front 1 Define constipation | back 1 infrequent bowel movements (less than 3 per week) or difficulty in passing stools (straining, lumpy/hard stools, pushing for more than 10 mins, digital evacuation) |
front 2 When constipation persists for several weeks or longer, and the cause is unknown, it is termed | back 2 chronic idiopathic constipation (CIC) |
front 3 Idiopathic constipation is associated with chronic or recurrent | back 3 abdominal discomfort that is relieved by defecation is termed irritable bowel syndrome with constipation (IBS-C) |
front 4 Medical conditions that can cause constipation | back 4 IBS-C, anal disorders (fissures), MS, cerebrovascular events, parkinson disease, spinal cord tumors, diabetes, hypothyroidism |
front 5 Non-drug treatments for constipation | back 5 increasing fluid intake, limiting caffeine and alcohol intake and increasing physical activity |
front 6 First-line treatment for constipation and treatment of choice in pregnancy | back 6 bulk-forming drugs |
front 7 MOA of bulk-forming drugs | back 7 they absorb water in the intestine which adds bulk to the stool. this increases peristalsis and decreases stool transit time |
front 8 MOA of osmotics | back 8 they draw fluid into the bowel lumen through osmosis which distends the colon and increases peristalsis |
front 9 MOA of stimulant laxatives | back 9 directly stimulate neurons in the colon, causing peristaltic activity |
front 10 MOA of stool softeners | back 10 emollients that reduce surface tension of the stool oil-water interface, allowing more water and fat to mix with the stool |
front 11 MOA of lubricants | back 11 they coat the bowel and stool with a waterproof film |
front 12 What drugs are bulk-forming | back 12 psyllium, calcium polycarbophil, methylcellulose, wheat dextrin |
front 13 Brand name of psyllium | back 13 Metamucil |
front 14 Brand name of calcium polycarbophil | back 14 FiberCon |
front 15 Brand name methylcellulose | back 15 Citrucel |
front 16 Brand name of wheat dextrin | back 16 Benefiber |
front 17 What drugs are osmotics | back 17 magnesium hydroxide, polyethylene glycol, glycerin, lactulose, sodium phosphates, sorbitol |
front 18 onset of action for bulk-forming drugs | back 18 12-72 hours |
front 19 Side effects of bulk-forming drugs | back 19 flatulence, abdominal cramping, bloating, bowel obstruction |
front 20 onset of osmotics | back 20 30 mins to 96 hours (oral), 5-30 mins (rectal) |
front 21 Side effects of osmotics | back 21 electrolyte imbalance, abdominal cramping, abdominal distention, dehydration |
front 22 lactulose is commonly used for | back 22 hepatic encephalopathy |
front 23 What drugs are stimulant laxatives | back 23 senna, bisacodyl |
front 24 Brand name of senna + docusate | back 24 Senna S or Senokot S |
front 25 Onset of action of stimulant laxatives | back 25 6-12 hours (oral), 15-60 mins (rectal) |
front 26 What drugs are emollients | back 26 docusate sodium |
front 27 Brand name of docusate | back 27 Colace |
front 28 Onset of action for emollients | back 28 12-72 hours (oral), 2-15 mins (rectal) |
front 29 docusate is preferred when | back 29 straining should be avoided (postpartum, post-MI, hemorroids) |
front 30 What drugs are lubricants | back 30 mineral oil |
front 31 onset of action for lubricants | back 31 6-8 hours (oral), 2-15 mins (rectal) |
front 32 MOA of lubiprostone | back 32 acts on chloride channels in the gut leading to increased fluid and peristalsis |
front 33 Brand name of lubiprostone | back 33 Amitiza |
front 34 Indications for lubiprostone | back 34 CIC, OIC, IBS-C in adult women |
front 35 MOA of linaclotide and plecanatide | back 35 guanylate cyclase C agonist- increase chloride and bicarbonate secretion into the lumen of intestine, increasing the speed of GI transit and reducing abdominal pain |
front 36 Brand name of linaclotide | back 36 Linzess |
front 37 Brand name of plecanatide | back 37 Trulance |
front 38 Indications for Linzess and Trulance | back 38 CIC, IBS-C |
front 39 Common side effect of Amitiza | back 39 Nausea |
front 40 Common side effect of guanylate cyclase C agonist | back 40 Diarrhea |
front 41 MOA of peripherally-acting mu-opioid receptor antagonists (PAMORAs) | back 41 act on mu-opioid receptors in the GI tract, decreasing constipation |
front 42 What drugs are PAMORAs | back 42 alvimopan, methylnaltrexone, naloxegol, naldemedine |
front 43 Brand name of alvimopan | back 43 Entereg |
front 44 Brand name of methylnaltrexone | back 44 Relistor |
front 45 Brand name of naloxegol | back 45 Movantik |
front 46 Entereg is for | back 46 hospitalized surgery patients to decrease risk of postoperative ileus |
front 47 What are the indications of Relistor, Movantik and Symproic | back 47 OIC |
front 48 Brand name for naldemedine | back 48 Symproic |
front 49 MOA of prucalopride | back 49 serotonin 5HT-4 receptor agonist- release ACh which causes muscle contractions and increases GI motility |
front 50 Brand name of prucalopride | back 50 Motegrity |
front 51 Which laxative used for whole bowel irrigation has a boxed warning for nephropathy | back 51 OsmoPrep |
front 52 Generic name for OsmoPrep | back 52 sodium phosphates |
front 53 Brand name for PEG electrolyte solution | back 53 Colyte, GoLytely |
front 54 Brand name for sodium sulfate, potassium sulfate and magnesium sulfate | back 54 Suprep Bowel Prep Kit |
front 55 Most common bacterial cause of diarrhea | back 55 E. Coli |
front 56 Non-drug treatment management of diarrhea | back 56 fluid and electrolyte replacement |
front 57 Patient with non-infectious diarrhea who require symptomatic relief can use short-term | back 57 bismuth subsalicylate or loperamide prn |
front 58 MOA of antimotility drugs | back 58 slows intestinal motility, prolonging the time for water absorption |
front 59 Which drugs are antimotility | back 59 loperamide and diphenoxylate |
front 60 MOA of eluxadoline | back 60 mixed mu-opioid receptor agonist- binds to opioid receptors as an agonist to treat diarrhea |
front 61 Brand name of eluxadoline | back 61 Viberzi (C-IV) |
front 62 Side effects of bismuth subsalicylate | back 62 black tongue/stools, salicylate toxicity (tinnitus, metabolic acidosis), nausea, abdominal pain |
front 63 What antidiarrheal can cause an increased risk of bleeding when used with anticoagulants and antiplatelets | back 63 bismuth subsalicylate |
front 64 Brand name for loperamide | back 64 Imodium A-D |
front 65 How to take loperamide | back 65 4 mg PO after the first dose, then 2 mg after each loose stool (max 8 mg/day) |
front 66 Brand name of diphenoxylate/atropine | back 66 Lomotil (C-V) |
front 67 Brand name of dicyclomine | back 67 Bentyl |
front 68 Contraindication for Viberzi | back 68 patients without a gallbladder |
front 69 Which medications for diarrhea have anticholinergic effects | back 69 Lomotil and Bentyl |
front 70 What drug is a serotonin 5HT-3 receptor antagonist and approved for women only but has restricted use due to the risk of ischemic colitis | back 70 Alosetron (Lotronex) |