Term
analgesics
anticholinergics
antacids containing calcium carbonate or aluminum hydroxide
calcium channel blockers |
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Definition
| drug induced constipation may be caused by... |
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Term
symptoms are severe
symptoms last > 3 weeks
symtpoms are disabling
red flag symptoms occur:
worsening of constipation
blood in stools
weight loss
fever
anorexia
nausea/vomiting |
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Definition
| when should a patient seek care for their constipation? |
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Term
dietary fiber increases fecal bulk by promoting movement of water into the feces
fluid intake
exercise
don't ignore bowel urges |
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Definition
| non-pharmacologic therapy for constipation |
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Term
bulk forming agents:
methylcellulose
polycarbophil
psyllium
emollients:
docusate sodium
docusate calcium
docusate potassium
latulose
sorbitol
mineral oi. |
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Definition
| agents that cause sofening of feces in 1-3 days |
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Term
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Definition
| agents that result in soft or semifluid stool in 6-12 hours |
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Term
magnesium citrate
magnesium hydroxide
magnesium sulfate
bisacodyl (suppository)
polyethylene glycol 3350 |
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Definition
| agents that cause watery evaculation in 1-6 hours |
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Term
natural: psyllium
semisynthetic: polycarbophil
synthetic: methylcellulose
MOA:
swell in intestinal fluid, forming a gel
aids in fecal elimination
promotes peristalsis
ADRs:
may cause flatulence (less with methylcellulose) and abdominal cramping |
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Definition
bulk producers
examples, MOA, place in therapy, ADRs |
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Term
must be taken with sufficient water (8 oz)
prevents lodging in esophagus |
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Definition
| patient counseling with bulk producers (psyllium, polycarbophil, methylcellulose) |
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Term
cause water to enter the lumen of the colon
osmolar sugars = lactulose, sorbitol, glycerin
lactulose: acidify contents of colon, increase water content of gut, softens stool
glycerin: local irritation, hyperosmotic action
sorbitol and glycerin may be administered rectally
polyethylene glycol 3350:
with electrolytes - bowel prep prior to GI exam
without electrolytes - acute constipation with inadequate response to other agents
ADRs:
may cause flatulence, abdominal cramping, bloating |
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Definition
hyperosmotics
examples, MOA, ADRs |
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Term
MOA:
coat the stool, allowing easier expulsion
oily film keeps stool from losing water
mineral oil:
OTC to be used with caution, it at all
potential aspiration into lungs (lipoid pneumonia)
interference with absorption of fat soluble vitamins |
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Definition
lubricants
examples, MOA, ADRs |
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Term
bisacodyl and senna
MOA:
selective action on nerve plexus of intestinal smooth muscle -> enhnaced motility
rapid onset of effect
ADRs:
may cause cramping
castor oil is infrequently used:
pregnancy category X (uterine contractions/rupture)
breastfeeding - possibly unsafe |
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Definition
stimulants
examples, MOA, ADRs |
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Term
| avoid taking within 1-2 hours of antacids, H2 blockers, PPIs, and milk |
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Definition
| patient counseling on stimulants (bisacodyl and senna) |
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Term
salts of docusate
also known as surfactants or stool softeners
increase surface wetting action on the stool
overall softening effect
reduce friction and make stool easier to pass
not recommended for treating constipation of long duration |
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Definition
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Term
salts of sodium, magnesium, and phosphate
MOA:
pull water into lumen of intestines
increase enteral pressure
magnesium and phosphate may accumulate in patients with renal failure
sodium phosphate concerns:
dehydration, hypernatremia, hyperphosphatemia, acidosis, hypocalcemia, worsening renal function
if CHF or renal dysfunction present, avoid use
OTC products recalled in 2009 |
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Definition
saline agents
examples, MOA, ADRs, contraindications |
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Term
MOA:
partial serotonin (5-HT4) agonist
increased peristaltic activity and intestinal secretion
increase frequency of bowel movements
decrease abdominal discomfort, bloating, straining
availability limited:
emergency situations in women < 55 yo
chronic idiopathic constipation
must meet specific guidelines
post marketing safety evaluation:
risk of stroke, heart attack, unstable angina |
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Definition
| MOA, ADRs of teaserod maleate |
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Term
approved for treatment of chronic idiopathic constipation in adults
MOA:
acts locally on intestinal chloride channels
increases intestinal fluid secretion
increases motility and stool passage
safety data:
contraindicated if history of mechanical GI obstruction or suspected obstruction
only studies x4 weeks
women need negative pregnancy test prior to beginning
ADRs:
N/V, diarrhea, abdominal distention, abdominal pain, flatulence, dyspepsia |
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Definition
| MOA, ADRs of lubiprostone |
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Term
indicated for opioid induced constipation
advanced illness or palliative care
insufficient response to laxative therapy
MOA:
selective anatgonist of opioid binding at mu-receptor with limited ability to cross BBB
ADRs:
abdominal pain, flatulence, nausea, dizziness, diarrhea
contraindicated - known or suspected GI obstruction |
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Definition
| MOA, ADRs of methylnaltrexone bromide |
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Term
chronic administration of hyperosmotics
stimulants reserved for acute failures |
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Definition
| treatment recommendations for constipation due to slow transit |
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Term
| stool softeners or mild laxatives like PEG 3350 |
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Definition
| treatment recommendations for patients with constipation that need to avoid straining due to hemorrhoids, hernia, or MI |
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Term
| children < 6 yo unless prescribed by a physician |
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Definition
| in what age group should laxatives be avoided? |
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Term
bulk producers often used
stool softeners probably safe (poorly absorbed)
lactulose and magnesium products are category B |
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Definition
| treatment recommendations for constipation in pregnancy |
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Term
| should have increase in stool frequency to 3 or more well formed stools per week |
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Definition
| goal of constipation treatment |
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Term
DM - sugar content of laxatives
heart disease - sodium content
kidney disease - saline agents, electrolytes
swallowing difficulties - bulk formers |
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Definition
| cautions of treating constipation in DM, heart disease, kidney disease, and patients with swallowing difficulties |
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Term
symptomatic therapy:
fluid/electrolyte replacement
loperamide, diphenoxylate (Rx only), or absorbent
diet |
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Definition
| treatment of acute diarrhea (< 3 days) with no fever or systmic symptoms |
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Term
check for WBC/RBC/ova/parasites
if negative:
symptomatic therapy (fluid/electrolyte replacement; loperamide, diphenoxylate, or absorbent; diet)
if positive:
use appropriate antibiotic and symptomatic therapy |
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Definition
| treatment of acute diarrhea (< 3 days) with fever or systemic symptoms |
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Term
oral rehydration solution (pedialyte)
consistent intake of water
slow sips
eating as tolerated
flat soft drinks (ginger ale), tea, fruit juice, broth or soup
caution using sport drinks
may not provide adequate electrolytes
severe dehydration may require IV fluid replacement |
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Definition
| fluid and electrolyte replacement for diarrhea |
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Term
attempt to maintain nutrition
provide nutrients and fluide to replace what is lost
chronic diarrhea:
increasing bulk in diet may help
rice, bananas, whole wheat, bran |
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Definition
| dietary modifications for diarrhea |
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Term
calcium polycarbophil (also used for constipation) - for chronic diarrhea
lopoeramide - for acute and chronic diarrhea
diphenoxylate/atropine - for acute and chronic diarrhea
bismuth subsalicylate - for traveler's diarreha and acute diarrhea |
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Definition
| pharmacotherapy for diarrhea |
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Term
calcium polycarbophil:
binds 60x its weight in water
forms gel that enhances stool formation
psyllium and methylcellulose:
reduces fluid in stool
may help in chronic diarrhea |
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Definition
absorbents and bulk agents
examples, MOA |
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Term
absorbs other nutrients and medications
separate from oral medications by 2-3 hours |
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Definition
| patient counseling for calcium polycarbophil (absorbent) |
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Term
MOA:
prolong transite time, reducing amount of fluid lost in stool
loperamide
diphenoxylate with atropine: atropine is abuse deterrent
effective for non-infectious diarrhea
safe from chronic diarrhea
D/C if diarrhea worsens despite therapy |
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Definition
antiperisatltic agents
examples, MOA, indications |
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Term
antisecretory and antimicrobial effects to treat acute diarrhea
avoid if salicylate allergy, including aspirin
stool and/or tongue may turn black |
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Definition
| MOA of bismuth subsalicylate and patient counseling |
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Term
antisecretory
severe, refractory diarreha associated with chemo, HIV, DM, gastric resection, GI tumors
ADRs:
nausea, bloating, pain at injection site
gallstones with prolonged therapy |
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Definition
| MOA, place in therapy, and ADRs of actreotide |
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Term
most traveler's diarrhea and community acquired infections caused by E. coli
routine stool cultures won't identify
ciprofloxacin or levofloxacin empirically
azithromycin for FQ resistance or allergy |
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Definition
| empiric antibiotics used for traveler's diarrhea |
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Term
symptoms resolution usually 48-72 hours
hydration status
chronic diarrhea: symptom control
if antibiotics are used, monitor for completion of course of therapy and ADRs |
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Definition
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Term
| symptomatic treatment including stress management and patient education |
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Definition
| first line treatment for IBS |
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Term
| increase dietary fiber and fluid intake |
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Definition
| treatment of mild IBS with constipation predominant |
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Term
increase dietary fiber and fluid intake
add bulk forming laxatives and consider antispasmotic agents
add serotonin-4 agonists (tegaserod) |
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Definition
| treatment of severe IBS that is constipation predominant |
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Term
increase dietary fiber and fluid intake
add bulk forming laxatives and consider antispasmotic agents
add serotonin-4 agonists (tegaserod) |
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Definition
| treatment of severe IBS that is constipation predominant |
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Term
lactose free, caffeine free diet
counsel patients on other diarrhea inducing foods and drugs to avoid |
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Definition
| treatment of mild IBS that is diarrhea predominant |
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Term
lactose free, caffeine free diet
counsel patients on other diarrhea inducing foods and drugs to avoid
add loperamide or other antispasmodic
add serotonin 3 antagonists (alosetron) |
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Definition
| treatment of severe IBS that is diarrhea predominant |
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Term
antispasmodics:
Dicyclomine
hyoscyamine
propantheline bromide
clidinium bromide plus chlordiazepoxide
hyoscyamine, scopolamine, atropine, phenobarbital
TCAs:
amitriptyline
doxepin
SSRIs:
paroxetine (and others)
bulk forming laxatives:
psyllium
methylcellulose
antimotility agents:
loperamide
5-HT3 receptor antagonists:
alosetron
5-HT4 receptor agonists:
tegaserod |
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Definition
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Term
peppermint oil:
Antispasmodic that relaxes GI smooth muscle
Also relaxes lower esophageal sphincter (reflux)
Matricaria recutita (German chamomile):
Purported to have antispasmodic activity
Can cause drowsiness
Contains coumarin derivatives |
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Definition
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Term
dicyclomine or hyoscyamine
place in therapy:
frequently used to treat abdominal pain with IBS
trial in patients with intermittent post prandial pain
effectiveness remain unconfirmed
ADRs:
blurred vision, constipation, urinary retention, psychosis (rare) |
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Definition
antispasmodics
examples, place in therapy, ADRs |
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Term
TCAs have had some success treating IBS-related pain
independent of mood altering effects
low doses may help with diarrhea or pain
tend to cause constipation, less useful for IBS-C
SSRIs potentially useful due to effects on serotonin in the gut
paroxetine, fluoxetine, sertraline, citalopram
may benefit IBS-C or IBS with mood disorder
pain and global symptoms |
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Definition
| antidepressants used for IBS |
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Term
may improve stool passage in IBS-C
not likely to help pain or overall symptoms
psyllium may worsen flatulence and discomfort
methylcellulose less likely to increase gas
may be dose-adjusted in IBS-D to increase stool consistency |
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Definition
| bulk producers use in IBS |
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Term
loperamide inhibits peristalsis and fluid secretion
most useful for IBS-D
improves stool consistency
reduces number of stools
may occasionally aggravate abdominal pain |
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Definition
| antimotility agents use in IBS |
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Term
MOA:
selective 5-HT3 antagonist
indicated for women with severe IBS-D
frequent and severe abdominal pain
frequent bowel urgency or inconticence
restricted daily activities
can improve overall symptoms and QOL
may cause constipation
associated with ischemic colitis
prescribed under strict guidelines with consent form |
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Definition
alosetron
MOA, place in therapy, ADRs |
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Term
MOA:
stimulates 5-HT4 receptors in the GIT
increases intestinal secretion, peristalsis, and small bowel transit
improves global IBS symptoms and altered bowel habits in IBS-C
higher risk of heart attack, stroke, and unstable angina
withdrawn from general use
FDA can authorize use for emergency situtations |
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Definition
tegaserod maleate
MOA, place in therapy, ADRs |
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