hepatitis, pericarditis)
-inhibition of folate absorption |
|
|
Term
| side effects of ASA derivatives that are better tolerated (other than sulfasalazine) |
|
Definition
-secretory diarrhea
-rare hypersensitivity
-renal tubular damage, interstitial nephritis (higher serum 5-ASA concentrations) |
|
|
Term
|
Definition
moderate to severe active disease (inflammatory bowel disease)
NOT for maintenance of remission |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| The side effects of glucocorticoids are associated with what? |
|
Definition
|
|
Term
| What can occur as a result of long-term use of glucocorticoids? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| maintenance and induction of remission in Crohn's disease and ulcerative colitis |
|
|
Term
| _________ --> 6-mercaptopurine after absorption |
|
Definition
|
|
Term
| _________ --> 6-thioguanine nucleotides |
|
Definition
|
|
Term
| 6-mercaptopurine mechanism of action |
|
Definition
cytotoxic
anti-metabolite
interferes with purine nucleic acid metabolism |
|
|
Term
| major side effect of 6-mercaptopurine |
|
Definition
bone marrow suppression
leukopenia, anemia, thrombocytopenia |
|
|
Term
| purine analog contraindication |
|
Definition
|
|
Term
| What is a key cytokine in IBD, especially Crohn's disease? |
|
Definition
| tumor necrosis factor-alpha |
|
|
Term
|
Definition
|
|
Term
|
Definition
| given IV in moderate to severe CD and UC |
|
|
Term
|
Definition
infection (reactivation of latent TB and HBV), other infections
infusion reactions (fever, headache, dizziness, itching, chest pain, dyspnea); severe reactions (hypotension, SOB, chest pain)
delayed serum-like sickness (myalgia, arthralgia, fever, rash, itching, edema)
acute liver failure |
|
|
Term
budesonide
topical corticosteroids
antibiotics
5-ASA |
|
Definition
|
|
Term
TNF antagonists
oral corticosteroids
methotrexate
6-mercaptopurine |
|
Definition
|
|
Term
surgery
natalizumab
cyclosporine
TNF antagonists
IV corticosteroids |
|
Definition
|
|
