ch 65 Flashcards by Brittany Blackston

production of a soft, formed stool over a period of 1 or more days

laxative effect

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prompt, fluid evacuation of the bowel

catharsis

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hard stools, infrequent stools, excessive straining, prolonged effort, a sense of incomplete evacuation and unsuccessful defacation

constipation - determined more by stool consistency then by how often bowel movements occur

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a common cause of constipation is

poor diet - specifically deficient in fiber and fluid

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other causes of constipation include

pelvic floor dysfunction

anal sphincter dysfunction

slow intestinal transit

IBS

use of certain drugs (opioids, anticholinergics, antacids)

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non-drug help for constipation

increase fiber (fruits and vegetables)

increase fluid

mild exercise - esp after meals

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laxatives safe for infants

docusate
lactulose
glycerin suppositories

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laxatives safe for children and adolescents

milk of magnesia
mineral oil
senna
docusate
bisacodyl

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laxatives safe in pregnancy

no! can induce labor

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laxatives in breastfeeding

Senna is safe

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older adults with laxatives

all can be used

monitor for dehydration

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constipation is determined by

stool consistency (degree of hardness)
not by how often BM occurs

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reason for laxatives in cardiovascular disease

prevent dangerous elevation of BP

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other uses for laxatives

adjunct to anthelmintic therapy (parasites) to get a fresh sample, facilitate export of dead parasites

emptying bowel before surgery and diagnostic procedures
modifying the effluent from an ileostomy and colonoscopy
prevent fecal impaction in bedridden pt
remove ingested poisons
correct constipation with pregnancy and certain drugs like opioids

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contraindications for laxatives

fecal impaction

abd pain, nausea, cramps, signs of appendicitis’

regional enteritis

diverticulitis

surgical abdomen

caution during pregnancy

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what criteria is used for constipation

Rome IV

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what type of laxative works by absorb water which softens and enlarges the fecal mass to promote peristalsis

Bulk forming laxatives

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name the bulk forming laxatives

methylcellulose
psyllium
polycarbophil

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which laxatives use surfactant action softens stool by facilitating penetration of water and also cause secretion of water and electrolytes into intestine

surfactant laxatives

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name surfactant laxatives

Docusate sodium (colace)
Docusate calcium

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Group I agents act

used for

rapidly (within 2-6 hours)

bowel prep

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Group II agents act

used for

intermediate latency (6-12 hours)
stool that is semifluid
most frequently abused

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Group III agents act

used for

slowly (1-3 days)
soft but formed stool
treat chronic constipation and prevent straining

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adverse effect of Bulk forming laxatives and how to prevent

esophageal obstruction can occur if they are swallowed in the absence of sufficient fluid. Swallow with a full glass of water or juice

intestinal obstruction or impaction

what group is bulk forming laxatives in

III

surfactants are group

III

surfactant laxatives should be taken with

a full glass of water

Stimulant laxatives

Bisacodyl (Dulcolax) Senna Castor oil

Stimulant laxatives are group

Oral bisacodyl acts within | Bisacodyl (dulcolax) suppositories act within

6-12 hours | 15 -60 min

What formulation of Bisacodyl (dulcolax) are used to prevent gastric irritation

enteric coated

Bisacodyl (dulcolax) food consideration

milk and antacids accelerate dissolution of the enteric coating so space 1 hour from these

adverse effect of Bisacodyl (dulcolax) suppositories

burning sensation and with continued use proctitis may develop. avoid long term use

what type of lax is Bisacodyl (dulcolax)

stimulant

which stimulant laxative is plant derived

Senna

which laxative causes a yellow brown or pink color to urine, what do you do?

Senna, harmless

Castor oil works on the

small intestine

Castor oil belongs in what group

I (other stimulant lax are in group II)

when should you give castor oil and how

not at bedtime | unpleasant taste, you can chill and mix with fruit juice

high doses of osmotic laxatives-laxative salts are used to

purge the bowel of ingested poisons | evacuate dead parasites after anthelmintic therapy

what are the 2 groups of laxative salts

magnesium salts magnesium hydroxide (milk of magnesia) magnesium citrate magnesium sulfate sodium salt sodium phosphate

Milk of magnesia is also known as

magnesium hydroxide

osmotic laxatives can cause substantial loss of

water - make sure to increase fluid intake to avoid dehydration

renal impairment - which lax can this pt not take

magnesium salts | and sodium phosphate

what lax can cause fluid retention that can exacerbate heart failure, HTN and edema

Sodium phosphate

which lax can cause acute renal failure | who is at higher risk

sodium phosphate | renal disease and those taking diuretics, ACEs and ARBS

Polyethylene Glycol (Miralax) adverse effect

``` nausea abd bloating cramping flatulence diarrhea ```

how long for a bowel movement with Polyethylene Glycol (Miralax)

2-4 days

Lactulose works in

1-3 days

lactulose side effects

flatulence | cramping

lactulose should be reserved for pt who do not respond to

bulk forming agent

lactulose is used to lower

lower ammonia in pt with portal HTN and hepatic encephalopathy secondary to chronic liver disease

Lubiprostone is what class

chloride channel activators

Lubiprostone works within

24 hours | semisoft stool

3 indications for Lubiprostone

chronic idiopathic constipation in adults IBS-C (at least 18 years old) opioid induced constipation in chronic noncancer pain

Lubiprostone side effect

nausea - can be reduced with food and water ``` diarrhea, abd distension abd pain gas vomiting loose stools ``` headache difficulty breathing and sense of tightness in chest

Plecanatide (Trulance) works by

indirectly stimulates secretion of chloride and bicarbonate into intestinal lumen take with food and water

Polyethylene Glycol-Electrolyte Solutions (GoLYTELY)

bowel cleansing product for colonoscopy has an osmotic with a ELS (potassium chloride, sodium chloride, sodium sulfate and sodium bicarbonate) dehydration does not occur and electrolyte balance is preserved. safe for renal impairment and cardiovascular disease

bowel cleansing products for colonoscopy

Polyethylene Glycol-Electrolyte Solutions (GoLYTELY) - safe Sodium Phosphate - electrolyte imbalance magnesium oxide/anhydrous citric acid/sodium picosulfate (prepopik) combo of stimulant and osmotic lax which is superior to the PEG-ELS - can cause fluid and electrolyte imbalances, renal impairment, seizures and dysrhythmias secondary to electrolyte abnormalities