Diarrhea And Constipation

Front 1

What are the four general pathophysiologic mechanisms of diarrhea?

Back 1

Change in active transport by either decreased sodium absoprtion or increased chloride secretion, change in intestinal motility, increased luminal osmolarity, increase in tissue hydrostatic pressure

Front 2

What are the non-pharmacologic treatments for diarrhea?

Back 2

Evaluate medication regimen (d/c meds if possible or make substitution), diet (brat -bananas, rice, apples, toast), rehydration and maintenance of water electrolytes, bulk forming laxatives

Front 3

What are the exclusions from self care for diarrhea?

Back 3

<6 mo old or > 6 mo with perisitent high fever, severe dehydration (8h w/o urination, loss of skin tugor), protracted vomiting, severe abdominal pain, diarrhea lasting > 1 month, blood mucus or pus in stool, high fever, pregnancy

Front 4

What is the MOA of loperamide?

Back 4

Interferes with peristalsis by a direct action on the circular and longitudinal muscle of the intestinal wall to slow motility, increase transit time of intestinal contents (reduces fecal volume, increases the bulk density and viscosity of the feces, decrease the loss of electrolytes and fluids from the body)

Front 5

What is the trade name for loperamide?

Back 5

imodium (related to opiods)

Front 6

What is the duration of action of loperamide?

Back 6

up to 24h

Front 7

What is the indication for loperamide?

Back 7

acute nonspecific diarrhea, including traveler's diarrhea

Front 8

What is the dosing on loperamide?

Back 8

4mg po initially, followed by 2mg po after each uniformed stool. Do not exceed 16mg/d. Should see improvement within 48h

Front 9

What are the drug interactions with loperamide?

Back 9

3A4, combined with opiates can cause severe constipation

Front 10

Should breast feeding pts take loperamide?

Back 10

No, must contact physician first

Front 11

What are the SEs of loperamide?

Back 11

generally well tolerated, epigastric or ab pain, ab distension, constipation drowsiness, dizziness, fatigue, HA, N/V

Front 12

What is the generic for Lomotil?

Back 12

diphenoxylate/atropine

Front 13

What is the MOA of Lomotil?

Back 13

exerts its effects locally and centrally on the smooth muscle cells of the GI tract to inhibit GI motility and slow excess GI propulsion

Front 14

Does diphenoxylate have analgesic properties?

Back 14

no

Front 15

What is diphenoxylate?

Back 15

opiate agonist with a chemical structure similar to meperidine

Front 16

What is the purpose of atropine in Lomotil?

Back 16

added in small quanities to discourage deliverate abuse or overdose of diphenoxylate

Front 17

What is the onset of action for Lomotil?

Back 17

45-60min

Front 18

What is the duration of action for lomotil?

Back 18

3-4 h

Front 19

What are the contraindications for lomotil?

Back 19

monitor for drug interactions with medications hepatically metabolized or drugs that decrease GI motility, should not be given to pts who are dehydrated or have an electrolyte imbalance, should not be given with MAOIs, incompatible with breast feeding

Front 20

What are the adverse effects of lomotil?

Back 20

drowsiness, dizziness, HA, euphoria, depression, malaise/lethargy, restlessness, numbness of extremities, atropinism (dryness of skin and mucous membranes, tachycardia, urinary retention, hyperthermia)

Front 21

What are absorbents indicated for in diarrhea?

Back 21

symptomatic relief (unproven effectiveness)

Front 22

What is the MOA of absorbents in diarrhea?

Back 22

absorb nutrients, toxins, drugs, digestive juices

Front 23

What type of drug is Kaolin-pectin?

Back 23

absorbent

Front 24

What kind of drug is fiber con?

Back 24

can be an absorbent (can be used for diarrhea or constipation)

Front 25

What is the generic name for fibercon?

Back 25

polycarbophil

Front 26

What are the three effects of Bismuth subsalicylate?

Back 26

antisecretory, anti-inflammatory, antibacterial

Front 27

What is the brand name for bismuth subsalicylate?

Back 27

Pepto-bismol

Front 28

What is the MOA of bismuth subsalicylate?

Back 28

Hydrolysis of BSS in the stomach produces salicylic acid which can in turn inhibit prostagladin synthesis (stops secretory diarrhea), shown to prevent bacterial attachment to intestinal mucosa, inactivate enterotoxins and exert a direct antimicrobial effect

Front 29

What are the precautions and contraindications for BSS?

Back 29

subsalicylate allergy, repeated doses of BSS for durations in excess of recommendations can cause salicylate toxicity; stop if tinnitus occurs, avoid use with other salicylates, contact Doc if diarrhea continues longer than 2 days or worsens

Front 30

When should salicylates be avoided during pregnancy?

Back 30

3rd trimester

Front 31

What are the drug interactions with BSS?

Back 31

avoid if on long term salicylate therapy, additive constipation may be seen with concurrent use of opiate agonist and other antidiarrheals

Front 32

What are the adverse effects of BSS?

Back 32

black stool and/or black tongue

Front 33

What are the causes of constipation?

Back 33

lack of fiber in diet, misconception about bowel function (3 in 1 day or 1 q 3 days), not a disease but a symptom of an underlying disease or problem (preg, lack of fiber or fluids, hypothyroid, DM, certain meds)

Front 34

What are the non-pharmacologic treatments for constipation?

Back 34

exercise regularly, increase water intake, increase fiber intake (increase stool bulk, retention of stool water and rate of transit through the intestines; 32g/d of fiber is recommended)

Front 35

What are the exclusions to self care for constipation?

Back 35

severe ab pain, fever, N/V, weight loss, para or quadriplegia, blood in stool, hypothyroidism, gi malignancies

Front 36

What are the non-pharmacologic tx bulk forming laxative listed in class?

Back 36

Citrucel, metamucil, fibercon, and benfiber

Front 37

What is the generic for citrucel?

Back 37

methylcellulose

Front 38

What is the generic for metamucil?

Back 38

psyllium

Front 39

What is the generic for fibercon?

Back 39

polycarbophil

Front 40

What is the generic for benfiber?

Back 40

guar gum

Front 41

What is the MOA of bulk forming laxatives?

Back 41

absorb liquid in the GI tract to form colloidal mixture that softens and increase the bulk of the stool (increased bulk stimulates peristalsis which increase bowel motility and decreases GI transit time)

Front 42

Why is use with recommend amount of fluid important in bulk forming laxative use?

Back 42

impaction can result if not enough fluid intake

Front 43

What kind of treatment is docusate sodium for constipation?

Back 43

emollient laxative

Front 44

What is the moa of docusate sodium for constipation relief?

Back 44

its a surfactant; lowers the surface tension at the oil-water interface of the feces allowing water and lipids to penetrate the stool, helps to hydrate and soften the fecal mater facilitating natural defication, DOES NOT INCREASE motility

Front 45

How long does it take for docusate sodium to work?

Back 45

1-3 days

Front 46

Is docusate sodium effective for tx in constipation?

Back 46

no, it does not increase motility and therefore is only used for prevention and to help avoid straining

Front 47

What is mineral oil classified as in terms of constipation relief?

Back 47

lubricant

Front 48

What is the MOA of mineral oil in constipation?

Back 48

coats stool and allows for easy passage, absorption of water increasing stool weight and decreasing transit time (does not increase motility; good for maintain soft stools and preventing straining)

Front 49

What are the side effects of mineral oil?

Back 49

can absorb systemically and cause foreign body reaction in lymphoid tissue, can aspirate and cause lipoid pnuemonia, decrease absorption of fat soluble vitamins, may leak from anal sphincter causing pruritus and soiling clothing

Front 50

What are lactulose and sorbitol classified as in reference to constipation?

Back 50

hyperosmotics

Front 51

What is the moa of lactulose in constipation relief?

Back 51

intracolonic breakdown of lactulose increases osmotic pressure which causes fluid accumulation that softens the stool and distends the colon, thus enhancing peristalsis

Front 52

How long for lactulose to work?

Back 52

1-2 days

Front 53

Is lactulose first line therapy in constipation?

Back 53

no, it is costly and not any more effective than sorbitol or milk of magnesia

Front 54

What is the dosing for lactulose in constipation?

Back 54

15-20ml po qd for 24-48h; may increase to 60ml/d prn. once a laxative effect has been established, dosing should be reduced to produce 2-3 loose stools qd

Front 55

What is the dosing for sorbitol in constipation?

Back 55

70% solution - 2 to 3 tablespoonfuls po qd; 25-30% sol 120ml rectally qd

Front 56

What are the adverse effects of sorbitol?

Back 56

gaseous distention with flatulence, belching, ab discomfort, cramping ab pain

Front 57

What are senna and bisacodyl classified in terms of laxatives?

Back 57

stimulant laxatives

Front 58

What is the moa of bisacodyl or senna?

Back 58

directly stimulating peristalic movement of the intestine via local mucosal irritation, thus increasing motility

Front 59

What is the onset of action for bisacodyl?

Back 59

6-8h po, 15-60 mins rectally

Front 60

What is the onset of action for senna?

Back 60

6-12h po, 30 min to 2h rectally

Front 61

What is the dosing for senna?

Back 61

dosing varies with formulation

Front 62

What are the adverse effects with senna or bisacodyl?

Back 62

ab pain, faintness, n/v, mild ab discomfort, suppositories may cause rectal burning and mild proctitis, senna relatively free from adverse effects if use occassionally and for short periods of time

Front 63

Which stimulant laxative can cause urinary discoloration?

Back 63

senna can cause discoloration from red--pink in alkaline urine to yellow-brown in acidic urine

Front 64

What are the adverse effects associated with prolonged use of stimulant laxatives?

Back 64

gi irritation, fluid and electrolyte loss, diarrhea, physiological dependence on the laxative. therefore daily use is strongly discouraged

Front 65

What are the saline cathartics?

Back 65

magnesium sulfate, phosphate, and citrate

Front 66

What is the moa of the saline cathartics?

Back 66

osmotic action in retaining fluid in Gi tract, additionally mag stimulates secretion of cholecytokinin which stimulates bowel motility and fluid secretion

Front 67

What is the onset of action for saline cathartics?

Back 67

results in a few hours after po, results in 1 h or less after rectal dose

Front 68

What are saline cathartics primarily used for?

Back 68

acute evacuation

Front 69

What are possible SEs with saline cathartics?

Back 69

fluid or electrolyte depletion, mag and sodium may accumulate if used in pts with renal dysfunction, sodium phos may accumulate if used in pts with CHF

Front 70

What is the moa of glycerin in constipation?

Back 70

osmotic effect on rectum

Front 71

What is the dosing for glycerin in adult constipation?

Back 71

3g rectally

Front 72

What is the moa of Polyethlene glycol-electrolyte lavage solution?

Back 72

osmotic agent that binds water and causes water to be retained within the stool, softens stool consistency, increases stoool frequency, facilitates stool evacuation. DOES NOT AFFECT COLONIC TRANSIT

Front 73

What is the dosing on polyethlene glycol-electrolyte lavage solution?

Back 73

4L of solution administered over 3h. Must be reconstituted with tap water, more palatable if chilled before drinking, do not add flavoring, results see after an hour of start of administration

Front 74

What is the generic name for Amitiza?

Back 74

lubiprostone

Front 75

What is the moa of amitiza?

Back 75

chloride channel activator; action is observed only on the luminal portion of the gastrointestinal epthelium; activation of the CIC-2 channels produces a chloride-rich intestinal fluid secretion without altering serum electrolyte concentrations

Front 76

What is the approved indication for amitiza?

Back 76

use in elderly for chronic idiopathic constipation

Front 77

What is the onset of action in amitiza?

Back 77

usually 1 week but 24h is possible.

Front 78

What is the dosing for amitiza?

Back 78

24mcg po bid with food and water for elderly idiopathic constipation; 8mcg po bid with food and water for IBS-constipation in females >=18yoa

Front 79

What are the adverse effects of amitiza?

Back 79

N/V, HA, Diarrhea

Front 80

What are the contraindications for amitiza?

Back 80

mechanical GI obstruction, diarrhea

Front 81

What is first line for prevention of constipation?

Back 81

bulk forming laxatives, docusate sodium

Front 82

What pts is prevention of constipation very important in?

Back 82

recovering from MI, recovering from rectal surgery, elderly