Gi - Laxatives/cathartics

Front 1

Greatest potential for cramping?

Should not be used with fecal impactions?

3 types of stimulants?

Which is hydrolyzed to ricinoleic acid?

Back 1

Stimulants for both

anthraquinones (senna, cascara)
diphenylmethanes (bisacodyl)
castor oil

castor oil

Front 2

How fast do the stimulants work?

Pt comes in complaining of urine discoloration and cramping; what laxative are they using?

Why should breast-feeding moms be careful with senna/cascara?

How can you get bisacodyl to act faster?

Back 2

2-8 h.

senna/cascara (stimulant)

passes into breast milk

suppository (.5-2 h)

Front 3

Examples of osmotic agents?

How fast do they work?

Which ones work over 1-3 days?

Which one used for hyperammonemia?

Back 3

Mg salts, Na PO4 (Fleets), lactulose, sorbitol/mannitol

6-8 h.

lactulose, sorbitol, mannitol

lactulose

Front 4

What drugs do they interact with?

Be careful in _______ and _______ pts.

Tx for chronic constipation?

Increased bulk/volume = ______ motility.

Back 4

diuretics (electrolyte changes)

CHF, renal

bulk-forming - fiber, psyllium, Metamucil, Citrucel,

increased motility

Front 5

AE's of bulk forming?

How do you get around it?

Which drugs are surfactant agents? (stool softeners)

Pt comes in, c/o hard stools and hemorrhoids:

Back 5

bloating/obstruction

drink lots of H2O

docusate salts, mineral oil

give stool softeners

Front 6

How fast do surfactants work?

AE's?

Which drug is a partial serotonin Type-4 partial agonist?

MOA?

Back 6

1-3 d.

abd cramping, "mineral leak" out the butt

Zelnorm (tegaserod)

stimulates peristalsis

Front 7

ST-4 agonists: AE's, and careful in which patients?

PGE1 Analog, name one:

increases _______ and _________.

Back 7

hypotension, dizziness -

any pt prone to these AE's - angina, orthostatic hypotension

Lubiprostone (Amitiza)

fluid secretion, motility

Front 8

Lubiprostone used for ___________.

BM's within ________, max effect in __________.

Back 8

chronic constipation

24 h, max effect 1 week

Front 9

Pt going to surgery next day, what to give today?

Mechanism?

How fast?

Back 9

PEG's (polyethylene glycol)
PEG, Colyte, GoLytely (terrible name!), Miralax

osmotic pull of H2O into intestine

within 1 h., done after 2-3 h.

Front 10

Which laxatives used first?

Limit stimulant laxative use to ______.

Use for bowel prep for surgery:

Back 10

fluid, fiber, bulk forming, stool softeners

7 days

PEGs

Front 11

Tx of IBS/diverticular disease:

Tx of 45 y/o pt, 1 stool/day, non-exercise, on Tums, large normal stools:

Which laxative don't you need to use?

Back 11

bulk forming

increase fluids, off Tums, bulk-forming: (Metamucil, Dulcolax)

Stimulants

Front 12

Tx of 27 y/o osteosarcoma pt, chronic narcotics and pain meds, never had/not c/o constipation:

Tx of 65 y/o, chronic constipation, pencil-thin stools, 1 stool/3 days:

Back 12

stool softener, bulk forming, NO STIMULANTS

SCOPE: maybe cancer
give stool softener, bulk-forming

Front 13

52 y/o, colonoscopy in the morning, maybe F/U surgery; what do you do?

Back 13

Give PEGs night before, NPO for 12 hrs.