Motility Disorder Medication

by Pravin Shukle, MD

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    Let's move on to the motility disorders. So the motility disorders can be treated by several agents. You have the dopamine antagonists, the motilin agonists, the laxatives, and the anti-diarrheal agents. Let's start off with the cholinomimetics. So cholinomimetics lower the sphincter tone of the lower esophageal sphincter. Now, in the past, we used drugs like bethanechol but not any more because bethanechol tends to be a toxic agent and doesn't really work as well as we had hoped. Neostigmine which is an acetylcholinesterase inhibitor is often used in the hospital for acute bowel distention. Now for further information on this particular agent, I encourage you to take a look at our autonomic nervous system pharmacology lectures, you'll have a much better discussion about this particular drug in that lecture. Other agents include the dopamine receptor antagonists, specifically the D2 receptors. So, metoclopramide is your prototypical example of this. It causes D2 blockade, and this causes increased bowel transit so things move a little bit quicker. They may also cause parkinsonian symptoms so you have to be fairly careful with these agents. They work also in the area postrema which is part of the emetic centre of the brain. And for that reason, it's a very effective antiemetic in surgery and in cancer patients. Domperidone is another example of this type of agents. It does not cross the blood brain barrier so it makes it a little bit different from metoclopramide. And it's therefore less likely to cause CNS effects. Not surprisingly, the anti-emetic effects of domperidone are really not that significant. Now, motilin receptor agonists are an interesting group because the prototypical agent is actually an antibiotic, erythromycin. It directly stimulates motilin receptors and has benefits in patients with gastroparesis. Now, this also explains the common side effect of...

    About the Lecture

    The lecture Motility Disorder Medication by Pravin Shukle, MD is from the course Gastrointestinal Pharmacology.

    Included Quiz Questions

    1. Similarities: D2 Receptor Antagonists Differences: domperidone does not cross the blood brain barrier.
    2. Similarities: Both are Agonists Differences: domperidone cross the blood brain barrier.
    3. Similarities: Neither are Antagonists Differences: domperidone does not cross the blood brain barrier.
    4. Similarities: Both are enzyme inhibitors Differences: metoclopramide does not cross the blood brain barrier.
    5. Similarities: Neither are enzyme inhibitors Differences: metoclopramide does not cross the blood brain barrier.
    1. Erythromycin
    2. Ampicillin
    3. Tobramycin
    4. Flonase
    5. Ceftriaxone
    1. A gel matrix in the stool absorbs water from the GI system.
    2. Increases the bulk of the stool to encourage stool passage.
    3. A motility receptors agonist.
    4. An opioid receptor antagonist.
    5. Stimulates the chloride channels in the gut to increase salt and water flow into the GI lumen.
    1. A patient with a history of opioid abuse or opioid dependence.
    2. A pregnant patient.
    3. A pediatric patient.
    4. A patient with Crohn's disease or Ulcerative colitis.
    5. A patient over 65 years old.
    1. Do not use anti-diarrheal agents in bloody or infectious diarrhea.
    2. Anti-diarrheal agents are useful in all types of diarrhea.
    3. Anti-diarrheal agents should never be administered with a laxative.
    4. Anti-diarrheal agents should always be given with salt water.
    5. Anti-diarrheal agents should only be administered in a diarrhea emergency.

    Author of lecture Motility Disorder Medication

     Pravin Shukle, MD

    Pravin Shukle, MD

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