34 Drugs used to treat constipation and diarrhea Flashcards
causes of constipation
-improper diet: too little fiber, or too little fluid, lacking fruits and veg
-lack of exercise, sedentary habits
-medications such as morphine, codeine, oxycodone, anticholinergic agents
Diarrhea: enzyme deficiencies- pt’s w/ deficiencies of digestive enzymes (ex: lactase or amylase) have difficulty with this
digesting certain foods. Diarrhea usually develops because of irritation from undigested food
Basic assessment: assessing pt and notice inelastic skin turgor, sticky oral mucous membranes, excessive thirst, a shrunken and deeply furrowed tongue, crushed lips, weight loss, deteriorating vital signs, soft or sunken eyeballs, delayed capillary filling, high urine specific gravity, or no urine output, and possible mental confusion, report this
dehydration
Lab studies indicating problems of malabsorption, dehydration and fluid, electrolyte, and acid-base balance show an increase in these
hemoglobin, hematocrit
pt education: medications: when opioids are used regularly this should be given and taken for how long
stool softeners; take as long as opioids are taken
Laxatives: stimulant laxatives: act directly where, causing what
intestine, causing an irritation that promotes peristalsis and evacuation
Laxatives: stimulant laxatives: orally act within how many hours; rectally act within how many min
6-10 hours; 60 to 90 min
Laxatives: osmotic laxatives: what kind of compound; which ones have an onset of action of 24 -48 hrs; which is 15-30 min
-hypertonic- draws water into the intestine from surrounding tissues;
-lactulose and lactitol onset of action 24 -48 hrs
-glycerine (rectal suppository) 15 - 30 min
Laxatives: stimulant laxatives: names
bisacodyl, sennosides A and B
Laxatives: osmotic laxatives: names
lactulose, PEG, glycerin, lactitol
Laxatives: lubricant laxatives: why could preg and geriatric pt use this
there is little cramping accompanying their use
Laxatives: bulk-forming laxatives: for whom would this be the drug of choice
someone who is incapacitated and needs a laxative regularly
Laxatives: stool softeners: used prophylactically how
to prevent constipation or straining at stool
pt recovering from MI or abdominal surgery would use this
stool softener
Peripheral opioid antagonists
methylnaltrexone, naloxegol, and naldemedine
Pts with advanced illness, receiving palliative care who have not responded well to laxative therapy, would use this for their opioid-induced constipation
peripheral opioid antagonists
Pt has undiagnosed abdominal pain or inflammation of the GI tract (possible gastritis, appendicitis, or colitis) should a laxative be prescribed
no
SAE of laxatives on GI
abdominal tenderness; failure to defecate or defecation of only a small amount may indicate the presence of an impaction; also symptoms of an acute abdominal condition
Drug interactions of the laxative Psyllium (Metamucil); why can’t psyllium and salicylates, nitrofurantoin, or digoxin be taken at the same time; how can they be taken
psyllium may inhibit absorption;
take salicylates, nitrofurantoin, or digoxin at least 1 hour before or 2 hours after psyllium
Antidiarrheal agent uses; when to use
-diarrhea is of sudden onset, lasted > 2-3 days, is causing significant fluid and water loss. Young children and elderly should start antidiarrheal therapy earlier
-Post-GI surgery pts who develop diarrhea can use agents to retain fluids and electrolytes
Pt’s with inflammatory bowel disease that develop diarrhea can use
antidiarrheal agents, adrenocorticosteroids or sulfonamides may be used to control the underling bowel disease
SAE of antidiarrheal agents; indications
prolonged or worsened diarrhea- indicates that toxins are present and antidiarrheal agent is causing retention of the toxins. Refer to hcp
