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Pharmacology > Constipation > Flashcards

Constipation Flashcards

1
Q

What is the appropriate treatment for constipation?

A

Laxatives, propulsives and prokinetics

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2
Q

What are the three bulk forming agents?

A

Ispaghula husk (psylilium), sterculia, methylcellulose

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3
Q

What class of laxatives does this MOA describe? absorb fluid from GIT to form soft bulky stool and promote peristalsis

A

Bulk-forming agents

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4
Q

T or F: The indication for bulk forming agents is short term Tx of constipation

A

False. They are indicated for the long term prophylaxis and Tx of constipation, IBS-C and diverticular disease

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5
Q

What are the A/E of bulk-forming agents?

A

Abd. distension, cramps, flatulence

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6
Q

Caution with bulk-forming agents?

A

other meds should be taken 3 hours before or after; adequate fluid intake advised to avoid intestinal compaction

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7
Q

What are the different types of osmotic agents?

A

MgSO4, Mg(OH)2, lactulose, polyethelene glycol (PEG), glycerine, sodium phosphate, sorbitol

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8
Q

What is MOA of osmotic agents?

A

Draw water and electrolytes into the bowel visa osmotic action to increase water retention in stool and increase stool frequency (stimulate peristalsis)

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9
Q

When are osmotic agents Indicated?

A

acute and chronic constipation, bowel prep

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10
Q

Are there specific indications for lactulose?

A

Acute/chronic constipation, hepatic encephalopathy

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11
Q

T or F: the cautions for lactulose are headaches?

A

False, Cautions are pregnancy and lactation

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12
Q

When is lactulose CI?

A

galactosaemia, warfarin

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13
Q

What are the AE of lactulose?

A

flatulence, abd distention & cramping

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14
Q

What are the specific indications of polyethylene glycol (PEG)?

A

acute constipation, bowel prep

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15
Q

T or F: the C of PEG include, pts over 60 and unconcious pts

A

True

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16
Q

When is PEG CI?

A

GI obstruction, bowel perforation, toxic megacolon

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17
Q

What is the onset of action for PEG?

A

24-96 hrs

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18
Q

AE of PEG?

A

flatulence, abd distension & cramping, ulceration, ischaemic colitis

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19
Q

What is the indication for Magnesium salts?

A

Rapid bowel evacuation

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20
Q

Cautions for magnesium salts?

A

hypermagnessaemia, renal insufficiency

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21
Q

When is magnesium salts CI?

A

intestinal obstruction/perforation, undiagnosed abd pain, existing electrolyte imbalance, myocardial damage

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22
Q

T or F: the AE of Magnesium salts include electrolyte imbalance and abd cramps

A

True

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23
Q

T or F: specific indication of Sodium Phosphate include pre operative, radiography and endoscopic bowel evacuation

A

True

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24
Q

What are the cautions associated with sodium phosphate?

A

risk of phosphate nephropathy, severe dehydration, heart failure

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25
Q

The CI for Sodium phosphate is undiagnosed abd distension. T or F?

A

False. Sodium phosphate is CI in bowel obstruction/perforation

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26
Q

What are the AE of sodium phosphate?

A

electrolyte imbalance, bloating, nausea, abd pain

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27
Q

What drugs are stimulant laxatives?

A

Bisacodyl, Senna, Sodium picosulphate, Castor Oil

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28
Q

What is the MOA of Bisacodyl?

A

direct stimulation of intestinal SM, colonic intramural plexus. They increase peristalsis. They also increase intestinal fluid accumulation by altering water and electrolyte secretion

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29
Q

What is the onset of action of Bisacodyl?

A

6-8hrs

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30
Q

Digoxin is the only DI for Bisacodyl. T or F

31
Q

CI for Bisacodyl are intestinal obstruction and abd pain. T or F

32
Q

What is the I for Bisacordyl?

A

Tx of short term constipation- cannot be used long term

33
Q

What is the MOA of Senna?

A

direst stimulation of intestinal SM, increases GI motility and increase accumulation of water and electrolytes in bowel lumen

34
Q

What is the onset of action of Senna?

35
Q

What are the I for Senna?

A

acute constipation and bowel prep

36
Q

DI of Senna?

37
Q

The CI of Senna are GI obstruction and IBD. T or F?

38
Q

What are the AE of Senna?

A

abd pain, excessive bowel activity, hypokalemia, dehydration

39
Q

What is the MOA for Sodium picosulfate?

A

It is the active metabolite of bisacodyl. It is metabolised by colonic bacteriaand will increase GI motility and increase the accumulation of water and electrolytes in the bowel lumen

40
Q

What is the onset of action of sodium picosulfate?

41
Q

When is sodium picosulfate indicated?

A

sereve constipation and bowel prep

42
Q

The CI of sodium picosulfate include: GI obstruction, toxic colitis, GI perforation, appemdicitus. T or F?

43
Q

What are the AE of sodium picosulfate?

A

Abd cramps, hypocalcaemia, hypokalemia

44
Q

What is the MOA of castor oil?

A

It is hydrolysed to ricinoleic acid by lipase enzymes in the GIT. Ricinoleic acid acts as a surfactant and increases water absorption by stools (faecal softening). Rcinoleic acid also stimulates peristalsis

45
Q

T or F: the onset of action of castor oil is 12 hrs?

A

False. It is 2-6hrs

46
Q

What are the indications for castor oil?

A

acute constipation, colonic evacuation

47
Q

CI for castor oil are: GI obstruction/perforation, appendicitus and what else?

A

Ulcerative colitis

48
Q

What are the AE of castor oil?

A

Abd cramps, electrolyte disturbances, hypotension

49
Q

What are the different lubricant laxatives?

A

Liquid paraffin, mineral oil, glycerine

50
Q

T or F: the MOA of all lubricant laxatives is: lubricate the intestine by decreasing water absorption from colon to allow for easy passage of stool

51
Q

When are lubricant laxatives indicated?

A

Acute constipation

52
Q

The onset of action for lubricant laxatives is 6-8hrs. T or F?

53
Q

When are liquid laxatives CI?

A

Abd pain, appendicitis, GI obstruction/perforation, UC

54
Q

What are the AE of lubricant laxatives?

A

Abd cramps, intestinal malabsorption, liquid pneumonitis

55
Q

What class of laxative is Docusate sodium?

A

It is a stool softener (surfactant laxative)

56
Q

What is the MOA of Ducosate sodium?

A

lowers surface tension and increase water absorption by stool (stool softening)

57
Q

T or F: Ducosate Sodium is indicated for vomiting?

A

False. It is indicated for acute/chronic constipation

58
Q

T or F: Ducosate Sodium has a rapid onset of action

A

False. Onset is 24-72hrs

59
Q

What are the AE of Ducosate Sodium?

A

Abd cramps, excessive bowel activity, throat irritation

60
Q

What drug class do these drugs belong to? Linaclotide, Prucalopride, Lubiprostone

A

Propulsives (prokinetics)

61
Q

What is the MOA of Linaclotide?

A

Increase cGMP concentrations in the gut to increase fluid secretions and intestinal transit

62
Q

When is Linaclotide indicated?

A

IBS-C, chronic idiopathic constipation

63
Q

Linaclotide is safe for all ages. T or F?

A

False. CI if <6 yrs and GI obstruction

64
Q

AE of Linaclotide?

A

Abd pain, severe diarrhoea

65
Q

What is the MOA of Prucalopride?

A

selective serotonin agonist, elicits GI prokinetic action, colonic peristalsis (increase GI motility

66
Q

When is Prucalopride indicated?

A

chronic ideopathic constipation

67
Q

When is Prucalopride CI?

A

GI obstruction, IBD

68
Q

What are the AE of prucalopride?

A

Abd pain, headache, anxiety

69
Q

What is the MOA of Lubiprostone?

A

Acts on chloride channels to increase intestinal fluid secretion and motility

70
Q

When is Lubiprostone indicated?

A

chronic ideopathic constipation, opioid-induced constipation, IBS-C

71
Q

What are the CI of Lubiprostone?

A

GI obstruction, IBD

72
Q

The AE of Lubiprostone are the same as Prucalopride. T or F?

A

True. (abd pain, headache, anxiety

73
Q

What are other examples of prokinetics?

A

Domperidone and metocloprimide. They prevent upward peristalsis and promote downward peristalsis (used as antiemitics)

Pharmacology (11 decks)

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