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PHRM 825 > Constipation > Flashcards

Constipation Flashcards

1
Q

mouth to anus transit time is normally ___ hours
* up to ___ may still be considered normal

A

30-40 hours
* 72 hours

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2
Q

acute constipation:
less than ___ bowel movements/week

A

3

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3
Q

chronic constipation:
symptoms lasting longer than ___ weeks
* may respond to laxatives but returns after they are stopped

A

6 weeks

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4
Q

disease states that slow down GI motility

A
  1. diabetes
  2. Parkinson’s
  3. CNS injury or disease
  4. MS
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5
Q

Common Drug Causes of Constipation

  • opioids - __ receptor agonist in GI tract, slows everything down
  • NSAIDs - inhibition of prostaglandins. ___ series play a significant role in ___ and fluid ___
  • antacids containing ___ and ___.
  • drugs with strong ___ properties
  • Verapamil, clonidine, Ca channel blockers
  • ___ preparations
  • dramatic dose increase in ___
A
  • mu
  • E, motility, movement
  • Ca, Al
  • anticholinergic
  • Iron
  • diuretics
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6
Q

T or F: as much fiber as possible should be added to the diet quickly

A

False; want to add fiber slowly ober 7-10 days to minimize gas

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7
Q

Prunes have a high [ ] of simple sugars like ___ , ___ g of fiber, and a natural laxative called ___

A

sorbitol, 12 g, dihydrophenylsatin

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8
Q

T or F: kiwi is a good alternative to prunes bc you wont toot as much

A

True;

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9
Q

when is colonic activity the greatest

A
  • first thing in the morning
  • within 30 minutes after meals
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10
Q

Bulk laxatives

psyllium - ___
methylcellulose - ___
calcium polycarbophil - ___
MOA: forms gels which retain ___, swells, and stimulates a BM

A
  • Metamucil
  • Cirucel
  • Fibercon
    water
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11
Q

T or F: bulk laxatives soften stool better than docusate

A

True

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12
Q

Disadvantage of Bulk Laxatives
* __ formation
* impacts drug ___

A
  • gas
  • absorption

use cold water to decrease gas

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13
Q

Surfactant/Emollient

Docusate
* Dose: 100 mg once or twice daily
* MOA: decreases fecal ___ (stool softener)
* not effective for ___ constipation, mostly preventitive

A
  • surface tension
  • active
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14
Q

Lubricant

mineral oil
MOA: lubricates lumen of the ___
* only effective for ___
* may decrease absorption of ___ vitamins

A

colon
* prevention
* fat soluble

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15
Q

Saline Laxatives

Examples: Milk of Magnesia, Fleet, and Mg citrate
MOA: draws fluid into the colon to stimulate motility
* ___ onset
* used for ___ management
* avoid in ___ patients

A
  • quick
  • acute
  • renal
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16
Q

Hyperosmotic agents

  • excellent for ___ constipation
  • softens while stimulating BM
A

chronic

17
Q

Hyperosmotic agents

glycerin suppositories
* ___ onset

A

quick

18
Q

Hyperosmotic agents

PEG 3350 - ____
* onset: ___

A

MiraLAX
1-3 days

19
Q

Stimulant Laxatives

Senna: 2 tabs 1-2x daily
Bisacodyl: 1-2 tabs daily
* ___ coated
* MOA: locally stimates ___ nerves to produce __ and mobility; also increased fluid and Na secretion into the lumen

A
  • enteric
  • enteric, contractions
20
Q

Stimulant Laxatives

Advantages:
* ___ hr onset
* works for patients with ___ disorders
* drug of choice for ___

Disadvantages:
* avoid ___ term continuous use in patients with normal GI motility

A
  • 6-12 hr
  • motility
  • opioid induced constipation
21
Q

Stimulant Laxatives

Bisacodyl ___
10 mg PR
___ onset

A

suppositories
quick

22
Q

Chloride Channel Acitvators

  • activates chloride channels in ___ resulting in ___ influx which increases fluid movement into intestinal lumen
  • negative goes through channel, positive follows to balance, brings its BFF water with it
A
  • Small intestine
  • Na
23
Q

Chloride Channel Activator

Lubiprostone ( ___ )
Indicaions: chronic ___ consitpation IBS-C, ___ with chronic, non-cancer pain
* Dose: 24 mcg ___ with food + water
* avoid in ___
* reserved for patients who do not respond or tolerate other laxatives

A

Amitiza
* idiopathic, OIC
* BID
* pregnancy

24
Q

Guanylate Cyclase-C receptor activator

Linaclotide ( ___ )
* increases chloride and ___ secretions into the lumen and inhibits ___ absorption
* indicated for ___
* Dose: ___ mcg once daily
* take 30 min before 1st meal of the day
* 72 mcg appears as effective with less diarrhea
* $$$

A

Linzess
* bicarbonate
* sodium
* CIC
* 145 mcg

25
Q

Guanylate Cyclase-C receptor activator

Plecanatide ( ___ )
Dose: ___ mg once daily
may be administered at any time of day, with or without food

A

Trulance
3 mg

26
Q

Chronic constipation treatment tiers

  1. relieve acute constipation with ___ modifications
  2. ___ forming laxatives and fluids
  3. PEG, lactulose, sorbitol
  4. short term use of ___
  5. lubiprostone, linaclotide, prucalopride, plecanatide
A
  • dietary
  • bulk
  • stimulants
27
Q

Special Populations

spinal cord injury pts:
* routine use of ___
* usually ___ form

A
  • stimulants
  • suppository
28
Q

Special Populations

pregnancy
* diet, fiber, ___
* ___ in more severe cases

A
  • docusate
  • senna
29
Q

Special Populations

diabetics
* prokinetic agents: ___ and ___
* stimulants

A

metoclopramide
prucalopride

30
Q

patients on opioids
* stimulants
* then add __, lactulose, or ___ prn
* avoid ___ laxatives
* opioid receptor ___ when other treatment doesnt work

A
  • docusate, PEG
  • bulk
  • antagonists
31
Q

T or F: bulk laxatives are first line therapy for patients on opioids

A

FALSE; avoid bulk laxatives

32
Q

Special Populations

patients on opioids
* methylnaltrexone ( ___ )
* mu opioids receptor ___
* dose based on ___
* 8-12 mg ___ every ___ day
* expect a BM within ___ minutes
* $$$

A
  • Relistor
  • antagonist
  • weight
  • SC, other
  • 30 min
33
Q

Special Populations

patients on opioids
* Naloxegol ( ___ )
* mu opioid receptor ___
* 25 mg __ once daily
* 1 hr prior to first ___ or 2 hrs after
* needs to be taken on a ___ stomach
* high ___ meal increases rate of ___
* tablet can be ___
* $$$

A
  • Movantik
  • antagonist
  • PO
  • meal
  • empty
  • fat, absorption
  • crushed
34
Q

Prep for colonoscopy

PEG
* 2-4 L
* drink 8 oz q ___
* refrigerate

A

10 minutes

35
Q

Prep for colonoscopy

prior day to procedure, “enjoy ___ all day”
* mix 1 bottle of ___ into 2 bottles of gatorade (cannot do red flavor)
* drink extra 8 oz of clear fluid every hour
* take ___ 5 mg bisacodyl tabs at noon
* at 2 pm, begin drinking gatorade solution, 8 oz q 10-20 minutes over an ___.
* Wait ___ minutes, then drink 2nd bottle

A

clear liquids
* Miralax
* 4 x
* hour
* 30 minutes

PHRM 825 (49 decks)

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