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92 Cards in this Set

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Constipation is characterized by what 3 things?
1. Absent or infrequent bowel movements
2. Difficult passage of hard, dry stools
3. Feeling of incomplete BMs
Which age & gender does constipation affect the most?
Affects ALL age groups, but elderly & pregnant get more.
Women get more than men.
What is normal BM frequency?
There is none; abnormal is simply a departure from normal for each individual
Is daily BM necessary?
NO
If a pt says they are constipated, what should a pharmacists first question be?
What makes you think you are constipated?
What can induce CHRONIC constipation?
Disease states
What can induce constipation besides disease?
Drugs & psychological disorders/lifestyle factors
Which Drugs can induce constipation?
Antacids
Anticholinergics (diphenhydramine)
Antidepressants
OPIATES (COMMON)
iron
Antihyperlipidemics
Benzodiazepines
Phenothizines
Abuse of laxatives
What Psych issues can induce constipation?
Depression
Anorexia nervosa
What lifestyle factors can induce constipation?
Dramatic change in diet
Dehydration
Lack of fiber in diet (MOST COMMON*)
Sedentray lifestyle
Travel
Suppressing defecation reflex
Elderly, children, pregnancy
What are the complications of constipation?
Hemorrhoids
Heart Attack
Elevated BP->Cardiac Arrythmia->Stroke->Death!
What are the exclusions to self-treatment for constipation?
1. Intense pain accompanied by fever, N &/or V (c/b appendicitis)
2. Extended use of laxatives (abuse?)
3. Blood in stool (red blood)
4. Weight loss (only if unplanned/significant)
What are the nonpharmalogical Txs for constipation?
Increase fiber intake
An apple a day (w/ skin!)
Cereal, citrus fruits, apples w/ skins, grains, prunes, dried fruit, raisins, corn, popcorn
Increased fluid intake 8-10 8-oz/day
Pay attn to defec. reflex
What types of laxatives are available for constipation?
1. Bulk-forming
2. Emollient
3. Lubricant
4. Saline
5. Hyperosmotic
6. Stimulant
Which type of laxative provides action that most closely resembles the NATURAL physiological mechanism?
Bulk forming laxatives
Which type of laxative forms an non-absorbable mass in the gut when it mixes w/ water & results in a normal BM
Bulk-forming laxative
Which type of laxative is considered the laxative of choice for most forms of constipation?
Bulk-forming laxative
Which pts are Bulk-Forming Laxatives especially recommended to?
Pts w/ low residue diets
Postpartum women
Pts w/ colostomies
Pt w/ IBS
Pt w/ diverticular disease
Pt who should not strain at stool
What are adverse effects of Bulk-forming Laxatives?
Improperly mixed powder may cause choking, pharyngeal or esophageal obstruction.
Inhalation may cause coughing or bronchospasm.
How long does it take for Bulk forming laxatives to work?
24 hours
What must you caution pts about re B-F-L
Make sure they take in adequate water
What are the 3 main ingredients that make up Bulk forming laxatives?
1. Polycarbophil (Konsyl, fiberlax)
2. Methylcellulose (citrucel)
3. Psyllium (Metamucil, Serutan, Effersyllium, Perdiem, Maltsuprex
What type of laxative is Fibercon?
Bulk forming laxative
What is another name for an emollient?
Stool softener
Which type of laxative is composed of surface active agents that increase the wetting efficiency of intestinal fluids?
Emollients
Which type is laxative is good if you don't/can't drink too much?
Emollients
Which type of laxative is very safe, incl for preg, cardiac, hemorrhoids, HTN, hernias?
Emollients
Onset of action for an emollient?
24-72 hours
Which type of laxative causes oily stools?
Lubricant
Name some lubricant laxatives
Liquid Petrolatum (Mineral Oil)
Kondremil (emulsified)
Name the lubricant laxative ingredients
Docusate Sodium
Docusate Calcium
Onset of action for Lubricants?
8 hours
A serious adverse effect of lubricants to caution pts about?
If take them before bed can aspirate & get lipoid pneumonia
What are saline laxatives?
Non-absorbable salts of Mg & Na
Which laxative causes movement of fluid into the GI tract by osmosis?
Saline
Onset of action for saline laxatives?
30min-3hrs oral
2-5 mins rectal
What is primary indication for saline laxatives?
Bowel cleansing
Can saline laxatives be taken by pregnant?
NO
When are saline laxatives contraindicated?
obstruction/impaction
ileostomy/colostomy
CHF
Renal impaired
Saline laxatives usu have which ingredients?
Mg citrate (Citrate of Magnesia, Citroma)
Mg OH (Phillips MOM, MOM)
Sodium Phosphate (Fleet Phospho-Soda, Ready to Use Enema)
Mg Sulfate (Epsom salts)
Which saline laxatives are often taken at night?
Mg OH- MOM
What ingredients are used for Hyperosmotic laxatives?
Glycerin (Fleet Rectal Applicators)
PEG3350 (Miralax)
What is the only Rte of admin for glycerin?
Rectally
What is a big benefit of glycerin?
NO drug interactions
What is the only side effect of glycerin?
rectal irritation
Glycerin laxatives are used commonly in who?
kids
Onset of action for glycerin laxatives?
15-30 minutes
How do glycerin laxatives work?
Combines osmotic effect w/ local irritation
How do PEG laxatives work?
cause water to be retained in intestines
Does miralax have drug interactions?
NO
What are the side effects of Miralax?
Nausea, bloating, cramping, flatulence, diarrhea-> severe laxative
What type of laxative works by increasing peristaltic activity and irritating mucosa?
Stimulant
Onset of action for stimulants?
8 hrs
Common stimulant laxative ingreds?
Anthraquinones= Casanthranol & Senna(common)
Diphenylmethanes=bisacodyl
Active ingred in metamucil?
psyllium
what type of laxative is Fiber-con?
bulk forming laxative
what type of laxative is citrucel?
bulk forming laxative
active ingred in Serutan?
psyllium
active ingredient in Colace?
docusate sodium
What type of laxative is docusate?
Emollient (stool softener)
what is active ingredient in Purge?
Castor Oil! YUCK!
What age group has highest incidence of diarrhea?
kids
Acute diarrhea= how many hours?
subsides w/in 72 hours
What is most common cause of diarrhea IN U.S.?
IN GENERAL?
IN US=improperly cooked, staff handled raw meat & poor hygiene
IN GENERAL=contaminated water/food, improperly cooked foord, improperly refrigerated food
Most common food sources of diarrhea pathogens?
Fruits, veggies, raw meat, seafood, water, icecubes
Which drugs induce diarrhea?
Broad spec antibx
Laxatives-> esp saline
Misoprosol
Olsalazine
Antineoplastic agents
Cochicine
What are signs of severe dehydration?
Sunken eyes & fontanel
Loss of skin turgor
Fever
Mild orthostatic hypotension
A few ways to treat dehydration (just the ones I wouldn't have thought of, not all!)
Yogurt
BRAT diet (bananas, rice, applesauce, toast)
What Pharm Tx are there for diarrhea?
Loperamide (Imodium)
Adsorbents(ie kaolin)
Bulk laxatives (Metamucil!)
Lactase enzyme
Lactobacillus
Bismuth Subsalicylate (Pepto, Kaopectate)
What are complications of GERD?
Odynaphagia
Esophageal Ulcers or stricture
Hoarseness, laryngitis, pharyngitis, bronchitis
Barretts esophagus
What is a side effect of Bismuth salicylate?
dark/black stools & sometimes tongue!
Who SHOULD NOT take Loperamide?
<2 y.o.
Who should not take pepto?
Pregnant
kids w/ viral infections
anyone who shouldn't take ASA
Primary goal of Tx in GERD?
Relieve sx & decrease tissue exposure to acid reflux
What meds will often help GERD?
Antacids & H2RA
Nonpharm tx for GERD?
elevation of head of bed
no eating b4 bed
avoid fat, choc, mints in pm
Reduce size of meals
avoid spicy, citrus, tomato, coffee
Decrease fluid intake exp beer & alco
reduce aerophagic habits
lose weight
Do antacids inhibit gastric secretions?
NO, just neutralize them
What does Alginic acid do?
Forms viscous protective soltn to prevents GERD sx
How are antacids measured?
ANC - good from 6-60
Which antacids have the shortest duration of action?
sodium bicarbonate
magnesium hydroxide
Which antacids have the longest duration of action?
Aluminum hydroxide
calcium carbonate
Which ingredient is most common in antacids?
magnesium hydroxide
What is the most frequent side effect of antacids?
diarrhea
which antacids causes acid rebound after large doses?
calcium carbonate
chronic use of which antacid can (rare) cause phosphate depletion, osteomalacia, osteopor?
aluminum hydroxide
Who should NOT take sodium bicarbonate antacids?
Pts w/ ulcers!
Alginic acid only works if patient is....
upright!
How can most drug interactions of antacids be prevented
2 hour spacing b/w antacid & other drug
Antacids are safe for whom?
Pregnant, lactating, geriatric w/ precautions, kids w/ advice of MD
What are the 4 H2RAs?
cimetidine
famotidine
nizatidine
famotidine
Name hemorrhoid local anesthetics
benzocaine
benzyl alcohol
dyclonine
lidocaine
pramoxine
tetracaine
Pharmacological txs for hemorrhoids?
Local anesthetics
Vasoconstrictors
Protectants
Astringents
Keratolytics (not rec)
Topical analgesic/antipruritic/anesthetic agents
Corticosteroids
Laxatives