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Exam 3 - Pharmacology > Chapter 51 - Bowel Disorder Drugs > Flashcards

Chapter 51 - Bowel Disorder Drugs Flashcards

1
Q

What is diarrhea?

A

abnormal passage of stools with increased frequency, fluidity, weight, or with increased stool water excretion acute and chronic

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2
Q

Causes of acute diarrhea

A

bacterial

viral

drug induced

nutritional factors

protozoa

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3
Q

Causes of chronic diarrhea

A

tumors

diabetes mellitus

Addison’s disease

Hyperthyroidism

IBS

AIDS

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4
Q

3 types of Antidiarrheals

A

Adsorbents

Antimotility drugs (anticholinergics and opiates)

Probiotics (AKA, Intestinal flora modifiers, bacterial replacement drugs)

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5
Q

MOA of adsorbents

A
  1. coat walls of GI tract
  2. Bind to the causative bacteria/toxin, then eliminated through stool
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6
Q

Examples of adsorbents

A

bismuth subsalicylate (Pepto-Bismol)

activated charcoal

aluminum hydroxide

others

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7
Q

MOA of antimotility drugs: anticholinergics

A
  • decreases intestinal muscle tone and peristalsis of GI tract
  • Result: slows movement of fecal matter through the GI tract
  • used in more severe cases of diarrhea
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8
Q

Example of anticholinergic antimotility drug

A

belladonna alkaloids (atropine, hyoscyamine)

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9
Q

MOA of opiate antimotility drugs

A
  • decrease bowel motility, relieve rectal spasms
  • decrease transit time through bowel -> allows more time for water/electrolyte absorption
  • reduce pain by relief of rectal spasms

Examples: paregoric, opium tincture, codeine, loperamide (OTC), diphenoxylate

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10
Q

MOA Antidiarrheals: Intestinal Flora Modifiers

A

probiotics or bacterial replacement drugs

bacterial cultures of lactobacillus organisms work by:

supplying missing bacteria to the GI tract

suppressing growth of diarhea-causing bactera

example: L. acidophilus (Lactinex)

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11
Q

What are the adverse effects of adsorbent antidiarrheals?

A

increase bleeding time,

constipation/dark stools,

confusion, twitching,

hearing loss, tinnitus, metallic taste, blue gums

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12
Q

What are the adverse effects of anticholinergic antidiarrheals?

A

CNS: h/a, dizziness, confusion, anxiety, fatigue, weakness, drowsiness

CV: hypertension, hypotension, dysrhythmias (VTach, VFib, palpitations

GU: urinary retention, hesitancy, impotence

Sense: mydriasis, blurred vision, increase intraocular pressure

Skin: dry skin, flushing

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13
Q

What are the adverse effects of opiate antidiarrheals?

A

drowsiness, sedation, dizziness, lethargy

nausea, vomiting, anorexia, constipation

respiratory depression

hypotension

urinary retention

flushing

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14
Q

Nursing Implications of antidiarrheals?

A

Do NOT give bismuth subsalicylate to children/teenagers with chickenpox or influenza because of the risk of Reye’s syndrome

obtain through history of bowel patterns, general state of health, and recent hisotyr of illness or dietary changes, assess for allergies

Use adsorbetns carefully in elderly, and those with increased bleeding time, clotting disorders, recent bowel surgery, confusion

Do not administer anticholinergics to pts with history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon

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15
Q

What to teach pts for antidiarrheals?

A

take meds exactly as prescribed, be aware of fluid intake/dietary chagnes

teach pts to notify their physician immediately if symptoms persist

monitor for therapeutic effect

assess fluid volume status, I&O and mucous membranes before, during, and after initiation of treatment

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16
Q

What is constipation?

A

abnormally infrequent and difficult passage of feces through the lower GI tract

disorder of movement through the colon/rectum

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17
Q

Is constipation a symptom or disease?

A

Symptom! yay!

18
Q

Different categories of laxatives?

A

Bulk-forming

Emollient

Hyperosmotic

Saline

Stimulant

Peripherally acting opioid antagonists

19
Q

MOA of Bulk-forming laxatives

A

high fiber

absorb water to increase bulk

distend bowel to initiate reflex bowel activity

examples: psyllium (Metamucil) and methylcellulose (Citrucel)

20
Q

MOA of emollient laxatives

A

stool softeners/lubricants

promote more water/fat in stools

lubricate the fecal material/intestinal walls

Examples: stool softeners: docusate salts (Colace, Surfak) lubricants (mineral oil)

21
Q

MOA of hyperosmotic laxatives

A

increase fecal water content

results in bowel distention, increased peristalsis, and evacuation

examples: polyethylene glycol (PEG) AKA: GoLytely; sorbitol, glycerin; lactulose (also used to reduce elevated serum ammonia levels)

22
Q

MOA of saline laxatives

A

increase osmotic pressure within the intestinal tract, causing more water to enter the intestines

results in bowel distention, increased peristalsis and evacuation

Examples: Magnesium hydroxide (Milk of Mag)

Magnesium citrate (Citroma)

23
Q

MOA of stimulant laxatives

A

increased peristalsis via intestinal nerve stimulation

Examples: senna (Senekot) bisacodyl (Dolculax)

24
Q

Peripherally Acting Opioid Antagonists

A

treatment of constipation r/t opioid use and bowel resection therapy

block entrance of opioid into bowel

strict regulations for use

allow bowel to function normally with continued opioid use

methylnaltrexone (Relistor)

alvimopan (Entereg)

25
Q

Indications fo Bulk Forming laxatives?

A

acute/chronic constipation

IBS

diverticulosis

26
Q

Indications of Emollient laxatives?

A

acute/chronic constipation

fecal impaction

faciliation of BMs in anorectal conditions

27
Q

Indications of Hyperosmotic laxatives?

A

chornic constipation

diagnostic/surgical preps

28
Q

Indications of Saline Laxatives?

A

constipation

diagnostic/surgical preps

29
Q

Indications of Stimulant Laxatives

A

Acute constipation

diagnostic/surgical preps

30
Q

Adverse effects of bulk forming laxatives?

A

impaction

fluid overload

electrolyte imbalances

esophageal blockages

31
Q

Adverse Effects of Emollient Laxatives?

A

skin rashes

decreased absorption of vitamins

electrolyte imbalances

lipid pneumonia

32
Q

Adverse effects of Hyperosmotic laxatives?

A

abdominal bloating

electrolyte imbalances

rectal irritation

33
Q

Adverse effects of Saline Laxatives?

A

magnesium toxicity (w renal insufficiency)

cramping

electrolyte imbalances

diarrhea

increased thirst

34
Q

Adverse effects of Stimulant laxatives?

A

Nutrient malabsorption

skin rashes

gastric irritation

electrolyte imbalances

discolored urine

rectal irritation

35
Q

What adverse effects do all laxatives cause?

A

All laxatives can cause electrolyte imbalances!

36
Q

Nursing implications that aren’t yellow highlighted

A

Obtain thorough history of presenting symptoms, elimination patterns, and allergies

assess fluid/electrolytes before initiating therapy

high fiber diet, increase fluid intake

37
Q

Nursing Implications:

When would you tell pt’s to not take a laxative/cathartic?

A

Inform pt’s not to take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain

38
Q

Nursing Implications:

Long term use has ______ effects.

A

long-term use has detrimental effects

39
Q

Nursing Implications:

What should pt’s take with water? What would a pt taking bulk-forming laxatives do?

A

Pt’s should take all laxative tablets with 6-8 oz of water

Pt’s should take bulk-forming laxatives as directed by the manufacturer with at least 240mL (8oz) of water

40
Q

Which should be given with water because of interactions with milk, antacids, and juices?

A

Give bisacodyl with water because of itneractions with milk, antacids, and juices

41
Q

What do we monitor for? (Same thing we always freakin’ monitor for)

A

Therapeutic effect

42
Q

When should you instruct your pt to contact their physician?

A

If they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss

Exam 3 - Pharmacology (4 decks)

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