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38 Cards in this Set
- Front
- Back
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constipation is a _____ not a ______
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symptom not a disease
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Laxatives contraindicated with..
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• Intestinal obstruction – perforation
• Severe abdominal pain • N/V • DM, abd surgery • Inflammatory Bowel Disease • Diverticulitis • Hx of laxative abuse |
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Causes of laxative abuse
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– Misconception that bowel movements must occur
daily – Can perpetuate their own use – Bowel replenishment after evacuation can be 2-‐5 days – often mistaken for constipation |
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Consequences of laxative abuse
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Diminished defecatory reflexes, leading to further reliance on laxatives
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5 categories of laxatives
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• Bulk-‐Forming Psyllium (Metamucil)
• Emollient/Surfactant Docusate sodium (Colace) • Stimulant Bisacodyl (Dulcolax) • Hyperosmotic – PEG;Miralax • Saline – fleets enema, citrate of magnesium |
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Safest and only group recommended for long-‐ term use
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BULK FORMING:
– Psyllium-‐(Metamucil); Calcium polycarbophil (Fibercon) |
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• Absorb water into the intestine
• Increases bulk, distends bowel • Bulk stimulates the intestine & increases peristalsis (reflex peristaltic activity) • RESULTS: bowel movement slow onset 24-48 hrs |
BULK FORMING LAXATIVES
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Indications for bulk forming laxatives
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– Acute and chronic constipation, irritable bowel syndrome, diverticulosis (not ‘litis)
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adverse effects of bulk forming laxatives
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– Abdominal fullness, cramping, gas formation – Fecal impaction
– Esophageal blockage |
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• May decrease effectiveness of warfarin & digoxin
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BULK FORMING LAXATIVES
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Emollient laxatives
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Stool softeners: docusate sodium (Colace)
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Routinely used for prophylactic purposes
– Pts at risk for constipation; no straining (post-‐op, MI) |
Emollient laxatives
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Draws more water and fat into the bowel to soften stools
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Emollient laxatives
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Does not stimulate peristalsis
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Emollient laxatives
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stimulates the nerves that innervate the intestines which results in increase peristalsis and evacuation of the bowel
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Stimulant laxatives
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• Senna (Senkot)
• Bisacodyl (Dulcolax) |
Stimulant laxatives
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**Most likely of all classes to cause
dependence |
Stimulant laxatives
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indications for Stimulant laxatives
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acute constipation, diagnostic/ surgical preps
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• Do not take po form with dairy products • Do not take if allergic to yellow food dye
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Stimulant laxatives
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• Enteric coated; 8-‐12 hours onset po form • Take before bed
• Rectal form-‐15-‐60 minutes |
Stimulant laxatives
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Hyperosmotic Laxatives
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olyethylene glycol (PEG); Lactulose (Cephulac)
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OTC hyperosmotic (safe daily use-‐17grams/day for chronic constipation); powder mixed with H2O; takes a couple days to work
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miralax
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Site of ac)on limited to the large bowel
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Hyperosmotic Laxatives
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adverse effects of Hyperosmotic Laxatives
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abd bloating, cramping, diarrhea, F&E loss
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A natural sugar that passes, as is, undigested into the lg intestine..there bacteria digest it and create an acidic environment that draws h2o into the colon
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Lactulose (Cephulac)
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traps ammonia (NH3) which prevents it from be reabsorbed back into circulation..
• Ammonia leaves via stool – Lowers serum ammonia levels – IMPORTANT to decrease hepatic encephalopathy |
Lactulose (Cephulac)
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Increases osmotic pressure in the small intestine
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saline laxatives
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a ‘salt’ administered in hypertonic solution to draw water into the intestinal lumen by osmosis, distending it and promoting peristalsis and evacuation
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saline laxatives
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names of saline laxatives
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Magnesium laxaitves-‐Citrate of Magnesium; Magnesium Hydroxide-‐Milk of Mg (MOM)
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treatment of constipation related to opioid use and bowel resection therapy
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Peripherally Acting Opioid Antagonists
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Block entrance of opioid into bowel without impacting opioid effects on CNS
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Peripherally Acting Opioid Antagonists
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type of peripherally acting opioid antagonists
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methylnaltrexone (Relistor)
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Adsorbents
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Absorb bacteria & toxins, thus remove the cause of diarrhea; provides relief of abdominal cramping.
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example of an adsorbent
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Bismuth subsalicylate (Pepto-‐Bismol)
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Intestinal Flora Modifier
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• lactobacillus acidophilus (Lactinex)
• Used to treat diarrhea caused by antibiotics; reestablishes normal intestinal flora and may be used prophylactically in patients with a history of antibiotic-‐induced diarrhea |
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2 anti-motility drugs
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a. Diphenoxylate with atropine sulfate (Lomotil)
b. loperamide (Imodium) also available OTC |
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Activates opioid receptors in the GI tract to
decrease motility; decrease transit time allowing for formation of solid stools |
anti-motility drugs
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Antidiarrheals are NOT used in pts with
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INFECTION
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