Pharm Exam 4: GI motility

What are common adverse effects of Laxatives?

Dehydration, Diarrhea + Electrolyte loss

What is Docusate Sodium?

Stool Softener

What is Psyllium and Methylcellulose?

First line for constipation

Soluble Fiber

What is Polyethylene Glycol-3350

Osmotic Laxative

Which Laxatives are used for Opioid Induced Constipation?

Polyethylene Glycol + Stimulant Laxatives

What is Lactulose?

Osmotic Laxative

What is Lactulose used for?

Constipation + HEPATIC ENCEPHALOPATHY

Which Laxative should you watch ammonia levels for?

Lactulose

What is Magnesium Hydroxide and Magnesium Citrate

Osmotic Laxative

What are magnesium-based laxatives used for?

Fast onset for treating Constipation + Heartburn

Which laxatives have higher risk for electrolyte loss?

Magnesium-based laxatives + Stimulant laxatives

Adverse for Mg. Hydroxide + Citrate?

Renal impairment form Mg accumulation

What is Senna?

Stimulant Laxative

What is Bisacodyl

Enteric-coated, Stimulant laxative

What bacteria can cause Peptic Ulcer disease?

Helicobacter pylori

What is administration timing of Antacids?

Should not be administered within 2 hours of any other medication

What element commonly causes constipation?

Aluminum

What element commonly causes diarrhea?

Magnesium (that’s why they are components of some laxatives)

What is an important consideration for aluminum/mg based agents

Renal impairment —> accumulation

Except short-term use of Al to treat hyperphosphatemia

What are adverse effects of Calcium salts?

Constipation

Kidney Stones

Milk alkali syndrome(calcium accumulation)

Adverse of sodium bicarbonate

Sodium content can cause issues with cardiac patients + renally impaired

What is Simethicone?

Antiflatulent

What is Cimetidine

H2RA (histamine antagonist)

What do H2RA’s do?

decrease Gastric Acid production

Adverse of H2RAs

Rebound hyperacidity

Drowsiness from accumulation in renal impairment

Gut flora change(more acid, effect gut bacteria)

Cimetidine Adverse:

Anti-androgenic reactions

Liver inhibition(toxicity)

What is Omeprazole “prazoles”

PPI, Protein pump inhibitor

PPI administration tips

In the morning, 30 min for eating, do not crush

PPI Adverse:

Diarrhea

change in gut flora

altered absorption of electrolytes(hypomagnesemia + hypocalcemia)

Which GI-agents can cause REBOUND ACID HYPERSECRETION

PPIs, H2RA, CALCIUM CARBONATE(antacid)

What is Sucralfate

Anti-Ulcer in Peptic Ulcer Disease

Used in Pregnancy

What is special about Sucralfate’s MOA?

Composed of Al Hydroxide, It creates a protective barrier at active ulcer sites

What is Bismuth Subsalicylate

Treatment of H. Pylori

Indigestion/HB

Traveler’s Diarrhea

Bismuth Subsalicylate adverse:

Black/Green stained tongue

Reye’s in Children

Salicylism risk(Asprin overdose)

What drugs are used to treat H. Pylori?

Amoxicillin, Calrithromycin, BSS, Tetracycline + metronidazole

What is Misoprostol?

treatment for NSAID-Induced Ulcers

Promotes labor induction + can also terminate pregnancies

Misoprostol adverse effects

Diarrhea + Adbominal pain

Spotting, dysmenorrhea

Pregnancy termination