Gastrointestinal Pharmacology Ii: Therapeutic Management Of Diarrhea And Constipation

Front 1

Laxative Agents include:
a)
b)
c)
d)
e)
f)

Back 1

Laxative Agents include:
a)Bulk-Forming agents: Citrucel, Fiberall, Metamucil
b)Lubricants: Kondremul, mineral oil (various)
c)Emollients/Surfactants/Stool Softeners: Colace
d)Osmotics: Lactulose, glycerin (various)
e)Saline: Philips Milk of Magnesia, Fleet Phospho Soda, citrate of magnesia
f)Irritant/Stimulant: Senna, Cascara sagrada, phenolphthalein, bisacodyl, castor oil (various)

Front 2

Bulk-Forming agents include:

Back 2

Bulk-Forming agents include:
Citrucel, Fiberall, Metamucil

Front 3

Bulk-Forming agents
cautions:

Back 3

Bulk-Forming agents
cautions: patients who must restrict fluid intake, at risk for fecal impaction/intestinal obstruction, sugar content for diabetic patients

Front 4

Bulk-Forming agents
contraindications

Back 4

Bulk-Forming agents
contraindications: fecal impaction, undiagnosed abdominal pain, adhesions/ulcerations in GI tract

Front 5

Bulk-Forming agents
drug interactions:

Back 5

Bulk-Forming agents
drug interactions: warfarin, digoxin, salicylates - decreased absorption due to physical binding

Front 6

Lubricants include:

Back 6

Lubricants include: Kondremul, mineral oil (various)

Front 7

Lubricants
adverse efects:

Back 7

Lubricants
adverse efects: lipid pneumonia (aspiration), rectal seepage

Front 8

Lubricants
drug interactions:

Back 8

Lubricants
drug interactions: oral contraceptives, warfarin, digoxin, fat-soluble vitamins (ADEK) - impaired absorption
*consider malabsorption of Vit K to fetus in pregnant women (caution)

Front 9

Emollients/Surfactants/Stool Softeners include:

Back 9

Emollients/Surfactants/Stool Softeners include: Colace, docusate salts (various)

Front 10

Osmotics include:

Back 10

Osmotics include: Lactulose, glycerin (various)

Front 11

Osmotics
adverse effects:

Back 11

Osmotics
adverse effects: flatulence, cramps, diarrhea, fluid/electrolyte imbalances, rectal irritation, burning

Front 12

Osmotics
cautions:

Back 12

Osmotics
cautions: DIABETIC - high sugar content of lactulose

Front 13

Saline includes:

Back 13

Saline includes: Philips Milk of Magnesia, Fleet Phospho Soda, citrate of magnesia

Front 14

Saline
adverse effects:

Back 14

Saline
adverse effects: serious fluid/electrolyte imbalances with chronic misuse or overdosage

Front 15

Saline
cautions:

Back 15

Saline
cautions:
a. children < 6 y/o (oral use) or rectally to infants < 2 y/o
b. patients with impaired renal function
c. patients with CHF/hypertension/edema/cirrhosis (sodium-containing agents)

Front 16

Saline
drug interactions:

Back 16

Saline
drug interactions: MAGNESIUM-CONTAINING products may DECREASE the absorption of warfarin, digoxin, chlorpromazine, tetracyclines

Front 17

Irritant/Stimulant include:

Back 17

Irritant/Stimulant includes: Senna, Cascara sagrada, phenolphthalein, bisacodyl, castor oil (various)

Front 18

Irritant/Stimulant
adverse effects:

Back 18

Irritant/Stimulant
adverse effects:
a. significant FLUID/ELECTROLYTE LOSS with chronic misuse or overdosage, severe abdominal cramping
b. castor oil causes violent purgation with therapeutic doses
c. phenolphthalein may cause skin rash which requires discontinuance of the drug
d. bisacodyl suppositories: proctitis; inflammation

Front 19

Irritant/Stimulant
cautions and considerations:

Back 19

Irritant/Stimulant
cautions and considerations:
a. contraindications:
1. intestinal obstruction; possible appendicitis
2. castor oil in pregnant and menstruating women
b. NOT recommended in children less than or equal to 6 y/o
c. habit-forming; chronic use may result in laxative dependence and cathartic colon
d. DO NOT USE AS INITIAL THERAPY or for more than 1 week in duration; cascara, senna and phenolphthalein may DISCOLOR urine.

Front 20

Therapeutic Management of Constipation - Non-pharmacologic includes:
1.
2.
3.
4.
5.
6.

Back 20

Therapeutic Management of Constipation - Non-pharmacologic includes:
1. Increased dietary fiber (20-35g/day)
2. Adequate fluid intake (4-6 glasses of water daily)
3. Daily exercise
4. Education
5. Responding to urge to defecate
6.Identify and treat the underlying cause

Front 21

Therapeutic Management of Constipation - Pharmacologic (General approach to laxative therapy) includes:
a.
b.
c.
d.
e.
f.

Back 21

Therapeutic Management of Constipation - Pharmacologic (General approach to laxative therapy) includes:
a. ALL LAXATIVES contraindicated in presence of abdominal pain/cramps, n/v, fever
b. USE FOR LESS THAN 1 WEEK
c. should not be used to treat constipation of intestinal pathology (e.g. obstruction) or due to laxative abuse
d. AVOID USE IN INFANTS AND CHILDREN IF POSSIBLE
e. rectal administration generally reserved for emptying colon prior to procedure
f. single ingredient products effeective and safer than combination products

Front 22

Therapeutic Management of Constipation - Clinical Indications includes:
1.
2.
3.
4.
5.
6.
7.
8.
9.

Back 22

Therapeutic Management of Constipation - Clinical Indications includes:
1. acute constipation
2. chronic constipation
3. pediatrics: for acute constipation
4. constipation following prolonged bed rest, hospitalization, or due to reduced muscle tone in elderly patients
5. constipation during pregnancy and post-partum
6. constipation associated with use of narcotic analgesics
7. to prevent straining with defecation for patients at risk of further problems i.e. MI, anal fissures, hernias, colorectal surgery
8. prevention of constipation, not treatment
9. acute evacuation of bowel as pre-op preparation/poisoning emergency

Front 23

Laxative Abuse
Abuse occurs WHEN:

Back 23

Laxative Abuse
Abuse occurs when:
1. Patient attempts to have "normal" bowel movements
2. Not enough fiber and water in diet
3. False belief of frequent bowel movements necessary
4. Eating disorders/binge eating

Front 24

Laxative Abuse
Abuse usually occurs IN the following:

Back 24

Laxative Abuse
Abuse usually occurs IN the following:
1. Usually women with eating disorders
2. Young to middle age (women) in jobs related to medicine
3. Children given laxatives as a form of abuse (POLLE SYNDROME)

Front 25

Laxative Abuse
Effects of laxative abuse:

Back 25

Laxative Abuse
Effects of laxative abuse:
1. can damage muscular function of bowel, drains water, vitamins, and minerals, affect other medications
2. MOST DANGEROUS: include products with CASCARA SAGRADA, BISACODYL, CASTOR OIL, SIENNA, AND PHENOLPHTHALIEN
3. SAFEST LAXATIVES are BULK-FORMING that contain PSYLLIUM (i.e. Metamucil and Fibercon)