CH 42: Bowel Disorder Drugs Flashcards
chronic constipation
fewer than three bowel movements per week accompanied by hard stools, straining to pass stools, and a feeling of incomplete evacuation.
s/s of constipation
abdominal distention
discomfort
flatulence
etiology of constipation may be related to:
lack of exercise
insufficient food intake, especially insoluble dietary fiber diminished fluid intake
medication regimen that includes drugs that reduce intestinal motility.
Opioids, anticholinergics, antihistamines, certain antacids, and iron supplements
hypothyroidism, diabetes, and irritable bowel syndrome
Bulk Forming Laxatives therapeutic effects
Psyllium
metamucil
Absorbs water and increase size of fecal mass
Bulk Forming Laxatives adverse effects
Psyllium
metamucil
Abdominal fullness or cramping, fainting
Esophageal or GI obstruction if taken with insufficient fluid
Bulk Forming Laxatives safety
Psyllium
metamucil
Always rule out obstruction before administering
Take with 8 oz of water or liquid
Can swell in the esophagus
Can decrease absorption of warfarin, dig, other medications
Saline and Osmotic Laxatives therapeutic effects
Miralax
Lactulose
Pull water into fecal mass to
create more watery stool
Saline and Osmotic Laxatives adverse effects
Miralax
Lactulose
Diarrhea
abdominal cramping
Hypermagnesemia with magnesium hydroxide
(dysrhythmias, respiratory failure)
Saline and Osmotic Laxatives
Miralax
Lactulose
Dehydration and fluid loss
Electrolyte depletion
Always rule out obstruction before administering
Stimulant Laxatives therapeutic effects
Correctol
Irritate the bowel mucosa
Stimulant Laxatives adverse effects
Correctol
Abdominal cramping
nausea
fainting
diarrhea
Fluid and electrolyte loss
Stimulant Laxatives safety monitoring
Correctol
Always rule out obstruction before administering
Surfactant – stool softener therapeutic effects
Cause more water and fat to be absorbed in
the stool
Surfactant – stool softener adverse effects
Abdominal cramping
nausea
fainting
diarrhea
Fluid and electrolyte loss
Surfactant – stool softener safety monitoring
Always rule out obstruction before administering
Herbal Laxatives therapeutic effects
Senna
Irritates the bowel and increases peristalsis
Herbal Laxatives adverse effects
Senna
Abdominal cramping
diarrhea
No serious adverse effects
Herbal Laxatives safety monitoring
Senna
Always rule out obstruction before administering
Opioid Antagonist Laxatives therapeutic effects
Naloxegol
Block opioid receptors in the colon
decrease opioid related constipation
Opioid Antagonist Laxatives adverse effects
Naloxegol
Abdominal pain
nausea
vomiting
diarrhea
flatulenceGI perforation
opioid withdrawal
Opioid Antagonist Laxatives safety monitoring
Naloxegol
Always rule out obstruction before administering
Mineral oil Laxatives therapeutic effects
Lubricates the stool and colon
Mineral oil Laxatives safety monitoring
uses of antidiarrheals
Post surgical to prevent straining and subsequent intra-abdominal
intraocular or raise blood pressure
People that take medications that cause constipation
Treat constipation
Remove toxins following poisoning or to remove dead parasites in the
intestinal tract following antihelminthic therapy
cleanse the bowel prior to diagnostic or surgical procedures of the
colon or genitourinary tract.
possible causes of diarrhea
medications
infections of the bowel
substances such as lactose.
Inflammatory disorders such as ulcerative colitis, Crohn’sdisease, and IBS, can cause episodes of intense diarrhea.
Antibiotics often cause diarrhea by killing normal intestinal flora, thus allowing an overgrowth of opportunistic pathogenic organisms.
antidiarrheals Opioids: adverse effects
Diphenoxylate with atropine
Loperamide
Immodium
Drowsiness
lightheadedness
nausea
dizziness
dry mouth (from atropine)
constipation
Paralytic ileus with toxic megacolon
**respiratory depression, central nervous
system (CNS) depression
antidiarrheals Opioids: safety monitoring
Diphenoxylate with atropine
Loperamide
Immodium
CNS depression
Opioid overdose
pepto mismol therapeutic effects
lactobacillus
binds to and absorbs toxins
pepto mismol adverse effects
lactobacillus
Constipation
nausea
tinnitus
Impaction
Reye’s syndrome
Stomach gas
diarrhea
abdominal pain
Allergic reactions
octreotide adverse effects
Nausea
diarrhea
abdominal pain
Changes in serum glucose
gallstones
cholestatic hepatitis
nonobstructive dilation of the colon, which can be total or
segmental and is usually associated with systemic toxicity
Toxic megacolon
condition where the motor activity of the
bowel is impaired, usually not associated with a mechanical cause
Paralytic ileus
characterized by the presence of ulcers in the distal (terminal) portion of the small intestine
(Crohn’s disease) or mucosal erosions in the large intestine (ulcerative colitis). Over 1 million
Americans are estimated to have
IBD
most common clinical presentation of ulcerative colitis
abdominal cramping with frequent bowel movements Severe disease may result in weight loss, bloody diarrhea, high fever, and dehydration
patient with Crohn’s disease presents with
abdominal pain
cramping
diarrhea
may have been present for years before the patient sought treatment.
Anti-inflammatory for UC and off label for CD
5-aminosalicylic acid (5-ASA)
Sulfasalazine
5-aminosalicylic acid (5-ASA)
Sulfasalazine
adverse effects
Headache
abdominal pain
diarrhea
nausea
vomiting
rash
flulike illness
allergic reactions
Hepatotoxicity
blood dyscrasias
chronic kidney disease
salicylate hypersensitivity,
crystalluria
(sulfasalazine)
5-aminosalicylic acid (5-ASA)
Sulfasalazine
safety monitoring
Check for allergy to sulfa drugs, ASA, and furosemide
Liver function!!
hypoglycemia
Increased anti-coagulant effect
Dyscrasia!!
defense mechanism used by the body to rid itself of toxic substances.
Vomiting
causes of vomiting
GI infections, food poisoning, nervousness, emotional imbalances, motion sickness, and extreme
pain. Other conditions that promote nausea and vomiting are general anesthetics, migraines,
trauma to the head or abdominal organs, inner ear disorders, and diabetes. Psychologic factors
Pregnancy
because the vomiting center lies in the brain, nausea and vomiting may occur with parenteral
formulations as well as with oral drugs
anti-neoplastic drugs
common reason for non-compliance to medications
Antiemetics: Anticholinergics and Antihistamines
(diphenhydramine)
adverse effects
Drowsiness
dry mouth
blurred vision (scopolamine)
Hypersensitivity reaction
sedation
tremors
seizures
hallucinations
paradoxical excitation (more common in children)
hypotension
Antiemetics:
Benzodiazepine
(Lorazepam)
adverse effects
drowsiness
ataxia
fatigue
slurred speech
Paradoxical excitation (more common in children)
seizures (if abruptly discontinued)
coma
Antiemetics: Cannabinoids
(Dronabinol)
adverse effects
Dizziness
drowsiness
euphoria
confusion
ataxia,
asthenia,
increased sensory awareness
Paranoia,
decreased motor coordination,
hypotension
Anitemetics: Corticosteroids adverse effects
Mood swings,
weight gain,
acne,
facial flushing,
nausea,
insomnia,
sodium and fluid retention,
impaired wound healing,
menstrual abnormalities,
insomnia
Peptic ulcer,
hypocalcemia,
osteoporosis with possible bone fractures,
loss of muscle mass,
decreased growth in children,
masking of infections
antiemetic: Neurokinin receptor antagonists
aprepitant adverse effects
Fatigue,
constipation,
diarrhea,
anorexia,
nausea,
hiccups
Dehydration,
peripheral neuropathy,
blood dyscrasias,
pneumonia
Antiemetic: Phenothiazine and phenothiazine like
(promethazine)
adverse effects
Fatigue,
constipation,
diarrhea,
anorexia,
nausea,
hiccups
Dehydration,
peripheral neuropathy,
blood dyscrasias,
pneumonia
*Mix with normal saline
Antiemetics: Serotonin receptor antagonists
(odansetron) adverse effects
Headache,
drowsiness,
fatigue,
constipation,
diarrhea
Dysrhythmias
EPS
