Chapter 73: Constipation & Diarrhea Flashcards
Term for when constipation persists for several weeks or longer and the cause is unknown
Chronic idiopathic constipation (CIC)
Idiopathic constipation associated with chronic or recurrent abdominal discomfort that is relieved by defecation if called
IBS with constipation (IBS-C)
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
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)
Most common SE of meds to reduce constipation
Diarrhea and abdominal cramping
First-line treatment in most cases of constipation
Bulk-forming drugs (e.g., soluble fiber such as psyllium)
Treatment of choice for constipation in pregnancy
Bulk-forming drugs
Which class of drugs does PEG fall under
Osmotics
draw fluid into bowel through osmosis
Which class of drugs do senna and bisacodyl fall under
Stimulants
increases peristalsis
Patients using chronic opioids often require which class of drugs
Stimulant laxatives
Which stool softener can be given with a stimulant laxative if the stool is hard
Docusate
Which medication is usually needed in patients taking iron supplements since they make the stool hard and compact
Docusate
Which class of drugs does mineral oil fall under
Lubricants
coat the bowel and stool with waterproof film
What should be given to adults for fast relief of constipation
bisacodyl or glycerin suppository
What should be given to children for fast relief of constipation
glycerin suppository
When should a patient be referred to a healthcare provider for constipation
If no improvement within 7 days
Psyllium brand name
Metamucil
Calcium polycarbophil brand name
FiberCon
Methylcellulose brand name
Citrucel
Wheat dextrin brand name
Benefiber
Side effects of bulk-forming drugs
Flatulence, abdominal cramping, bloating
Which bulk-forming drug must be separated from select drugs due to binding interaction
FiberCon (calcium polycarbophil)
Magnesium hydroxide brand name
Milk of Magnesia
Polyethylene Glycol 3350 brand name
MiraLax
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
13
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
