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56 Cards in this Set

  • Front
  • Back
contributing factors to constipation include travel, diet, and exercise (less exercise).
prenatal vit. cause constipation bc it contains?
iron and calcium
avoidance of deffication due to ______ can cause constipation
hemorrhoids, anal fissure or fistuale
diseases that may cause constipation
IBS, diabetic neuroapthy, chronic renal failure, parkinson's disease
Drugs that cause constipation
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.
treatment of constipation
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.
Bulk laxatives: (swell in intestinal fluid)
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)
Bulk laxatives:
not indicated for:
-pts who can not take in fluids.
-people with parital intestinal obstruction, fecal impaction, or swallowing difficulties
bulk lax. can dec the absorption of
digoxin, warfarin or salicylates (take lax 3h later)
bulk lax onset of action
emollient lax. (stool softeners). how does it work?
surfactants; soften fesces by facilitating the mixing of aqueous and fatty substances in the intestine
docusate sodium (colace), kaopectate stool softener
indication of emollients
when straining at stool should be prevented.
A.E. of emollients
it is minimally absorbed, transient GI cramps are the most common adverse effects.
emollients can inc. the absorption of other agents
reserpine, digoxin, warfarin, mineral oil.
emolients onset of action
1-3 days
Mineral Oil
lubircant laxatives:soften feces by coating and preventing reabsorption of water
Indication for mineral oil
for short term use when straining at stool should be avoided.
mineral oil onset of action
6-8 hours
A.E. of mineral oil
works in 6-8h, aspiration can occur if taken while reclining (take atleast 30 min. prior to bedtime)
mineral oil contraindicated in:
pts with GERD, difficulty swallowing, hietal hernia (like the messed up tire)
mineral oil can inh. the absorption of
warfarin, o.c., fat-soluble vitamins
saline laxative
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)
indication for saline lax
only for acute evacuation of the bowel (colonoscopy)
onset of action for saline lax.
1-6 h
magnesium contain lax (saline lax) are contraindicated in:
pts. with ileus, intestinal obstruction, heart block, renal failure
sodium containing lax (saline lax) are contraindicated in
pts. with CHF, cirrhosis, and fluid restriction
glycerin suppositories
hyperosmotic lax; exert both osmotic (glycerin) and irritant (sodium stearate) effects. (works w/i 30min.)
stimulant lax (most often abused)
stimulate peristalsis by local irritation and by stimulating fluid and electrolyte secretion
onset of action for stimulant lax
stimulant lax should not be used for longer than
1 week, chronic use can cause cathartic colon
adverse effects of stimulant lax.
severe cramping, fluid and electrolyte imbalances, and malabsorption
a.e. of stimulant laxative
it is absorbed systemically and can be excreted in urine and breast milk.
Stimulant lax. Senna.
activated in colon by bacteria, effects limited to colon
a.e. of senna (solid, grannules, syrup, suppository)
chronic use can cause brown pigmentation of the colon and discolor urine pink to red.
stimulant lax. bisacodyl (correctol)
diphenlymethamine; stimulates mucosal nerve plexus of colon (inc. peristalsis)
onset of action for bisacodyl
a.e. of bisacodyl
~5% absorbed, chronic use can cause metabolic acidosis or alkalosis, hypocalcemia and malabsorption
stimulant lax. castor oil (neoloid) prodrug
hydrolyze to ricinoleic acid by lipase; stimulate secretion of fluid and electrolytes into the s.i.
indication for castor oil
only for acute bowel evacuation
onset of action for castor oil
Four general cause of diarrhea: inc. luminal osmolality.
-nonabsorable solute in intestine
-osmotic effect promotes retention of fluid in intestine, stimulates peristalsis eg:magnesium antacid, lactase def.
Four general cause of diarrhea: increased chloride secretion.
fluid follows sodium chloride into the intestine eg: bacterial toxins, lax. abuse
Four general cause of diarrhea: increased intestinal motility.
dec. contact time for fluid reabsorption to occur
eg: diabetic neuropathy, ibs
Four general cause of diarrhea: exudative diarrhea
inflammation of the intestinal mucosa (defective fluid reabsorption) eg: UC, laxative abuse
Treatment of diarrhea: oral rehydration solutions.
for mild to mod. diarrhea if pt. is not vomiting. rehydration tx should be started first if pt. has signs of dehydration
sodium conc. > 50 mEq/L can induce?

carbohydrate conc. > 30g/l can induce

treatment of diarrhea. Loperamide.
binds to opiod receptors in intestinal neurons, dec. GI motility and secretion of fluid and electrolytes
A.E of loperamide
H.A., drowsiness, and ab. pain
loperamide contraindicated in?
pts. with infectious diarrhea or ibs
recommended usage of loperamide
-should not be used for no longer than 48h
-should not be given to children under 6 yrs. of age.
Treatment of diarrhea:
Bismuth Subsalicylate (pepto bismol, kaopectate)
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
A.E. of B.S.
can darken tongue and stool, tinnitus, neurotox.
precaution for B.S.
should not be taken by children or adolescents following recent flu or viral infection; salicylate allergy; or concurrent use of other salicylates
Contraindications of B.S
pregnancy-see doc. first
Drug interactions of B.S.
warfarin, V.A., and methotrexate
recommendations for B.S.
not recommended for children <12 y.o. w/o physician supervision.