Chapter 73: Constipation & Diarrhea Flashcards by Emily Jansen

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

Chronic idiopathic constipation (CIC)

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

IBS with constipation (IBS-C)

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Medical conditions that can cause constipation

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

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Key drugs that can cause constipation

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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Most common SE of meds to reduce constipation

Diarrhea and abdominal cramping

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First-line treatment in most cases of constipation

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

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Treatment of choice for constipation in pregnancy

Bulk-forming drugs

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Which class of drugs does PEG fall under

Osmotics

draw fluid into bowel through osmosis

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Which class of drugs do senna and bisacodyl fall under

Stimulants

increases peristalsis

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Patients using chronic opioids often require which class of drugs

Stimulant laxatives

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

Docusate

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

Docusate

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Which class of drugs does mineral oil fall under

Lubricants

coat the bowel and stool with waterproof film

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What should be given to adults for fast relief of constipation

bisacodyl or glycerin suppository

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What should be given to children for fast relief of constipation

glycerin suppository

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

If no improvement within 7 days

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Psyllium brand name

Metamucil

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Calcium polycarbophil brand name

FiberCon

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Methylcellulose brand name

Citrucel

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Wheat dextrin brand name

Benefiber

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Side effects of bulk-forming drugs

Flatulence, abdominal cramping, bloating

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

FiberCon (calcium polycarbophil)

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Magnesium hydroxide brand name

Milk of Magnesia

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Polyethylene Glycol 3350 brand name

MiraLax

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Sodium phosphates brand name

Fleet enema

Side effects of osmotics

Electrolyte imbalance, abdominal cramping

Lactulose, an osmotic, is also used for

hepatic encephalopathy

Which osmotic drug must be used with caution in renal impairment

Milk of Magnesia | anything that contained Mg or Al

Senna brand name

Ex-Lax, Senokot

Senna + docusate brand name

Senna S, Senokot S

Bisacodyl brand name

Dulcolax

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

At bedtime to induce a bowel movement the following morning

Docusate brand name

Colace

When is docusate preferred

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

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

Lubiprostone

Linaclotide MOA

A guanylate cyclase agonist - increases chloride and bicarbonate secretion into the lumen of the intestines, increasing the speed of GI transit and reducing abdominal pain

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

GI tract

``` Lubiprostone can be used in which of the following CIC IBS-C OIC Surgery ```

CIC IBS-C (in adult women) OIC

``` Linaclotide & Plecanatide can be used in which of the following CIC IBS-C OIC Surgery ```

CIC | IBS-C

``` Alvimopan can be used in which of the following CIC IBS-C OIC Surgery ```

Surgery

``` Methylnaltrexone, Naloxegol and Naldemedine can be used in which of the following CIC IBS-C OIC Surgery ```

OIC

Lubiprostone brand name

Amitiza

Lubiprostone side effect

Nausea

Linaclotide brand name

Linzess

Linaclotide side effect

Diarrhea

Alvimopan brand name

Entereg

Use of Alvimopan

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

Max doses of Alvimopan

15 doses

Methylnaltrexone brand name

Relistor

Naloxegol brand name

Movantik

Contraindication of PAMORAs | Peripheral acting mu opioid receptor antagonists

Therapeutic doses of opioids for > 7 days

PAMORA boxed warnings

Risk of MI with long-term use

Tegaserod contraindications

Intestinal ischemia and history of CV events

Tegaserod warnings

Suicide ideation (serotonin 5HT-4 agonist)

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

Sodium phosphates brand name for whole bowel irrigation

OsmoPrep

PEG-electrolyte solution brand name for whole bowel irrigation

Colyte, GoLytely, NuLytely

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

Suprep Bowel Prep Kit

Boxed warning for OsmoPrep

Nephropathy

OsmoPrep Contraindication

acute phosphate nephropathy, gastric bypass or stapling surgery

When are bowel prep regimen doses usually required

Evening before colonoscopy and morning of

Which food colorings should be avoided prior to colonoscopy

red or blue/purple

Most common cases of diarrhea are

viral

Most common bacterial cause of diarrhea

E.coli

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

IBS-D

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

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

Bismuth subsalicylate or loperamide as needed

loperamide and diphenoxylate effect on motility

slows intestinal motility, prolonging time for water absorption

Eluxadoline (Viberzi) drug class

Mu opioid receptor agonist

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)

Bismuth contraindications

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

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

Bismuth side effects

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

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

Loperamide contraindications

Acute dysentery, pseudomembranous colitis, bacterial enterocolitis

Loperamide side effect

constipation

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

48 hrs

Bismuth subsalicylate brand name

Pepto-Bismol

Loperamide brand name

Imodium A-D

diphenoxylate/atropine brand name

Lomotil

What drug schedule is Lomotil

C-V

Liquid formulation of Lomotil is recommended in children < ___ years

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

< 2 < 6

Dicyclomine brand name

Bentyl

Dicyclomine should be used with caution in patients ≥ what age

65 years d/t anticholinergic side effects

Dicyclomine can cause

toxic megacolon or paralytic ileus

Side effects of dicyclomine

dizziness, dry mouth, nausea, blurred vision (anticholinergic)

Eluxadoline is CI in

patients without a gallbladder

Eluxadoline (Viberzi) schedule

C-IV