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A - 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
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 (Amitizia)

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 (Linzess)

37
Q

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

A

GI tract

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

CIC
IBS-C (in adult women)
OIC

Functional constipation, also known as chronic idiopathic constipation (CIC), is defined by less than three bowel movements per week, hard stools, severe straining, the sensation of anorectal blockage, the feeling of incomplete evacuation, and the need for manual maneuvers during feces, without organic abnormalities

39
Q 
Linaclotide & Plecanatide can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

CIC

IBS-C

40
Q 
Alvimopan can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

Surgery

41
Q 
Methylnaltrexone, Naloxegol and Naldemedine can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

OIC

42
Q 
Tenapanor can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

IBS-C

43
Q 
Prucalopride can be used in which of the following
CIC
IBS-C
OIC
Surgery
A

CIC

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

A

Amitiza

46
Q

Lubiprostone side effect

A

Nausea

47
Q

Linaclotide brand name

A

Linzess

48
Q

Linaclotide side effect

A

Diarrhea

49
Q

Alvimopan brand name

A

Entereg

50
Q

Use of Alvimopan

A

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

51
Q

Max doses of Alvimopan

A

15 doses

52
Q

Methylnaltrexone brand name

A

Relistor

53
Q

Naloxegol brand name

A

Movantik

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

A

OsmoPrep

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

A

viral

67
Q

Most common bacterial cause of diarrhea

A

E.coli

68
Q

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

A

IBS-D

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

A

48 hrs

80
Q

What drug schedule is Lomotil

A

C-V

81
Q

Liquid formulation of Lomotil is recommended in children < ___ years

A

13

82
Q

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

A

< 2

< 6

83
Q

Dicyclomine brand name

A

Bentyl

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

A - NAPLEX (83 decks)

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