C/D/H Blackboard Quiz

Prucalopride (Motegrity®) is a/an _____ used in the treatment of ____ :

5-HT4R agonist / chronic constipation

Which product would you first recommend for SM for her hemorrhoids?

Preparation H Soothing Relief Wipes

What is the likely cause of DH's diarrhea?

Eating food not prepared or stored appropriately

What is the most appropriate first line recommendation for RM and his family?

Drink Pedialyte to ensure adequate hydration

Which one of the following is a bacteria often associated with causing diarrhea?

Escherichia coli

Which constipation agent is MOST likely associated with causing lung aspiration?

Mineral oil

Which pharmacologic option is the most appropriate first line monotherapy to recommend for MJ taking opioids?

Senna or bisacodyl (Dulcolax)

Which drug is classified as a bulk forming agent?

Methylcellulose

Which of the following appropriately describes a cause for stool to be yellow?

Fat undigested in stool

Which of the following is the correct dosage for loperamide (Imodium)?

Take 4 mg by mouth now, then 2 mg by mouth after each loose stool

Consider the structures of Dulcolax and Senokot, which is a natural product and which is synthetic?

The chiral structure of the natural product Senokot and its elaboration with sugars differs from the flat planar structure of the synthetic drug Dulcolax.

What further information would you like to determine a plan for her?

All of the above

What would be the best OTC treatment option for JM?

Oral rehydration solution in small, frequent sips and loperamide 4 mg for 1 dose, then 2 mg after each stool (max 8 mg/day)

With these self care strategies, ST should expect to:

All of the above

Which medication most likely causes constipation?

Hydromorphone

Which statement is TRUE regarding management of constipation in special populations?

Bulk-forming laxatives are considered the first-line pharmacologic agent in pregnant patients

Which side effect of plecanatide should be discussed with ST?

Diarrhea

Which patient is a candidate for self care for diarrhea?

A 33-year-old male with diarrhea the last 2 days who has not tried any treatment yet

A new opioid drug binds receptors with same affinity as morphine. Will it have same euphoric effects?

Only with CNS access, it must first be able to cross the blood-brain barrier

Which antidiarrheal drug can be bought OTC even though it is technically an opioid?

Loperamide

LM's new medication is likely contributing to her constipation.

True

How would you classify TJ's diarrhea?

Exudative

Which medications are recommended for chronic idiopathic constipation (not conditionally recommended)?

Linaclotide; Plecanatide; Prucalopride

Which drug can cross the blood brain barrier when given at high doses?

Diphenoxylate

Which statement is TRUE regarding nonpharmacologic interventions for constipation?

An increase in physical activity can help improve constipation

Which statement is TRUE regarding treatment of diarrhea?

Loperamide is considered a first-line treatment option for acute diarrhea in adults

What other recommendations would you give DH while he is experiencing diarrhea?

Avoid spicy foods and fatty foods; Replace fluid losses with Pedialyte

Pregnancy is a contraindication to self care for hemorrhoids.

False

Which drug is classified as a stimulant laxative?

Senna

According to the Bristol Stool Chart, how would you classify LM's stool?

Type 1

What recommendations are appropriate for DT for hemorrhoids?

Increase fluid intake; Preparation H Soothing Relief Spray; Miralax 1 packet daily with 4-8 oz water

In addition to oral rehydration solution, what OTC medication should TM start?

Loperamide

Which BEST describes slow transit constipation?

Classified as idiopathic constipation

Why are opioid antagonists for opioid induced constipation made more polar than morphine?

It prevents CNS access, restricting effects to the periphery

Which medication most likely causes constipation?

Oxycodone

What is the FDA boxed warning for linaclotide?

Serious dehydration risk in pediatric patients

Which is NOT a reason fluorine is incorporated into drug molecules?

Fluorine chemistry is cheap and easy to work with, so it is very common

Which type of diarrhea is MOST commonly associated with laxative use?

Secretory

Which drug is a peripherally acting opioid antagonist?

Naldemedine

According to the Bristol Stool Chart, how would you classify TJ's stool?

Type 7

Which electrolyte abnormalities are expected with sodium phosphate saline laxatives?

Hyperphosphatemia; Hypocalcemia; Hypernatremia

What could cause black stool color during pregnancy?

Iron supplementation

Which OTC option is best for speed, comfort, and daily regulation for ST?

Polyethylene glycol (PEG)

Which drug inhibits release of acetylcholine in the submucosal and myenteric nerves?

Loperamide

What medication can be given to treat DH's diarrhea?

Azithromycin 500 mg PO daily for 3 days

Which drug can cross the blood brain barrier and has potential for abuse?

Paregoric

Which stool color cause/rationale is correct?

Gray: biliary obstruction

Which statement about ziconotide and plecanatide is true?

Only plecanatide can be administered orally because it acts at the luminal surface

What further information would you gather to determine if ST is a candidate for self care?

Fever, other disease states, medication use

What is the mechanism of action of linaclotide?

Guanylate cyclase agonist

Which describes exudative diarrhea?

Associated with discharge of mucus, proteins, and blood

Is ET a candidate for self care?

Yes

Which patient is a candidate for self care for constipation?

A 22-year-old who hasn't had a bowel movement for several days with no other issues

Based on symptom onset, what is the most likely cause of his diarrhea?

Pathogen-associated diarrhea: bacterial cause

Which bacteria is often associated with causing diarrhea?

Clostridium difficile

Which description is associated with Bristol Stool Chart type 5?

Soft blobs that are passed easily

What timeframe should you see improvement in diarrhea before recommending a doctor visit?

48 hours

Which BEST describes pelvic floor dysfunction?

Inappropriate contractions of muscles

What are DT's risk factors for hemorrhoids?

Constipation; Sedentary lifestyle; Straining during defecation

What is the most appropriate next step for EK with chronic constipation?

Refer to physician for possible initiation of linaclotide

Which statement is TRUE regarding diarrhea management in special populations?

Medical referral is recommended in geriatric patients

Which type of diarrhea is MOST commonly associated with inflammatory bowel disease?

Exudative

What should you recommend for SP's constipation?

Advise SP to see a physician as she is not a candidate for self-care

Which medication most likely causes black tongue?

Pepto-Bismol

What is the onset of action for oral senna?

6-10 hours

Which is the MOST appropriate first line treatment for EJ?

Methylcellulose

Is MC a candidate for self care?

No, she is at risk for severe dehydration

Which drug acts as an opioid agonist to reduce motility?

Difenoxin