Deng Active Learning Worksheet

1. LL has IBS-C. She has tried all lifestyle changes, but her IBS-C symptoms persist. Which prescription medication is the most appropriate treatment for this patient? What are some ADE associated with this medication? IBS-C = Constipation-predominant IBS 1st-line treatment for IBS-C: Linaclotide (Linzess) Take 30 minutes before first meal of the day or on an empty stomach. ADRs: diarrhea, abdominal pain/distension, flatulence 2. Which of the following statements is correct regarding IBS-D? For each INCORRECT statement, please rewrite it to make it a correct statement Statement 1: Eluxadoline (Viberzi) is a 5 HT3 receptor antagonist indicated for IBS-D False. Eluxadoline (Viberzi) is a µ-opioid receptor agonist indicated for IBS-D. Statement 2: Rifaximin is first line option for IBS-D True. Statement 3: Loperamide is not preferred in patients with IBS-D due to the risk of C. dif infection False. Loperamide is not preferred in patients with IBS-D because it does not improve IBS symptoms such as pain. Statement 4: Lotrenex (Alosetron) has a REMS program due to ischemic colitis and it is indicated for male patients False. Lotrenex (Alosetron) has a REMS program due to ischemic colitis and it is indicated for only female patients. 3. G.I. is a 54 y/o M with diarrhea for the past two days. Allergies include Penicillin (throat swelling) and sulfa. The patient is admitted to the ICU with the following labs: WBC = 15 x10 3/mm3, Hgb/Hct: 11.3g/dL/35%, Na = 157 mEq/L, K = 3.2 mEq/L, HCO3- = 14 mEq/L, Cl = 115 mEq/L, SCr = 1.8 mg/dL, BUN = 36 mg/dL, and glucose = 98 mg/dL. BP = 78 mm Hg/40 mm Hg, HR =122 bpm, Temp = 101.3 °F. On physical exam, patient has decreased skin turgor. Current medications include: metformin, lisinopril, calcium carbonate, magnesium oxide 400 mg po qday, hydrochlorothiazide, naproxen, and norco. a. Which medication have an ADE of diarrhea? • Metformin b. What are your plans for this patient? • • • LR (no NS due to Na elevated) → improve BP, lower HR Correct K+ (K is low, may need K rider) Secondary causes – evaluation, possibly infection (elevated WBC) • maybe start antimotility, antinausea agents once pt is adequately hydrate and stabilized 4. EC is a 25 YOM who presents to your pharmacy with a c/o watery stool, most likely due to the sushi dinner he ate last night with his roommates. Assuming today is 04/04/2024 at 1100 hour. EC denies any other sx, medications, and PMH. Please provide your recommendation. Be sure to state the drug name, strength, route of administration, and frequency, as well as rationale to use your chosen agent. • • • • • Drug: Loperamide (Imodium) o Not indicated for invasive bacterial diarrhea or C. difficile o Pt mostly suffer from mild-moderate watery diarrhea, may use Loparet for 48 hours Strength: 2 mg per caplet Route of Administration: Oral Frequency: Take 4 mg (2 caplets) initially, followed by 2 mg (1 caplet) after each loose stool o Max: 8mg/day Rationale: Loperamide is a synthetic opioid agonist that acts by stimulating micro-opioid receptors in the intestinal muscles, slowing down motility, and increasing the absorption of water and electrolytes. It is commonly used to control symptoms of diarrhea. In this case, EC's symptoms of watery stool are indicative of diarrhea, and Loperamide can help reduce the frequency and fluid loss associated with diarrhea, providing him with relief. 5. G.I. is a 26 y/o F who comes into the pharmacy complaining of mild constipation. Her current medications include: docusate, ferrous sulfate, diphenhydramine, and nortriptyline. Which of these medications are most likely to increase her risk for constipation? Ferrous sulfate will most likely increase her risk of constipation as it is one of the common side effects of the medication. Diphenhydramine and nortriptyline (TCA) have anticholinergic effects which causes constipation 6. G.I. is a 66 y/o F with metastatic breast cancer. She is on MS Contin® (long-acting morphine) 60 mg po bid. The patient is now on docusate 100 mg po bid and po Dulcolax®. The patient has not had a bowel movement in 4 days. The physician wants an oral medication that will produce a bowel movement as soon as possible (< 6 hours). What is the most appropriate recommendation and why? Glycerin rectal suppository or Magnesium citrate, or Magnesium hydroxide or fleet rectal enema. All can work with 15-30 minutes 7. G.I. is a 57 y/o M with metastatic esophageal cancer. He is on high dose morphine PCA and has not had a bowel movement x7 days. The physician wants to give an opioid receptor antagonist to reverse the opioid effects on the gut. He cannot take oral medications. What would be the appropriate recommendation and why? 3 medications in the PAMORA class: 1. Methylnaltixone (Relister)- PO, SQ 2. Naloxegol (Movantik) - PO 3. Naldemedine (Smprioic) - PO