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64 Cards in this Set
- Front
- Back
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What can cause diarrhea?
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spicy foods
spoiled foods fecal impaction bacteria (C coli, Salmonella virus (parvovirus, rotavirus toxins drug reaction laxative abuse malabsoption syndrome caused by lack of digestive enzymes stress and anxiety bowel tumor inflammatory bowel disease such as ulcerative colitis or Crohn's disease |
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What is the max. time you should use antidiarrheals for
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2 days
NOTE: antidiarrheals should not be used if a fever is present |
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Loss of bicarbonate can cause
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metabolic acidosis
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Foods to avoid if diarrhea is present are
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foods rich in fat and milk.
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Nonpharmacologic measures for the tx of diarrhea are:
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Gatorade
Pedialyte or Ricolyte (both for use in children) IV electrolyte solutions. NOTE: aNTIDIARRHEAL DRUGS ARE FREQUENTLY USED IN COMBINATION WITH NONPHARMACOLOGIC TX. |
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If Traveller's Diarrhea becomes severe it is normally tx with:
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Fluoroquinolone (antibiotic)
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Antidiarrheals are classified as what:
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opiates and opiate-related agents.
somatostatin analog adsorbents miscellaneous antidiarrheals. |
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How do opiates work.
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Decrease intestinal motility thereby decreasing peristalsis.
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Common side-effect of opiates is
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Constipation
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Examples of opiates are:
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tincture of opium
Paregoric (camphorated opium tincture) codeine |
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If you take alcohol, sedatives or tranquilizers what can happen when taking opiates.
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CNS depression.
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Duration of action with opiates is approximately how lone
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2 hours
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Which piate has a less potentiall for causing drug dependence than other opiates such as codeine
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Diphenoxylate (Lomotil)NOTE: frequently prescribed for traveler's diarrhea.
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What is Difenoxin (Motofen)
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an active metabolite of diphenoxylate but is more potent than diphenoxylate. It is combined with atropine to decrease ab. cramping, intestinal motility and hypersecretion.
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Loperamide (Imodium) - what is a good thing to note about Loperamide vs Diphenoxylate
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Although it is structurally r/t to Diphenoxylate, it will cause less CNS depression.
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Which clients should not take Dipenoxylate
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Those with severe hepatic impairment. Also
children and older adults are more susceptible to respiratory depression than other age groups taking Dipenoxylate. |
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Diphenoxylate with atropine is an opium agonist with anticholinergic properties (atropine) that decrease GI motility. How long is its onset and duration of action
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45 to 60 minutes
3 to 4 hours. |
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What is Somatostatin Analog/Octreotide (Sandostatin) commonly prescribed for
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Severe diarrhea resulting from metastatic cancer.
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What is the mode of mechanism for Octreotide (Sandostatin)
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inhibits gastric acid, pepsinogen, gastrin, cholecystokinin and serotonin secretions and intestinal fluids and decreases smooth muscle contraction.
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How do Absorbents work
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Coat the side of the wall of the GI tract and absorb bacteria or toxins that cause the diarrhea.
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Absorbant antidiarrheals include
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kaolin and pectin
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Kaolin and pectin and combined in what
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Kaopectate
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Pepto-bismal is considered what
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absorbant because it absorbs toxins.
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CONSTIPATION (Chapter 43 Pharm. Kee)
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x
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Causes of constipation are
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fecal impaction
bowel obstruction chronic laxative use neurologic disorders (paraplegia) ignoring the urge to defecate lack of exercise selected drugs such as anticholinergics, narcotics and certain antacids |
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What is considered a normal bowel movement
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one to three a day to three a week.
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What is a cathartic
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An active purgative, producing bowel movements.
Cathartics result in a soft to watery stool with some cramping - frequently the dosage determines whether the drug acts as a laxative or cathartic. |
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What are laxatives
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promote a soft stool
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What are purgatives
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Harsh cathardics that cause a watery stool with ab. cramping.
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What are the four types of laxatives:
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Osmotics (saline)
Stimulants (contact or irritants) Bulk-forming Emollients (stool softeners) |
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osmotic saline laxatives are
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OSMOTICS
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Do not use saline cathartics on which clients
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CHF
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GoLYTELY can be used with which client
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renal impairment or cardiac disorder
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How does Lactulose work and which type of client would use it
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draws water into the intestines to form a soft stool.
Useful for liver diseases, such as cirrhosis. |
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Clients who have renal insufficiency should avoid which type of laxative
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magnesium salts. Hypermagnesemia can result from continuous use of magnesium salts, causing symptoms such as drowsiness, weakness, paralysis, complete heart block, hypotension, flush and respiratory depression.
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What is the side effect of Lactulose from excess use
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flatulence, diarrhea, ab. cramps, nausea and vomiting.
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who should avoid Lactulose
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diabetics because the lactulose contains glucose and fructose
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How do Stimulant (Contact) Laxatives work
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by irritating sensory nerve endings in the intestinal mucos.
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Types of Stimulant (Contact) Laxatives include
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Ex-Lax
Feen-A-Mint Correctol Bisacodyl (Dulcolx)cascara sagrada senna (Senokot) caster oil |
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Stimulant (Contact) Laxatives normally work within how many hours
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6-12 hours
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The main purpose of caster oil is what and why
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for bowel preparation and produces a watery stool within 2-6 hours.
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What is the onset of action of Bisacodyl
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6-12 hours and within 15-60 minutes with the suppository (rectal) administration.
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What are the side effects of Biscodyl
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nausea
ab cramps weakness reddish-brown urine caused by excretion of phenolphthalein, senna or cascara. |
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Bulk-forming laxatives have an onset of action within
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8-24 hours; however, it may take 3 days after drug therapy is started for the stool to be soft and well-formed.
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Which group of clients can use these bulk-forming laxatives
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diviticulosis
irritable bowel syndrome ileostormy and colostomy |
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Which are examples of bulk-forming laxatives
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Calcium polycarbophil (FiberCon)
Methylcellulose (Citrucel) Fiber granules (Perdiem) Psyllium hydrophilick mucilloid (Metamucil) |
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Onset of action for Metamucil is
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10-24 hours. Peak action is 1-3 days.
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Emollients are
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stool softeners
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How do emollients work
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by lowering surface tension and promoting water accumulation in the intestine and stool.
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Who are emollients typically prescribed for
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clients following MI or surgery. Also given before administration of other laxatives in tx fecal impaction.
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Examples of stool softeners are
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Docusate calcium (Surfak)
docusate potassium (Dialose) docusate sodium (Colace) docusate sodium with casanthranol (Peri-Colace) |
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How do lubricants such as mineral oil work
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increase water retention in the stool. Mineral oil absorbs essential fat-soluble vitamins ADEK. Some of the minerals can be absorbed into the lymphatic system.
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Which client should not take a stool softener
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children, older adults or clients with debilitating diseas because they might aspirate the mineral oil resulting in lipid pneumonia.
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What are the contrainindiatioins to the use of laxatives
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inflammation disorders of GI tract, such as appedicitis, ulcerative colitis, undiagnosed sever pain that could be caused by an inflammation of the intestine(diverticulitis, appendicitis, pregnancy, spastic colon or bowel obstruction.
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QUESTION: C.S. was prescribed diphenoxylate with atropine (Lomotil) 2.5 mg tid
1) is the Lomotil dosage for him within the normal prescribed range and why |
The dosage of 2.5 mg is within acceptable range however it should be given bid not tid. ***CHECK ANSWER CLARE***
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2)What clinical conditions are contrainindicated for the use of Lomotil
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Lomatil should not be used in pts with hepatic or renal disease, glaucoma, severe electrolyte imbalance, or children <2yrs.
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3) What are some of the combination drugs that may be prescribed to control diarrhea. Give advantages and disadvantages
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Motofen (difenoxin with atropine) to tx traveller's diarrhea.
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4) What are at least two otc antidiarrheals. Explain how frequently they should be administered.
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Kaolin-pectin (Kapectoin, Kaopectate) - administer after each loose stool.
Pepto-Bismol - administer PO 2 tab qid ac and hs. Loperamide HCL (Imodium) - does not effect CNS. A: PO: initially 4 mg then 2 mg after each loose stool. |
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5) Give an example of an adsorbent. Do you think C.S. should receive an adsorbent? Explain.
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Pepto-bismol (bismuth salts) -
**** CLARE RETURN TO THIS *** |
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How are paregoric (Camphorated opium tincture) for diarrhea and opium tincture different? What type of antidiarrheal is paregoraic.
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Paregorics decrease intestinal peristalsis.
****Clare return to this answer**** |
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Diphenoxylate (Lomotil) is what type of drug? What are the side effects?
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Antidiarrheal Trade name: Lomotil
Side effects: drowsiness, dizziness, constipation, dry mouth, weakness, flush, rash, blurred vision, mydriasis, urine retinetion. |
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What are the differences between laxatives and cathartics.
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Laxatives promote a soft stool.
Cathartics result in soft to watery stool with some cramping. It is the DOSAGE which determines if the drug acts as a laxative or a cathartic. |
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What is the action of contact (irritant) laxatives? What are the side effects?
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Irritant laxatives increase peristalsis by irritating the sensory nerve endings in the intestinal mucosa.
Side effects: nausea, ab. cramps, weakness, and reddish-brown urine caused by excretion of phenolphthalein, senna or cascara. |
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The client takes a bulk-forming laxative. What instructions should be given?
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Tell pt that defecation usually occurs within 8 to 24 hours; however, it may take up to 3 days after drug therapy is started for the stool to be soft and well-formed. Powdered bulk-forming laxatives should be mixed in water or juice, drank immediately, and followed by half to full glass of water. Not enough water can cause the drug to solidify in the GI tract, which can result in intestinal obstruction. Can be used for the client with diverticulosis, irritable bowel syndrome, and ileostomy and colostomy.
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