Ch 60 Pharm

Front 1

the infrequent and painful expulsion of hard, dry stools.

Back 1

Constipation

Front 2

bowel elimination that is normally stimulated by movements and reflexes in the gastrointestinal (GI) tract.

Back 2

Defecation

Front 3

a mass of hard, dry stool in the rectum; caused by chronic constipation.

Back 3

Impaction

Front 4

The term _________ implies mild effects and elimination of soft, formed stool.

Back 4

laxative

Front 5

The term ________implies strong effects and elimination of liquid or semiliquid stool.

Back 5

cathartic

Front 6

____________ such as ____________ or __________are substances that are largely unabsorbed from the intestine. When water is added, these substances swell and become gel-like. The added bulk or size of the fecal mass stimulates peristalsis and defecation.

Back 6

Bulk-forming laxatives polycarbophil or psyllium seed

Front 7

How long does it take bulk forming laxatives to work?

Back 7

They usually act within 12 to 24 hours but may take as long as 2 to 3 days to exert their full effects.

Front 8

_____________ also known as ________, ___________, ________ or ___________decrease the surface tension of the fecal mass to allow water to penetrate into the stool. They also act as a detergent to facilitate admixing of fat and water in the stool.

Back 8

Surfactant laxatives docusate calcium, potassium, or sodium

Front 9

How long does it take for surfactant laxatives to work and why?

Back 9

They usually act within 1 to 3 days and should be taken daily. Their main value is to prevent straining while expelling stool.

Front 10

__________ such as _________ or ______________are not well absorbed from the intestine. Consequently, they increase osmotic pressure in the intestinal lumen and cause water to be retained. Distention of the bowel leads to increased peristalsis and decreased intestinal transit time for the fecal mass. The resultant stool is semifluid.

Back 10

Saline laxatives such as magnesium citrate, or milk of magnesia

Front 11

What is the function of a saline laxative and how long does it take before the patient has results?

Back 11

These laxatives are used when rapid bowel evacuation is needed. With oral magnesium preparations, effects occur within 0.5 to 6 hours; with sodium phosphate-containing rectal enemas, effects occur within 15 minutes.

Front 12

Saline laxatives are not safe for frequent or prolonged usage they may produce fluid and electrolyte imbalances. What patients would be in danger if they used saline laxatives?

Back 12

1. Patients with impaired renal function who are at risk of developing hypermagnesemia with magnesium-containing laxatives because some of the magnesium is absorbed systemically.

2. Patients with congestive heart failure are at risk of fluid retention and edema with sodium-containing laxatives.

Front 13

_________________is a non- absorbable oral solution that induces diarrhea within 30 to 60 minutes and rapidly evacuates the bowel, usually within 4 hours. It is a prescription drug used for bowel cleansing before GI examination. (Nurses and nurses aids know this as "Go lytely" however, it is more like go very quickly.

Back 13

Polyethylene glycol-electrolyte solution (e.g., NuLytely)

Front 14

When is it not a good idea to use Polyethylene glycol electrolyte solution?

Back 14

patients with GI obstruction, gastric retention, colitis, or bowel perforation

Front 15

______________combine polyethylene glycol with a stimulant cathartic, bisacodyl, to evacuate the colon in preparation for a colonoscopy.

Back 15

HalfLytely

Front 16

__________is an oral laxative that may be used to treat occasional constipation. Effects may require 2 to 4 days. It is a prescription drug and should not be taken longer than 2 weeks.

Back 16

MiraLax

Front 17

This bulk forming laxative is PO 1 heaping tbsp 1-3 times daily with water (8 oz or more)
In children 12 y and older: PO same dosage as adults 6-11 y: PO 1/2 the adult dosage in 8 oz water once daily

Back 17

Methylcellulose (Citrucel)

Front 18

What is the max dose of Polycarbophil (FiberCon, Mitrolan), a bulk forming laxative, in adults and children?

Back 18

Drug is taken PO 1 g 1-4 times daily or PRN with 8 oz of fluid; maximum dose 4 g/24 h for adults. Children 6-12 y: PO 500 mg 1-3 times daily or PRN; maximum dose 2 g/24 h
2-6 y: products vary, consult labels

Front 19

This bulk forming laxative is taken PO 1 rounded tsp 1-3 times daily, stirred in at least 8 oz water or other liquid for adults. Children 12 y and older: PO same dosage as adults 6-11 y: PO 1/2 the adult dosage in 8 oz water once daily

Back 19

Psyllium preparations (Metamucil, Effersyllium, Serutan, Perdiem Plain)

Front 20

This Surfactant Laxatives aka stool softener is taken PO 50-300 mg daily in adults. Children 12 y and older: PO same dosage as adults. 6-11 y: 100 mg daily
2-6 y: products vary, consult labels

Back 20

Docusate sodium (Colace)

Front 21

This Surfactant Laxatives aka stool softener is taken PO 240 mg daily. Children 12 y and older: PO same dosage as adults.

Back 21

Docusate calcium (Surfak)

Front 22

This saline cathartic is taken PO 1/2-1 bottle at bedtime. Children 12 y and older: PO same dosage as adults. 6-11 y: 1/2-1/4 bottle at bedtime.

Back 22

Magnesium citrate solution

Front 23

Magnesium hydroxide (milk of magnesia, magnesia magma) is a saline cathartic. What is the dose in adults and children?

Back 23

For adults: Regular liquid: PO 30-60 mL at bedtime

Concentrated liquid: PO 15-30 mL at bedtime
For children, Regular liquid:
12 y and older: PO same dosage as adults

6-11 y: 15-30 mL at bedtime

2-5 y: 5-15 mL at bedtime

Concentrated liquid:

12 y and older: PO same dosage as adults

6-11 y: 7.5-15 mL at bedtime

2-5 y: 2.5-7.5 mL at bedtime

Front 24

This Saline cathartic is taken PO 17 g in 8 oz water and no pediatric dosage is available. What is it?

Back 24

Polyethylene glycol (PEG) solution (Miralax)

Front 25

This saline cathartic is taken for bowel cleansing before GI examination PO 240 mL every 10 min until 4 L is consumed (go lytely yeah right lol) No recommended for children.

Back 25

Polyethylene glycol-electrolyte solution (PEG-ES) (CoLyte, GoLytely, NuLytely, OCL)

Front 26

This saline cathartic is can be taken PO or via enema. PO 20-40 mL in 8 oz water. Rectally 60-120 mL
For children 10 y and older: PO 10-20 mL in 8 oz of water

5-10 y: PO 5-10 mL in 8 oz of water

Rectal enema, 60 mL

Back 26

Sodium phosphate and sodium biphosphate (Fleet Phosphosoda, Fleet Enema)

Front 27

This Stimulant Cathartic is taken PO 10-15 mg and Rectal suppository, 10 mg for adults. For children 6 y and older: PO 5 mg. Rectal suppository, 5 mg

Back 27

Bisacodyl (Dulcolax)

Front 28

This Stimulant Cathartic is taken PO tablets, 325 mg, PO aromatic, 2.5-5 mL. PO aromatic fluid extract, 2-6 mL. For children 12 y and older: same dosage as adults PO aromatic: 2-12 y: PO 1/5-1/2 tsp.

Back 28

Cascara sagrada

Front 29

This stimulant cathartic is taken PO 15-60 mL for adults in children 5-15 y: PO 5-30 mL depending on strength of emulsion.

under 2 y: PO 1.25-7.5 mL depending on strength of emulsion

Back 29

Castor oil (Neoloid)

Front 30

This stimulant catharic is used as a rectal suppository, 3 g in adults in children under 6 y: rectal suppository 1-1.5 g.

Back 30

Glycerin

Front 31

This stimulant catharic is in granules, PO 1 level tsp once or twice daily. Syrup, PO 2-3 tsp once or twice daily. Tablets, PO 2 tablets once or twice daily. For geriatric, obstetric, gynecologic patients, reduce all dosages by half. For children it is based on weight and > 27 kg: granules, syrup, and tablets, 1/2 the adult dosage

Back 31

Senna preparations (Senokot, Black Draught)

Front 32

This combination product is for bowel cleansing before colonoscopy: PO 4 bisacodyl tablets (5 mg each) with water. After bowel movement occurs, drink 8 oz of HalfLytely solution every 10 min until 2 L of solution is consumed.


Pediatric dosage not established

Back 32

HalfLytely and bisacodyl tablets Bowel Prep Kit

Front 33

This lubricating laxative is taken PO 15-30 mL at bedtime or as a
Rectal enema, 30-60 mL. For children older than 6 y: PO 5-15 mL at bedtime Rectal enema, 30-60 mL

Back 33

Mineral oil (Agoral Plain, Milkinol, Fleet Mineral Oil Enema)

Front 34

__________________ is used for constipation: PO 15-30 mL daily; maximum dose 60 mL daily
Also it is used for Portal systemic encephalopathy dose is PO 30-45 mL 3 or 4 times daily, adjusted to produce two or three soft stools daily. Rectally as retention enema, 300 mL with 700 mL water or normal saline, retained
30-60 min, every 4-6 h
Infants: PO 2.5-10 mL daily in divided doses

older children: PO 40-90 mL daily in divided doses

Back 34

Lactulose (Chronulac, Cephulac)

Front 35

This is used for chronic constipation and is taken PO 24 mcg twice daily with food.

Back 35

Lubiprostone (Amitiza)

Front 36

Is taken for hyperkalemia (with Kayexalate), PO 30-50 g daily

Back 36

Sorbitol

Front 37

The ______________ are the strongest and most abused laxative products. These drugs act by irritating the GI mucosa and pulling water into the bowel lumen. As a result, feces are moved through the bowel too rapidly to allow colonic absorption of fecal water, so a watery stool is eliminated.

Back 37

stimulant cathartics

Front 38

Why should stimulant cathartics not be taken for longer than 1 week?

Back 38

They may produce serum electrolyte and acid-base imbalances (e.g., hypocalcemia, hypokalemia, metabolic acidosis or alkalosis)

Front 39

____________ is the only lubricant laxative used clinically. It lubricates the fecal mass and slows colonic absorption of water from the fecal mass, but the exact mechanism of action is unknown.

Back 39

Mineral oil

Front 40

True or false?

Oral mineral oil may cause several adverse effects and is not recommended for long-term use. Mineral oil enemas are sometimes used to soften fecal impactions and aid their removal.

Back 40

True

Front 41

__________is a disaccharide that is not absorbed from the GI tract. It exerts laxative effects by pulling water into the intestinal lumen. It is used to treat constipation and hepatic encephalopathy. The latter condition usually results from alcoholic liver disease in which ammonia accumulates and causes stupor or coma.

Back 41

Lactulose

Front 42

___________________is indicated for the treatment of chronic idiopathic constipation in adults. Chronic idiopathic constipation, defined as the infrequent or difficult passage of stool, is characterized by abnormal GI motility, abdominal discomfort, bloating, and straining to pass hard, lumpy stools.

Back 42

Lubiprostone (Amitiza)

Front 43

True or false?

Taking lubiprostone with food may aid in decreasing nausea.

Back 43

True

Front 44

__________ is a monosaccharide that pulls water into the intestinal lumen and has laxative effects. It is often given with sodium polystyrene sulfonate (Kayexalate), a potassiumremoving resin used to treat hyperkalemia, to prevent constipation, and aid expulsion of the potassium-resin complex.

Back 44

Sorbitol

Front 45

True or false?

Oral aloe is sometimes used as a laxative. However, it is not recommended for this use because it is a strong stimulant laxative. With oral ingestion, aloe can cause severe cramping and other potentially serious adverse effects, including hypokalemia and cardiac dysrhythmias.

Back 45

True

Front 46

What are the herbal and dietary supplements commonly used as laxatives that are plant based and are safe and effective when used as directed?

Back 46

cascara, psyllium, senna, castor oil

Front 47

Laxatives and cathartics are drugs used to promote bowel ___________

Back 47

Elimination

Front 48

The term Laxative implies mild effects and elimination of _________ , ___________ stool.

Back 48

soft formed

Front 49

The term _________ implies strong effects and elimination of liquid or semi liquid stool.

Back 49

cathartic

Front 50

___________ is normally stimulated by movements and reflexes in the gastrointestinal tract.

Back 50

Defecation

Front 51

Substances that are largely unabsorbed from the intestine

Back 51

Bulk forming laxatives such as polycarbophil and psyllium seed

Front 52

The strongest and most abused laxative products

Back 52

Stimulant cathartics

Front 53

Decrease surface tension of the fecal mass to allow water to penetrate into the stool

Back 53

Surfactant laxatives such as docusate calcium potassium or sodium.

Front 54

The only lubricant laxative used clinically

Back 54

Mineral Oil

Front 55

Not well absorbed form the intestine increase osmotic pressure in the intestinal lumen and cause water to be retained.

Back 55

saline laxatives such as magnesium citrate, milk of magnesia.

Front 56

Mrs. Rice is diagnosed with chronic idiopathic constipation. What is the drug of choice to treat constipation?

a. Lubiprostone

b. Polycarbophil

c. Mineral Oil

d. Magnesium citrate

Back 56

a Lubiprostone (Amitiza) aids in treating chronic idiopath constipation by increasing intestinal fluid secretion and there by stimulation intestinal motility and defecation.

Front 57

Mr. Medina is under treatment for acute congestive heart failure. His current drug regiment includes the potassium wasting diuretic furosemide and replacement therapy that includes potassium. His current laboratory report indicates that his potassium level is 6.4. The physician will order Kayexalate in conjunction with which of the following?

a. Milk of magnesia

b. Mineral Oil enema

c. Sorbitol

d. Colace

Back 57

c. Sobital is often given with sodium polystyrene sulfonate (kayexalate) in the treatment of hyperkalemia to aid in the expulsion of the potassium resin complex.

Front 58

Mr. Givens is diagnosed with hepatic encephalopathy. His ammonia level is 60. The physician orders which of the following medications to decrease the production of the waste product, ammonia?

a. Milk of magnesia

b. Colace

c. Sorbitol

d. Lactulose

Back 58

d Lactulose exerts an osmotic effect pulling water into the colon and stimulating peristalsis. It also is useful in treating hepatic encephalopathy by decreasing the production of the waste product ammonia

Front 59

Mr. Blue stone is on aspiration precautions secondary to a CVA. He is experiencing constipation and has not had a bowel movement for 5 days. Digital examination reveals hard stool in the rectal vault. The physican orders a lubricant laxative. Mr. Bluestone is at risk for which of the following?

a. Hemorrhoids

b. Lipid aspiration pneumonia

c. Decreased Peristalsis secondary to CVA

d. Bowel obstruction secondary to CVA.

Back 59

b Lubricant laxatives lubricate the fecal mass and slow colonic absorption of water from the fecal mass. These medicatoin may interfere with the absorption of fat soluble vitamins and if aspirated may result in a lipid aspiration pneumonia.

Front 60

Ms. Shaw presents to the emergency room with skeletal muscle weakness dysrhythmias and hypotension. While taking a drug history you learn that the patient is taking stimulant cathartics to lose weight. Which of the following diagnoses do you suspect?

a. Alcohol abuse

b. Hemorrhage

c. Fluid and electrolyte imbalance

d. Crohns disease.

Back 60

c Stimulant cathartics are the strongest and most abused laxative products. They irritate the GI mucosa pull water into the colon and stimulate peristalsis. They produce a watery stool and may lead to fluid electrolyte and acid base imbalances.

Front 61

Polyethylene glycol - electrolyte solution is a non absorbable oral solution taht rapidly evacuates teh bowel within ______ hours

Back 61

4

Front 62

Mrs. Cheshire uses saline laxatives as a method of weight control. As part of your education plan you inform the patient that she is at risk for which of the following conditions?

a. Electrolyte imbalances

b. Hemorrhage

c. Anorexia

d. Binging and purging

Back 62

a. Saline laxatives increase the osmotic pressure in the intestinal lumen resulting in the retention of water which distends the bowel and stimulates peristalsis. They produce a semifluid and electrolyte imbalances.

Front 63

Mr. Briggs has hemorrhoids and the physician orders a sufactant laxative. Which of the following effects will this laxative have on the stool?

a. Make it liquid and easier to expel

b. Make it semiliquid and easier to expel.

c. Make it softer and easier to expel

d. Make it formed and easier to expel

Back 63

c Surfactant laxatives decrease the surface tension of the fecal mass to allow water and fat penetrate into the stool making it softer and easier to expel. They have little true laxative effects.

Front 64

Which of the following is the most desirable type of laxative for long term use?

a. Surfactant laxatives

b. Stimulant cathartics

c. Saline laxatives

d. Bulk forming laxatives

Back 64

d Bulk forming laxatives add mass to the feces stimulating peristalsis and defecation. They must be taken with water to avoid obstruction. In general bulk forming drugs are the most desirable laxative for long term use.

Front 65

Mr. Koh presents to the ER with severe abdominal pain. He states that he hasn't moved his bowels in 5 days. His bowel sounds are absent. He states that he wants a laxative. Which of the following would you expect the physician to order?

a. Further tests

b. Saline laxative

c. Mineral Oil enema

d. A sedative.

Back 65

a Laxatives and cathartics should not be used in the presence of undiagnosed abdominal pain or other signs of intestinal obstruction because of the risks of perforation and peritonitis.

Front 66

Which of the following are common reasons for abuse of laxatives and cathartics? (select all that apply)

a. Eating disorders

b. Desire for strict weight control

c. Belief that a daily BM is necessary for health.

d. General health colonics

Back 66

a, b, c Common reasons for abuse of laxatives and cathartics include eating disorder desire for strict weight control and belief that a daily bowel movement is necessary for health.

Front 67

______ and __________ are drugs to promote bowel elimination.

Back 67

Laxatives and Cathartics

Front 68

Mrs. Decker fears that she is becoming addicted to laxatives. She asks you what she can do to treat her constipation. Which of the following lifestyle modifications would you recommend?

a. Fluid restriction

b. Milk of magnesia every third day

c. Increase fluid and fiber intake

d. Limit exercise

Back 68

c Lifestyle modification such as increased fluid and fiber intake and increased exercises are preferred to medications in the treatment of constipation.

Front 69

_________ is the infrequent and painful expulsion of hard dry stools.

Back 69

constipation

Front 70

Mr. Knight is diagnosed with upper neuron injuries after a motor vehicle accident. Which of the following will help this patient to evacuate his bowels?

a. Bowel program

b. Bladder training program

c. Regimen of daily saline enemas

d. Regimen of laxatives every other day.

Back 70

a Individuals with upper motor neuron injuries usually follow a bowel program that includes taking daily stool softener such as docusate sodium and stimulating bowel movements at the desired time using digital stimulation and rectal suppositories such as bisacodyl or glycerin.

Front 71

Mrs. Keene is a hospice patient and is dependent for pain management on opioid analgesics which slow her gastric motility and cause chronic constipation. Which of the following do you expect the physician to order?

a. Lifestyle changes

b. Routine laxative administration

c. Suppositories each evening

d. Reduction in the opioid analgesic.

Back 71

b Many patients with cancer require moderate to large amount of opioid analgesics for pain control. The analgesics slow GI motility and cause constipation. These patients often need a bowel management program that includes routine laxative administration.

Front 72

Parents should be advised not to give children any laxative more than _________ per _________ without consulting a healthcare provider.

Back 72

Once per week

Front 73

Mrs. Smiths child presents to the pediatricians office with her daughter who is 4 yrs old and suffers from constipation. The physician does not order a laxative. You are responsible for the clients education plan. Which of the following would you encourage Mrs. Smith to do?

a. Increase her daughters intake of fluids and high fiber foods

b. Encourage a sedentary lifestyle for her daughter

c. Decrease her daughters exercise because it leads to dehydration and constipation.

d. Increase pectin in her daughters diet.

Back 73

a Constipatoin is resonsible for 3% of visits to the pediatric clinics and up to 30% of visits to pediatric gastroenterologists. As in adults, increasing fluids high fiber foods and exercise is preferred when possible.

Front 74

Mrs. Belt is diagnosed with congestive heart failure. She suffers from periodic constipation. You are responsible for her education plan. Which of the following substances should she avoid using?

a. Suppositories

b. Milk of Magnesia

c. Saline cathartics

d. Colace

Back 74

b Saline cathartics containing sodium salts are contraindicated in patients with edema or congestive heart failure because enough sodium may be absorbed to cause further fluid retention and edema.

Front 75

Oral use of mineral oil may cause potentially serious adverse effects such as which of the following? (select all that apply)

a. Decreased absorption of fat soluable vitamins

b. Decreased absorption of some drugs

c. Hypertensive crisis

d. Lipid pneumonia if aspirated into the lungs

Back 75

a, b, d Oral use of mineral oil may cause potentially serious adverse effects. Ex. decreased absorption of fat soluble vitamins and some drugs lipid pneumonia if aspirated into the lungs.