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56 Cards in this Set
- Front
- Back
What is loperamide?
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phenylpiperidine analgesic analog, delayogen
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How is loperamide excreted?
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stool
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What is loperamide's MOA?
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increases segment contractions in proximal colon, decreases propulsive spike activity in distal colon
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What are the adverse effects of loperamide?
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constipation, distension, bloating, nausea, vomiting
CNS depression, drowsy, dizzy, toxic megacolon |
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What are the contraindications of loperamide?
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avoid in toxic patietn, dysentery, severe ulcerative coloitis
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What kind of drug is diphenoxylate and atropine?
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opiod, anticholinergic, delayogen
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how id diphenoxylate excreted?
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fecally
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Why is atropine included in diphenoxylate and atropine?
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to discourage opiate abuse
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What are the side effects of diphenoxylate and atropine?
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toxic megacolon, CNS depression, constipation
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What happens with peds patients and diphenoxylate/atropine?
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can become toxic from atropine and respiratory depresison from diphenoxylate
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How should you give loperamide?
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after every BM
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What is the MOA of bismuth subsalicylate?
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binds bacterial toxins, nonspecific anti-inflammatory effect
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Why do you give bismuth salicylate?
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traveller's diarrhea
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What are the adverse effects of bismuth salicylate?
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black stools, bismuth toxicity with enteritis
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Who should not get bismuth subsalicylate?
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renal failure, enteritis
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What is bismuth toxicity?
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seizures, encephalopathy
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In what diseases do you use cholestyramine?
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cholecystectomy, terminal ileal resection or disease
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What is the MOA of cholestyramine?
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anion exchange resin, binds bile acids
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What are the adverse effects of cholestyramine?
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bloating, constipation, binds other drugs
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What is octreotide?
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somatostatin analog, anti-secretory agent
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What is octreotide's MOA?
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hyperpolarizes gut neurons, decreases ACh release, slows peristalsis, prevents release of secretion-inducing NTs
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Why would you give octreotide?
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severe refractory secretory diarrhea, endocrine tumor-related diarrhea
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What are the adverse effects of octreotide?
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gallbladder stasis, inhibition of pancreatic secretion, injection site irritation
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What is psyllium?
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fiber, bulk forming agents
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Why do you use psyllium?
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more gritty, but also less expensive
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What is psyllium's MOA?
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adds weight and bulk to the stool by absorbing water, speeds transit through colon, digested by bacteria
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What are psyllium's adverse effects?
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bloating, flatulence
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What are the adverse effects of psyllium?
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obstruction of the bowel, severely slow colon
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what is Bisacodyl's MOA?
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stimulates enteric nerves to cause colonic mass movement, increases fluid/NaCl secretion
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What are the adverse effects of Bisacodyl?
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cramps
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What is castor oil's MOA?
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hydrolyzed to ricinoleic acid, stimulates fluid and water secretion, increases intestinal permeability
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What should you do with castor oil?
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avoid it! causes cramping
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What is Docusate's MOA?
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anionic surfactant, does not need accelerated colon transit, mild contact laxatives that increase NaCl secretion via cAMP
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What's good about docusate?
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softer bm in 3-5 days, safter, milder, long-term
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What is mineral oil's MOA?
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penetrates and lubricates feces, prevents H2O reabsorption
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How is mineral oil absorbed?
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somewhat orally, not at all if in enema
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Why would you give mineral oil?
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fecal impaction, post-MI to avoid straining/vagal stimulus, post-surgical or post partum
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What are the adverse effects of mineral oil?
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aspiration causes lipoid pneumonia, anal leakage with irritation, malabsorption of fat soluble vitamins, chronic intestinal hypomotility
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What is the MOA of magnesium salts?
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poorly absorbed ions, hold H2O in the lumen and stimulate peristalsis
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What are the adverse effects of magnesium salts?
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hypermagensemia with renal failure, cramping/pain with magnesium citrate
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What is polyethylene glycol?
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balanced salt solution, causes mass fluid passage through GI tract, little absorbed without glucose or slow drinking
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Why do you give polyethylene glycol?
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prepare for colonoscopy, fecal impaction, severe chronic constipation
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What is the MOA of sodium phosphate?
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osmotic purge
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What are the adverse effects of sodium phosphate?
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hyperphosphatemia and hypocalcemia with renal insufficiency
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What is lactulose?
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galactose-fructose
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What are the adverse effects of lactulose?
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gas/gloat/distention
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Why would you use lactulose?
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treatment of hepatic encephalopathy, acidifies colon, traps ammonia and amines in colon for excretion
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What are the adverse effects of enemas?
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phosphate can be absorbed and cause hypocalcemia in patients iwth renal failure
repeated water/soap suds enemas can cause hyponatremia |
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What are the indications for enema use?
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intermittent constipation, fecal impaction, bowel obstruction is a concern/oral laxatives are constrained
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What do you give for acute infectious diarrhea with a fever and systemic illness??
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nothing, bismuth subsalicylate, antibiotics
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What do you give for acute mild infectious diarrhea?
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bismuth subsalicylate, loperamine, diphenoxylate-atropine
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What do you give for chronic diarrhea?
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fiber, loperamide
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What do you give for episodic constipation?
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bisacodyl, docusate
MOM, magnesium citrate, lactulose |
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What do you give for fecal impaction?
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enema
polyethylene glycol, mineral oil |
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What do you give for chronic mild constipation?
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fiber, osmotic salts or enema
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What do you give for chronic severe constipation?
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low fiber, daily osmotic agent: MOM, mag citrate, sodium phosphate, polyethylene glycol, misoprostol
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