ch 65 Flashcards
production of a soft, formed stool over a period of 1 or more days
laxative effect
prompt, fluid evacuation of the bowel
catharsis
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
a common cause of constipation is
poor diet - specifically deficient in fiber and fluid
other causes of constipation include
pelvic floor dysfunction
anal sphincter dysfunction
slow intestinal transit
IBS
use of certain drugs (opioids, anticholinergics, antacids)
non-drug help for constipation
increase fiber (fruits and vegetables)
increase fluid
mild exercise - esp after meals
laxatives safe for infants
docusate
lactulose
glycerin suppositories
laxatives safe for children and adolescents
milk of magnesia mineral oil senna docusate bisacodyl
laxatives safe in pregnancy
no! can induce labor
laxatives in breastfeeding
Senna is safe
older adults with laxatives
all can be used
monitor for dehydration
constipation is determined by
stool consistency (degree of hardness) not by how often BM occurs
reason for laxatives in cardiovascular disease
prevent dangerous elevation of BP
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
contraindications for laxatives
fecal impaction
abd pain, nausea, cramps, signs of appendicitis’
regional enteritis
diverticulitis
UC
surgical abdomen
caution during pregnancy
what criteria is used for constipation
Rome IV
what type of laxative works by absorb water which softens and enlarges the fecal mass to promote peristalsis
Bulk forming laxatives
name the bulk forming laxatives
methylcellulose
psyllium
polycarbophil
which laxatives use surfactant action softens stool by facilitating penetration of water and also cause secretion of water and electrolytes into intestine
surfactant laxatives
name surfactant laxatives
Docusate sodium (colace) Docusate calcium
Group I agents act
used for
rapidly (within 2-6 hours)
bowel prep
Group II agents act
used for
intermediate latency (6-12 hours)
stool that is semifluid
most frequently abused
Group III agents act
used for
slowly (1-3 days)
soft but formed stool
treat chronic constipation and prevent straining
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
II
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
