Self Care

Front 1

contributing factors to constipation include travel, diet, and exercise (less exercise).

Back 1

true

Front 2

prenatal vit. cause constipation bc it contains?

Back 2

iron and calcium

Front 3

avoidance of deffication due to ______ can cause constipation

Back 3

hemorrhoids, anal fissure or fistuale

Front 4

diseases that may cause constipation

Back 4

IBS, diabetic neuroapthy, chronic renal failure, parkinson's disease

Front 5

Drugs that cause constipation

Back 5

analgesics (opiates, NSAIDs),
anticholingers (antihistamines, benztropine, phenothiazines, TCAs),
calcium or aluminum containing antacids, clonidine,
non-k sparring diuretics, ganglionic blockers,
iron supplements,
skeleltal muscle blockers, polystyrene sodium sulfonate,
abuse of stimulant or irritant laxatives.

Front 6

treatment of constipation

Back 6

dietary modification.
if there is no organic cause: fiber (10-15g/d), fluids (atleast 8 glasses/day of non-caffeinated beverage), aerobic exercise. (increased bulk soften the stool)-->trial for atleast 1 month.

Front 7

Laxatives:
Bulk laxatives: (swell in intestinal fluid)
Indication:

Back 7

AN EMOLLIENT
safest of prolonged use.
-only for pts. who cannot or will not inc. dietary fiber intake
-only laxative class that can be used for a long time periods.
-not absorbed systemically (no systemic a.e)
-must be taken with 1 full glass of water (so as to form the emolient)
methylcellulose (citrucel, calcium polycarbophil (FiberCon), malt soup extract (Maltsupex)

Front 8

Bulk laxatives:
not indicated for:

Back 8

-pts who can not take in fluids.
-people with parital intestinal obstruction, fecal impaction, or swallowing difficulties

Front 9

bulk lax. can dec the absorption of

Back 9

digoxin, warfarin or salicylates (take lax 3h later)

Front 10

bulk lax onset of action

Back 10

12-72h

Front 11

Laxatives:
emollient lax. (stool softeners). how does it work?

Back 11

surfactants; soften fesces by facilitating the mixing of aqueous and fatty substances in the intestine
docusate sodium (colace), kaopectate stool softener

Front 12

indication of emollients

Back 12

when straining at stool should be prevented.

Front 13

A.E. of emollients

Back 13

it is minimally absorbed, transient GI cramps are the most common adverse effects.

Front 14

emollients can inc. the absorption of other agents

Back 14

reserpine, digoxin, warfarin, mineral oil.

Front 15

emolients onset of action

Back 15

1-3 days

Front 16

Laxative:
Mineral Oil

Back 16

lubircant laxatives:soften feces by coating and preventing reabsorption of water

Front 17

Indication for mineral oil

Back 17

for short term use when straining at stool should be avoided.

Front 18

mineral oil onset of action

Back 18

6-8 hours

Front 19

A.E. of mineral oil

Back 19

works in 6-8h, aspiration can occur if taken while reclining (take atleast 30 min. prior to bedtime)

Front 20

mineral oil contraindicated in:

Back 20

pts with GERD, difficulty swallowing, hietal hernia (like the messed up tire)

Front 21

mineral oil can inh. the absorption of

Back 21

warfarin, o.c., fat-soluble vitamins

Front 22

Laxatives:
saline laxative

Back 22

non-absorbable ions; osmotic effect draws fluid into the insestine to increase intraluminal pressure and mechanically stimulate motility
magnesium citrate, magnesium hydroxide (Philip's MOM), magnesium sufate (Epsom Salt), dibasic sodium phosphate (Fleet), monobasic sodium phosphate (Fleet)

Front 23

indication for saline lax

Back 23

only for acute evacuation of the bowel (colonoscopy)

Front 24

onset of action for saline lax.

Back 24

1-6 h

Front 25

magnesium contain lax (saline lax) are contraindicated in:

Back 25

pts. with ileus, intestinal obstruction, heart block, renal failure

Front 26

sodium containing lax (saline lax) are contraindicated in

Back 26

pts. with CHF, cirrhosis, and fluid restriction

Front 27

Laxatives:
glycerin suppositories

Back 27

hyperosmotic lax; exert both osmotic (glycerin) and irritant (sodium stearate) effects. (works w/i 30min.)

Front 28

Laxative:
stimulant lax (most often abused)

Back 28

stimulate peristalsis by local irritation and by stimulating fluid and electrolyte secretion

Front 29

onset of action for stimulant lax

Back 29

6-12h

Front 30

stimulant lax should not be used for longer than

Back 30

1 week, chronic use can cause cathartic colon

Front 31

adverse effects of stimulant lax.

Back 31

severe cramping, fluid and electrolyte imbalances, and malabsorption

Front 32

a.e. of stimulant laxative

Back 32

it is absorbed systemically and can be excreted in urine and breast milk.

Front 33

Stimulant lax. Senna.

Back 33

activated in colon by bacteria, effects limited to colon

Front 34

a.e. of senna (solid, grannules, syrup, suppository)

Back 34

chronic use can cause brown pigmentation of the colon and discolor urine pink to red.

Front 35

stimulant lax. bisacodyl (correctol)

Back 35

diphenlymethamine; stimulates mucosal nerve plexus of colon (inc. peristalsis)

Front 36

onset of action for bisacodyl

Back 36

6-10h

Front 37

a.e. of bisacodyl

Back 37

~5% absorbed, chronic use can cause metabolic acidosis or alkalosis, hypocalcemia and malabsorption

Front 38

stimulant lax. castor oil (neoloid) prodrug

Back 38

hydrolyze to ricinoleic acid by lipase; stimulate secretion of fluid and electrolytes into the s.i.

Front 39

indication for castor oil

Back 39

only for acute bowel evacuation

Front 40

onset of action for castor oil

Back 40

2-6h

Front 41

Four general cause of diarrhea: inc. luminal osmolality.
eg:?

Back 41

-nonabsorable solute in intestine
-osmotic effect promotes retention of fluid in intestine, stimulates peristalsis eg:magnesium antacid, lactase def.

Front 42

Four general cause of diarrhea: increased chloride secretion.
eg?

Back 42

fluid follows sodium chloride into the intestine eg: bacterial toxins, lax. abuse

Front 43

Four general cause of diarrhea: increased intestinal motility.
eg?

Back 43

dec. contact time for fluid reabsorption to occur
eg: diabetic neuropathy, ibs

Front 44

Four general cause of diarrhea: exudative diarrhea
eg?

Back 44

inflammation of the intestinal mucosa (defective fluid reabsorption) eg: UC, laxative abuse

Front 45

Treatment of diarrhea: oral rehydration solutions.
indications?

Back 45

for mild to mod. diarrhea if pt. is not vomiting. rehydration tx should be started first if pt. has signs of dehydration

Front 46

ORS.
sodium conc. > 50 mEq/L can induce?

carbohydrate conc. > 30g/l can induce

Back 46

-hypernatremia

-diarrhea

Front 47

treatment of diarrhea. Loperamide.
MOA

Back 47

binds to opiod receptors in intestinal neurons, dec. GI motility and secretion of fluid and electrolytes

Front 48

A.E of loperamide

Back 48

H.A., drowsiness, and ab. pain

Front 49

loperamide contraindicated in?

Back 49

pts. with infectious diarrhea or ibs

Front 50

recommended usage of loperamide

Back 50

-should not be used for no longer than 48h
-should not be given to children under 6 yrs. of age.

Front 51

Treatment of diarrhea:
Bismuth Subsalicylate (pepto bismol, kaopectate)
MOA:

Back 51

reacts with gastric acid to form bismuth oxychloride (nonabsorbable) and salicylic acid (absorbed systemically)--> both cont. to inc. stool consistency, dec. cramping, and dec. N/V

Front 52

A.E. of B.S.

Back 52

can darken tongue and stool, tinnitus, neurotox.

Front 53

precaution for B.S.

Back 53

should not be taken by children or adolescents following recent flu or viral infection; salicylate allergy; or concurrent use of other salicylates

Front 54

Contraindications of B.S

Back 54

pregnancy-see doc. first

Front 55

Drug interactions of B.S.

Back 55

warfarin, V.A., and methotrexate

Front 56

recommendations for B.S.

Back 56

not recommended for children <12 y.o. w/o physician supervision.