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NAPLEX > Chapter 73: Constipation & Diarrhea > Flashcards

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
Sodium phosphates brand name
Fleet enema
26
Side effects of osmotics
Electrolyte imbalance, abdominal cramping
27
Lactulose, an osmotic, is also used for
hepatic encephalopathy
28
Which osmotic drug must be used with caution in renal impairment
Milk of Magnesia
29
Senna brand name
Ex-Lax, Senokot
30
Senna + docusate brand name
Senna S, Senokot S
31
Bisacodyl brand name
Dulcolax
32
Stimulants such as senna and bisacodyl should be taken at what time of day
At bedtime to induce a bowel movement the following morning
33
Docusate brand name
Colace
34
When is docusate preferred
When straining should be avoided (postpartum, post-MI, anal fissures, hemorrhoids)
35
Which Rx drug acts on chloride channels in the gut, leading to increased fluid and peristalsis
Libiprostone
36
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
Linaclotide
37
Peripherally-acting mu-opoid receptor antagonists (PAMORAs) act on the mu-opioid receptors in the ____, decreasing constipation
GI tract
38
``` Lubiprostone can be used in which of the following CIC IBS-C OIC Surgery ```
CIC IBS-C (in adult women) OIC
39
``` Linaclotide & Plecanatide can be used in which of the following CIC IBS-C OIC Surgery ```
CIC | IBS-C
40
``` Alvimopan can be used in which of the following CIC IBS-C OIC Surgery ```
Surgery
41
``` Methylnaltrexone, Naloxegol and Naldemedine can be used in which of the following CIC IBS-C OIC Surgery ```
OIC
42
``` Tenapanor can be used in which of the following CIC IBS-C OIC Surgery ```
IBS-C
43
``` Prucalopride can be used in which of the following CIC IBS-C OIC Surgery ```
CIC
44
``` Tegaserod can be used in which of the following CIC IBS-C OIC Surgery ```
IBS-C (in adult women < 65 yo)
45
Lubiprostone brand name
Amitiza
46
Lubiprostone side effect
Nausea
47
Linaclotide brand name
Linzess
48
Linaclotide side effect
Diarrhea
49
Alvimopan brand name
Entereg
50
Use of Alvimopan
For hospital surgery patients to decrease risk of post-op ileus
51
Max doses of Alvimopan
15 doses
52
Methylnaltrexone brand name
Relistor
53
Naloxegol brand name
Movantik
54
Contraindication of PAMORAs
Therapeutic doses of opioids for > 7 days
55
PAMORA boxed warnings
Risk of MI with long-term use
56
Tegaserod contraindications
Intestinal ischemia and history of CV events
57
Tegaserod warnings
Suicide ideation (serotonin 5HT-4 agonist)
58
Use extra caution in which populations when using laxatives for whole bowel irriation
Can cause fluid & electrolyte losses - CV disease - renal insufficiency - if taking loop diuretics (d/t additional fluid loss) - NSAIDs
59
Sodium phosphates brand name for whole bowel irrigation
OsmoPrep
60
PEG-electrolyte solution brand name for whole bowel irrigation
Colyte, GoLytely, NuLytely
61
Sodium sulfate, potassium sulfate and magnesium sulfate brand name for whole bowel irrigation
Suprep Bowel Prep Kit
62
Boxed warning for OsmoPrep
Nephrotoxicity
63
OsmoPrep Contraindication
acute phosphate nepthopathy, gastric bypass or stapling surgery
64
When are bowel prep regimen doses usually required
Evening before colonoscopy and morning of
65
Which food colorings should be avoided prior to colonoscopy
red or blue/purple
66
Most common cases of diarrhea are
viral
67
Most common bacterial cause of diarrhea
E.coli
68
Recurrent idiopathic diarrhea associated with chronic or reoccurring abdominal discomfort that is relieved by defacation is termed
IBS-D
69
Key drugs that can cause diarrhea
- 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
Most patients with non-infectious diarrhea who require symptomatic relief can use short-term
Bismuth subsalicylate or loperamide as needed
71
Eluxadoline (Viberzi) drug class
Mu opioid receptor agonist
72
Loperamide dose for diarrhea and max dose
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
Bismuth contraindications
Salicylate allergy, taking other salicylates (e.g., ASA), GI ulcer, bleeding problems, black/bloody stool
74
Bismuth warnings
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
Bismuth side effects
Black tongue/stool, salicylate toxicity is used excessively (tinnitus), nausea Can cause increased bleeding when used with anticoags, antiplatelets or NSAIDs
76
Loperamide boxed warnings
Cardiac arrest and sudden death with doses higher than recommended; do not exceed the recommended dose Do not use in children < 2 yrs
77
Loperamide contraindications
Acute dysentery, pseudomembranous colitis, bacterial enterocolitis
78
Loperamide side effect
constipation
79
Loperamide should not be used for longer than ___ hours for self treatment
48 hrs
80
What drug schedule is Lomotil
C-V
81
Liquid formulation of Lomotil is recommended in children < ___ years
13
82
Do not use Lomotil if < __ years old or < ___ years of age for tablets
< 2 | < 6
83
Dicyclomine brand name
Bentyl
84
Dicyclomine should be used with caution in patients >/= what age
65 years d/t anticholinergic side effects
85
Dicyclomine can cause
toxic megacolon or paralytic ileus
86
Side effects of dicyclomine
dizziness, dry mouth, nausea, blurred vision
87
Eluxadoline is CI in
patients without a gallbladder

NAPLEX (74 decks)

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