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Constipation and Diarrhea
Lecture 21 and 22
18
Pharmacology
Professional
11/11/2012

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Term
What are different types of diarrhea?
Definition
Increased frequency and decreased consistency
- Acute - <14 days
- Persistant - >14 days
- Chronic - >30 days. Infection, in nursing homes
Term
What are the 4 physiological processes of the gut?
Definition
- Digestion - converts nutrients to usable material
- Secretion - Fluid secreted into GI
- Motility - Secretions moved towards anus by contraction
- Absorption - products of digestion taken into the body
Term
What is the etiology of diarrhea?
Definition
Infectious - traveler's, antibiotics
Non-infectious - Medications, lactose intolerance, fructose, artificial sweetener
Term
What are the 4 changes that can cause diarrhea?
Definition
- Change in ion transport - Secretory. Increased secretion or decreased absorption
- Change in intestinal motility - Osmotic - poor absorption
- Increase in lumenal osmolarity - exudative - mucus and blood
- Increase in hydrostatic pressure - altered intestinal transit - premature emptying
Term
What is non-pharmacologic tx for diarrhea?
Definition
Prevent excessive water, electrolyte, acid-base. Rehydrate and maintain w/ pedialyte.
Symptomatic relief
Diet: D/c solid and dairy
Term
What are pharmacological treatments for diarrhea?
Definition
- Antimotility agents - opiates and derivatives. Diphenoxylate, Loperamide, Paregoric, Difenoxin
- Adsorbents - Kaolin pectin, Polycarbophil, Attapulgite
- Antisecretory agents - bismuth salicylate/pepto bismol (only for 2 days), Octreotide inhibits secretion
- Enzymes - lactase for lactose intolerance.
- Probiotics - decrease antibiotic induced diarrhea
- Antibiotics - for traveler's diarrhea. Cipro, Bactrim, Azith
Term
What is the clinical presentation of constipation?
Definition
Straining, lumpy/hard stools. Sensation of blockage
Term
What are types of constipation?
Definition
- Primary constipation - idiopathic.
Normal transit - difficulty passing
Slow transit - infrequent due to slow transit
Disordered - muscle dysfunction
- Secondary constipation - Lifestyle and age. Disease, Metabolic/endocrine, neurogenic, pregnancy
Term
What is non-pharmacologic tx for constipation?
Definition
- Increase dietary intake gradually
Maintain hydration
Term
How are pharmacologic tx used for constipation?
Definition
Limit self tx to 7 days
Geriatrics - bulk forming laxatives are 1st line
Hospital w/o GI disease - glycerin or milk of magnesia
Term
How are bulk forming agents used for constipation?
Definition
Adds different kinds of fiber. Attempt to be soluble to attract
water and non-fermenting. Drink water!
- Psyllium/Metamucil - natural soluble/insoluble fermentable fiber
- Methylcellulose/Citrucel - soluble fermentable fiber
- Polycarbophil/Fibercon - non-fermentable
**Increase stool mass
Term
How are osmotic agents used for constipation?
Definition
Hyperosmotics that are poorly absorbed
- Sorbitol - increase mass by water retention
- Lactulose - lots of GI AEs
- PEG/Miralax
Term
How are lubricants used for constipation?
Definition
Mineral oil - inhibit abs of water to increase bulk and decr transit time
**NOT recommended for routine use or for geriatrics
Term
How are emollients used for constipation?
Definition
Allows water to interact w/ stool
Docusate/Colace
Term
How do stimulant laxatives work for constipation?
Definition
Directly stimulate peristalsis
- Senokot/Sennosides
- Bisacodyl/Dulcolax
Term
How are saline cathartics used for constipation?
Definition
FAST acting, poorly absorbed ions such as citrate and magnesium. Do not use routinely.
- Magnesium Citrate
- MgOH
- MgSO4 - most potent
- NaPO4/Fleet enema
Term
What Tx for constipation can be used in special populations?
Definition
- Children - Fleet or glycerin, MgOH or senna, Docusate
- Pregnancy - Low risk are PEG, Docusate, and stimulants
Term
What non-OTC therapies are there for constipation?
Definition
- Chronic - Lubiprostone/Amitiza
- Opioid induced - Methylnaltrexone/Relistor
- Colonoscopy - PEG, Osmoprep
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