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Chapter 73: Constipation & Diarrhea Flashcards

1
Q

Term for when constipation persists for several weeks or longer and the cause is unknown

A

Chronic idiopathic constipation (CIC)

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2
Q

Idiopathic constipation associated with chronic or recurrent abdominal discomfort that is relieved by defacation if called

A

IBS with constipation (IBS-C)

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3
Q

Medical conditions that can cause constipation

A 
IBS (constipation-predominant)
Anal disorders (fissures, fistulae, rectal prolapse)
Multiple sclerosis
Cerebrovascular events
Parkinson Disease
Spinal cord tumors
Diabetes
Hypothyroidism
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4
Q

Key drugs that can cause constipation

A

Antacids (aluminum- and calcium-containing)
Clonidine
Colesevelam
Drugs with anticholinergic effects: antihistamines, antispasmodics (e.g., baclofen), phenothiazines (e.g., prochlorperazine), TCAs (e.g., amitriptyline)
Urge incontinence drugs (e.g., oxybutinin)
Iron
Non-DHP CCBs (esp verapamil)
Opioids
Sucralfate (contains an aluminum complex)

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5
Q

Most common SE of meds to reduce constipation

A

Diarrhea and abdominal cramping

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6
Q

First-line treatment in most cases of constipation

A

Bulk-forming drugs (e.g., soluble fiber such as psyllium)

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7
Q

Treatment of choice for constipation in pregnancy

A

Bulk-forming drugs

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8
Q

Which class of drugs does PEG fall under

A

Osmotics

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9
Q

Which class of drugs do senna and bisacodyl fall under

A

Stimulants

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10
Q

Patients using chronic opioids often require which class of drugs

A

Stimulant laxatives

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11
Q

Which stool softener can be given with a stimulant laxative if the stool is hard

A

Docusate

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12
Q

Which medication is usually needed in patients taking iron supplements since they make the stool hard and compact

A

Docusate

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13
Q

Which class of drugs does mineral oil fall under

A

Lubricants

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14
Q

What should be given to adults for fast relief of constipation

A

bisacodyl or glycerin suppository

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15
Q

What should be given to children for fast relief of constipation

A

glycerin suppository

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16
Q

When should a patient be referred to a healthcare provider for constipation

A

If no improvement in < 7 days

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17
Q

Psyllium brand name

A

Metamucil

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18
Q

Calcium polycarbophil brand name

A

FiberCon

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19
Q

Methylcellulose brand name

A

Citrucel

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20
Q

Wheat dextrin brand name

A

Benefiber

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21
Q

Side effects of bulk-forming drugs

A

Flatulence, abdominal cramping, bloating

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22
Q

Which bulk-forming drug must be separated from select drugs due to binding interaction

A

FiberCon (calcium polycarbophil)

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23
Q

Magnesium hydroxide brand name

A

Milk of Magnesia

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24
Q

Polyethylene Glycol brand name

A

MiraLax

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25
Q

Sodium phosphates brand name

A

Fleet enema

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26
Q

Side effects of osmotics

A

Electrolyte imbalance, abdominal cramping

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27
Q

Lactulose, an osmotic, is also used for

A

hepatic encephalopathy

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28
Q

Which osmotic drug must be used with caution in renal impairment

A

Milk of Magnesia

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29
Q

Senna brand name

A

Ex-Lax, Senokot

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30
Q

Senna + docusate brand name

A

Senna S, Senokot S

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31
Q

Bisacodyl brand name

A

Dulcolax

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32
Q

Stimulants such as senna and bisacodyl should be taken at what time of day

A

At bedtime to induce a bowel movement the following morning

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33
Q

Docusate brand name

A

Colace

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34
Q

When is docusate preferred

A

When straining should be avoided (postpartum, post-MI, anal fissures, hemorrhoids)

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35
Q

Which Rx drug acts on chloride channels in the gut, leading to increased fluid and peristalsis

A

Libiprostone

36
Q

Which Rx drug is a guanylate cyclase agonist that increases chloride and bicarbonate secretion into the lumen of the intestines, increasing the speed of GI transit and reducing abdominal pain

A

Linaclotide

37
Q

Peripherally-acting mu-opoid receptor antagonists (PAMORAs) act on the mu-opioid receptors in the ____, decreasing constipation

38
Q 
Lubiprostone can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

CIC
IBS-C (in adult women)
OIC

39
Q 
Linaclotide & Plecanatide can be used in which of the following
CIC
IBS-C
OIC
Surgery
40
Q 
Alvimopan can be used in which of the following
CIC
IBS-C
OIC
Surgery
41
Q 
Methylnaltrexone, Naloxegol and Naldemedine can be used in which of the following
CIC
IBS-C
OIC
Surgery
42
Q 
Tenapanor can be used in which of the following
CIC
IBS-C
OIC
Surgery
43
Q 
Prucalopride can be used in which of the following
CIC
IBS-C
OIC
Surgery
44
Q 
Tegaserod can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

IBS-C (in adult women < 65 yo)

45
Q

Lubiprostone brand name

46
Q

Lubiprostone side effect

47
Q

Linaclotide brand name

48
Q

Linaclotide side effect

49
Q

Alvimopan brand name

50
Q

Use of Alvimopan

A

For hospital surgery patients to decrease risk of post-op ileus

51
Q

Max doses of Alvimopan

52
Q

Methylnaltrexone brand name

53
Q

Naloxegol brand name

54
Q

Contraindication of PAMORAs

A

Therapeutic doses of opioids for > 7 days

55
Q

PAMORA boxed warnings

A

Risk of MI with long-term use

56
Q

Tegaserod contraindications

A

Intestinal ischemia and history of CV events

57
Q

Tegaserod warnings

A

Suicide ideation (serotonin 5HT-4 agonist)

58
Q

Use extra caution in which populations when using laxatives for whole bowel irriation

A

Can cause fluid & electrolyte losses

  • CV disease
  • renal insufficiency
  • if taking loop diuretics (d/t additional fluid loss)
  • NSAIDs
59
Q

Sodium phosphates brand name for whole bowel irrigation

60
Q

PEG-electrolyte solution brand name for whole bowel irrigation

A

Colyte, GoLytely, NuLytely

61
Q

Sodium sulfate, potassium sulfate and magnesium sulfate brand name for whole bowel irrigation

A

Suprep Bowel Prep Kit

62
Q

Boxed warning for OsmoPrep

A

Nephrotoxicity

63
Q

OsmoPrep Contraindication

A

acute phosphate nepthopathy, gastric bypass or stapling surgery

64
Q

When are bowel prep regimen doses usually required

A

Evening before colonoscopy and morning of

65
Q

Which food colorings should be avoided prior to colonoscopy

A

red or blue/purple

66
Q

Most common cases of diarrhea are

67
Q

Most common bacterial cause of diarrhea

68
Q

Recurrent idiopathic diarrhea associated with chronic or reoccurring abdominal discomfort that is relieved by defacation is termed

69
Q

Key drugs that can cause diarrhea

A
  • Antacids containing magnesium
  • Antibiotics (esp broad-spectrum drugs)
  • Antidiabetics (e.g., metformin, GLP1 agonists)
  • Antineoplastics (e.g., irinotecan, capecitabine, flourouracil, MTX, TKIs)
  • Colchicine
  • Drugs used for constipation
  • Misoprostol
  • Mycophenolate
  • Prokinetic drugs (e.g., metoclopramide, cisapride)
  • Protease inhibitors (esp nelfinavir)
  • Quinidine
  • Roflumilast
70
Q

Most patients with non-infectious diarrhea who require symptomatic relief can use short-term

A

Bismuth subsalicylate or loperamide as needed

71
Q

Eluxadoline (Viberzi) drug class

A

Mu opioid receptor agonist

72
Q

Loperamide dose for diarrhea and max dose

A

4 mg PO after the first loose stool, then 2 mg after each susequent stool
Max: 8 mg/day (self-care) or 16 mg/day (under healthcare supervision)

73
Q

Bismuth contraindications

A

Salicylate allergy, taking other salicylates (e.g., ASA), GI ulcer, bleeding problems, black/bloody stool

74
Q

Bismuth warnings

A

Children and teens who are recovering from the flu, chickenpox or other viral infections should not use this drug d/t risk of Reye’s syndrome

75
Q

Bismuth side effects

A

Black tongue/stool, salicylate toxicity is used excessively (tinnitus), nausea
Can cause increased bleeding when used with anticoags, antiplatelets or NSAIDs

76
Q

Loperamide boxed warnings

A

Cardiac arrest and sudden death with doses higher than recommended; do not exceed the recommended dose
Do not use in children < 2 yrs

77
Q

Loperamide contraindications

A

Acute dysentery, pseudomembranous colitis, bacterial enterocolitis

78
Q

Loperamide side effect

A

constipation

79
Q

Loperamide should not be used for longer than ___ hours for self treatment

80
Q

What drug schedule is Lomotil

81
Q

Liquid formulation of Lomotil is recommended in children < ___ years

82
Q

Do not use Lomotil if < __ years old or < ___ years of age for tablets

83
Q

Dicyclomine brand name

84
Q

Dicyclomine should be used with caution in patients >/= what age

A

65 years d/t anticholinergic side effects

85
Q

Dicyclomine can cause

A

toxic megacolon or paralytic ileus

86
Q

Side effects of dicyclomine

A

dizziness, dry mouth, nausea, blurred vision

87
Q

Eluxadoline is CI in

A

patients without a gallbladder

NAPLEX (74 decks)

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