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