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  1. tegasord
    • selective serotonin type 4 receptor agonist,
    • binds to the enteric receptors initiating the peristaltic reflex.
    • normalizes motility and stimulates intestinal secretion
    • dec visceral sensitivity
    • 6mg b.i.d. before meals 4-6 wks, another 6 wk course prn.
    • significant global symptom relief in women with IBS and constipation.
    • most effective and preferred medication for abdominal pain and bloating
  2. loperamide
    • decrease stool frequency,
    • improve stool consistency,
    • no effect on abdominal pain or bloating
  3. Low doses of tricyclic antidepressants
    decrease the frequency of diarrhea
  4. alosetron
    • severe diarrhea predominant IBS-female
    • serotonin type 3-receptor antagonist
    • Side effects include constipation (25%) and ischemic colitis
  5. antispasmodic agentsDicyclomineand hyoscyamine
    • abdominal discomfort associated with IBS
    • 70% rate of anticholinergic side effects
    • used cautiously in IBS patients with constipation
    • 30-60 minutes prior to a meal
  6. serotonin type 4 agonists
    • cisipride and prucalopride
    • strong contractions of the proximal colon
    • cardiac arrhythmias and carcinogenesis
  7. Bulking agents
    • increase in the size of the stool bolus
    • make the stool softer

    deliver a mass of non-digestible substrate to the colon and due to their hydrophilic nature, facilitate the absorption and retention of fluid in the stool

    • psyllium (Metamucil, Konsyl),
    • methylcellulose (Citrucel),
    • calcium polycarbophil (Fibercon).
    • Side effects bloating and flatulence.
  8. Fiber
    SE: gas, bloating, obstrx, fecal impaction
    dec chol< bind bile salts < dec absorption < dec bile salt pool
    • cellulose
    • lignin
    • gums
    • pectins, dec SE
    • hemicelluloses, dec SE
    • polysacharides
  9. fiber products: provide bulk and increase water content
    psyllium husk (powder or granules), plantain

  10. fiber products, hydrophilic substances

    powdered karaya gum, 4-10 g/day
  11. lactulose
    • polysaccharide,
    • 20-60 mg /d effective laxative
    • SE: gas, bloating, cramps, flatulence, fluid losses
  12. Osmotic laxatives
    • osmotically active sugars or salts
    • sucrose based sorbitol and lactulose or nonabsorbable ions

    • MiraLAX®, adds osmotic neutral fluid to colon
    • polyethylene glycol 3350
    • magnesium hydroxide (Milk of magnesia), mg >release of CCK from duo>inc SB motility; high phosphate, impair cardiac contractility, avoid in renal, cardiac and hepatic d.
    • sodium phosphate (Fleets Phosphosoda)
  13. colonic irritants
    inc mass moverments
    dec segmental contractions
    4-6 hours
    SE; cramping, diarrhea
    • anthracene derivatives:
    • senna (Senekot)
    • cascara( Pericolace)

    • Phenolphthalein derivatives
    • Diphenylmethane: Bisacodyl(Dulcolax)

    pseudomelanosis coli
  14. Dulcolax
    • diphenylmethane similar to phenopthalmein
    • oral and rectal
    • enteric coated.
    • 10-15 mg
  15. Senna and cascara
    SE: cramping, melanosis coli
  16. castor oil
    • triglyceride of ricinoleic acid
    • acts in SI by pancreatic hydrolysis>dec water and electrolyte absorption > dec transit time
    • avoid long term
  17. laxatives-manipulation of stool
    Mineral oil, lubricant coats the stool bolus, preventing fluid loss, SE-dec absorption of fat soluble vitamins and essential fatty acids, dont use with surfactant, foreign body reaction

    Docusate sodium (colace) lowers the surface tension at the stool water interface, allowing greater penetration of the stool with fluid.
  18. Stool softeners
    docusate (dioctyl sulfosuccinate), sodium, ca, K, inhibit normal water-absorptive capacity of colon, soften stool, do not promote defecation, 1-3 days before effect, 50-250 mg/day, do not give with mineral oil.
  19. promotion of defecation
    • distension (saline enema)
    • rectal irritation (soapsuds, bisacodyl)
    • physical softening of the stool (glycerine)
  20. Lubiprostone (Amitizia®)
    • functional constipation 25 µg bid and IBS-C 8 µg bid
    • bi-cyclic fatty acid
    • chloride channel activator that induces intestinal secretion without elevating serum electrolyte levels
    • activates type2 chloride channels in the apical membrane of the intestinal epithelium.
    • nausea, diarrhea, and headaches
  21. PEG
    • constipation
    • 17 g x 14 days inc freq BM's
Card Set:
2011-07-13 01:33:05

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