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15 Cards in this Set
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Bulk forming laxatives (should be taken w/ adequate fluids)
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mao - hyd sub increase stool bulk, reduce stool consistency by increase retention of water in stool. increase stool in pt w/ diarrhea.
Indications - chronic Onset - PO: 12-72 hr ADR - gas, bloating, esophageal/colonic obstruction Precaution - avoid people taking opioid Drug - Psyllium, poycarbophil, methycellulose, wheat dextrin |
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Stimulating laxatives (one time bases, not for long period of time)
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Mao - increase intestinal peristaltic activity of nerve plexus of intes sm muscle. cause local mucosal irritation. decrease reabsorption of water and electrolytes from large intestines
Indications - acute, opioid induced Onset - po 6-12 hr, pr 15-60m ADR - cramping, diarrhea, excessive fluid loss w/ chronic use Drugs - bisacodyl, senna |
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Saline osmotics (quick fast onset) (reports of acute phosphate nephropathy w/ fleets po)
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Mao - retain water in the intestinal lumen by create an osmotic gradient
Indications - acute constipation Onset - po: 1-6 hr, pr 15-60m ADR - cramping, excessive fluid loss, hypovolemia, electrolyte disturbances, hypermagnesemia, hyperphosphatemia Precaution - renal failure pt due to mag and phosphate salts, cardiac pt due to sodium salt Drugs - magnesium citrate, magnesium hydroxide, sodium/potassium phosphate |
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Osmotic laxatives
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Mao - retain water in the intestinal lumen by creating an osmotic gradient
Indications - acute/chronic Onset - po 24-48 h, pr 15-60 m ADR - cramping, bloating, gas, nausea-lactulose and sorbital are nauseatingly Drugs - Lactulose (liq), sorbital, peg 3350 (powder glycerin (supp) |
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Stool Softeners
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Mao - Soften stool by enhancing interaction of water with stool
Indications - Adjuncts to prevent straining, exacerbation of hemorrhoids Not for acute constipation Onset - PO 24-72 h Precaution - Do not give with mineral oil- increases absorption Drugs - Docusate Na And docusate Ca |
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Lubricants
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Mao - Coat stool, inhibit colonic reabsorption of water, increase stool weight and decrease colonic transit time
Indications - Acute and chronic Onset - PO 48-72h PR 15-60 m ADR - Aspiration pneumonia Decreased absorption of fat soluble vitamins (A, D, E, K) Leakage thru anal sphincter Precaution - Avoid in debilitated pt- may aspirate Do not give with docusate- may increase absopt. Of mineral oil Drugs - Mineral oil |
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Peripheral mu-opioid receptor antagonist
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Mao - Antagonizes effects of opioids binding to peripheral mu-opioid receptors, counteracts decreased peristaltic effects of opioids
Indications - Refractor opioid induced contipation (methylnaltrexone) Prevention of post-operative ileus Alvimopan Onset - Subcut 0.5-4h Adr - Abdominal pain Gas Dizziness Nausea Increased risk of MI’s (alvimopan)- it is available thru restricted access to healthcare facilities only Drugs - Methylnaltrexone alvimopan |
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Loperamide & Diphenoxylate
Structurally- related to meperidine & fentanyl anti-motility |
Mao - Dexrease intestinal motility thru actions on peripheral mu-opioid receptor.
Dose/indic - antimotility Precaution - Poor CNS Penetration No pain Relief |
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Diphenoxylate 2.5mg & atropine 0.025mg (lomotil)
antimotility |
Dose/indic - 2 tabs PO after 1st LBM, then 1 tab after each LBM, NTE 8tabs/day, for antimotility
ADR - Anti-cholinergic S.E. Blurred vision, Confusion, Dry mouth, Urinary retention Precaution - Atropine dose is subtherapeutic- only to reduce abuse potential |
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Loperamide (Imodium A-D)
antimotility |
Dose/indic - 4mg PO after 1st LBM, then 2 mg PO after each LBM, NTM 16 mg 8 Caps/day, antimotility drug
Precaution - Can exceed the usual ax dose in certain situations (chemo-induced diarrhea) |
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Tincture of opium
Schedule II antimotility |
Dose/indic - 10% solution= morphine 10mg/cc
tincture= 19% alcohol , antimotility |
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Paregoric- camphorated tincture of opium
Schedule III antimotility |
Dose/indic - Morphine 0.4 mg/cc 45% alcohol, antimotility
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Bismuth Sabsalicylate
(pepto-bismol, kaopectate) Anti-secretory |
Mao - Anti-secretory, Anti-inflammatory, Anti-bacterial effects
Dose/indic - Indigestion, abdominal craps, Diarrhea, Travelers diarrhea, H.pylori eradication, 524 mg PO Q30-60 m, up to 8 doses/day 524 mg PO QID-TID prophylaxis Adr - Bismuth discoloration Blackish tongue, stools. Harmless Bismuth encephalopathy Anxiety, confusionHA, Slurred speech, muscle weakness, facial spasms, salicylate toxicity hearing loss tinnitus Precaution - Bleeding potential Pts on anticoagulants Thrombocytopenia, Pregnancy 3rd trimester, Children’s Reye’s syndrome, Allergies salicylate, asprin, NAIDS Probenecid (interferes with uricosuic effects |
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Octreotide (Sandostatin)
antisecretory |
Mao - Somatostatin analog that decreases GI peptide secretions, GI motility & increases water absorption
Dose/indic - Chemo-induced diarrhea, Graft vs. host disease diarrhea GI peptide-secreting tumors, antimotility drug 100-150mcg subcut/slow IVP Q8H Titrate by 100mcg/dose Q48h up to a max of 500mcg subcut Q8h ADR - Abdominal cramps Nausea (mild), Hypoglycemia (high doses in type I DM) Hyperglycemia ( in type II DM or non-diabetics) Injection site reactions |
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Bulk formers- psyllium Polycarbophil Metamucil fibercon
Absorbants |
Mao - Absorb colonic water, reduce liquidity of stool
Dose/indic - Polycarbophil: 2 caps PO daily-QID Psyllium: 5-15cc PO up to TID Adr - Bloating Gas Esophageal/colonic obstruction Hives Bronchospasm (psyllium Precaution - Separated by 2 hrs from other meds |
