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INTRODUCTION

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The material in this chapter covers the material presented in Chapters 46 and 47 of Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition; this chapter will be most useful after having a basic understanding of these chapters in the 12th Edition. In addition to the material presented here, Chapters 46 and 47 of the 12th Edition contain:

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  • A description of gastric motility (see Chapter 46)

  • A description of the pathophysiology of constipation (see Chapter 46), including Table 46-3 that provides a classification and comparison of representative laxatives, and Table 46-4 that shows the properties of different dietary fibers

  • The general principles and approaches to the treatment of diarrhea (see Chapter 46)

  • A general description of irritable bowel syndrome (IBS) (see Chapter 46)

  • A pharmacological approach to the management of nausea and vomiting (see Chapter 46), including Table 46-6 that shows the receptor specificity of antiemetic agents, and Table 46-7 that shows some antiemetic regimens used in cancer chemotherapy and their initial doses

  • A description of the pharmacological management of chronic pancreatitis and steatorrhea (see Chapter 46)

  • The pathogenesis of inflammatory bowel disease (IBD) (see Chapter 47), including Table 47-1 which details medications commonly used to treat IBD

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LEARNING OBJECTIVES

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  • Describe the mechanisms of action of laxatives and cathartics, and understand their use.

  • Describe the mechanisms of action of antidiarrheal agents and understand their use.

  • Understand the pharmacotherapy of IBS.

  • Identify drugs used to treat nausea and vomiting, and describe the mechanisms of action of these drugs.

  • Identify the drugs used to treat IBD, their mechanisms of action, untoward effects, and understand how they are used to treat IBD.

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DRUGS INCLUDED IN THIS CHAPTER

  • Adalimumab (HUMIRA)

  • Alosetron (LOTRONEX)

  • Alvimopan (ENTEREG)

  • Aprepitant (EMEND)

  • Azathioprine (IMMURAN)

  • Balsalazide (COLAZIDE)

  • Bisacodyl (DULCOLAX, CORRECTOL, others)

  • Bismuth (OTC PEPTO-BISMOL)

  • Budesonide (ENTOCORT ER)

  • Carboxymethylcellulose

  • Certolizumab pegol (CIMZIA)

  • Cholestyramine (QUESTRAN, others)

  • Cisapride (PROPULSID) available only in a limited-access program

  • Cyclosporine

  • Dexpanthenol (ILOPAN, others)

  • Dicyclomine (BENTYL, others)

  • Difenoxin (MOTOFEN)

  • Diphenoxylate (LOMOTIL)

  • Docusate sodium (COLACE, DOXINATE, others)

  • Domperidone (MOTILIUM)—not available in the United States

  • Dronabinol (MARINOL)

  • Glycopyrrolate (ROBINUL, others)

  • Hyoscyamine (LEVSIN, others)

  • Infliximab (REMIDCADE)

  • Lactulose (CEPHULAC, others)

  • Loperamide (IMODIUM, others)

  • Lubiprostone (AMITIZA)

  • Mesalamine (5-aminosalicylic acid, 5-ASA)

  • Methotrexate

  • Methscopolamine (PAMINE, others)

  • Methylnaltrexone (RELISTOR)

  • Metoclopramide (REGLAN, others)

  • Nabilone (CESAMET)

  • Natalizumab (TYSABRI)

  • Octreotide (SANDOSTATIN)

  • Olsalazine (DIPENTUM)

  • Ondansetron (ZOFRN, others)

  • Polyethylene glycol (COLYTE, GOLYTELY, others)

  • Prucalopride (RESELOR)—available in Europe for use in women with chronic constipation

  • Saline laxatives

  • Senna (SENOKOT, EX-LAX, others)

  • Sulfasalazine (AZULFIDINE)

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Table Graphic Jump Location
MECHANISMS OF ACTION OF DRUGS USED TO TREAT BOWEL DISORDERS

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