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Fall 2014 - Pharm GI/ENT > Constipation > Flashcards

Constipation Flashcards

1
Q

Causes of Constipation

A
  • frequently caused by inadequate intake of dietary fiber
  • also influenced by misconceptions about adequate frequency of stooling
  • GI, metabolic/endocrine, pregnancy, neurogenic, psychogenic, drug-induced
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2
Q

Examples of GI Constipation

A
  • IBS
  • diverticulitis
  • hernias
  • volvulus
  • stricture
  • Hirshsprung’s dz
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3
Q

Examples of Metabolic/Endocrine Constipation

A
  • hypothyroidism
  • pheochromocytoma
  • hypercalcemia
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4
Q

Pregnancy Induced Constipation

A

-secondary to depressed gut motility, inadequate diet and water intake

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5
Q

Examples of Neurogenic Constipation

A
  • CVAs
  • CNA or spinal injury
  • Parkinson’s
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6
Q

Examples of Psychogenic Constipation

A
  • improper toilet training

- occupational (eg truck drivers)

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7
Q

Examples of Drug-Induced Constipation

A
  • analgesics (opiates)
  • anticholinergics
  • iron supplements
  • aluminum and calcium containing antacids
  • also CCBs, diuretics, clonidine, phenothiazines, TCAs
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8
Q

3 Options for Therapeutic Management of Constipation

A
  1. dietary modification
  2. increase exercise and fluid intake
  3. drug therapy
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9
Q

Dietary Modification for Constipation

A
  • fiber: undigestable vegetable material –> increases stool bulk, increases retention of stool water, increases rate of transit through the GI tract
  • results in increasing frequency of stooling
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10
Q

Dietary Sources of Fiber

A

-beans, whole grains, fruits, veggies, bran cereals

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11
Q

Fiber Products for Constipation

A

psyllium (Metamucil, Perdiem)
methylcellulose (Citrucel)
polycarbophil (Mitrolan)

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12
Q

Bulk-Forming Drugs MOA

A
  • nondigested plant cell wall absorbs water into feces

- softens stool

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13
Q

Bulk-Forming Drugs Generics

A
  • psyllium
  • methylcellulose
  • polycarbophil
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14
Q

Bulk-Forming Drugs Trade Names of:

  • psyllium
  • methylcellulose
  • polycarbophil
A
  • psyllium: (Metamucil, Perdiem)
  • methylcellulose: (Citrucel)
  • polycarbophil: (Mitrolan)
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15
Q

Bulk-Forming Drugs Efficacy

A

-best option for prevention of chronic constipation

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16
Q

Bulk-Forming Drugs Safety/AEs

A
  • well tolerated

- flatulence, impaction possible

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17
Q

Emollients MOA

A
  • stool softeners

- facilitate mixing of aqueous and fatty materials

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18
Q

Emollients Generics

A
  • docusate sodium

- docusate potassium

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19
Q

Emollients Trade Names of:

  • docusate sodium
  • docusate potassium
A
  • docusate sodium: Colace

- docusate potassium: Kaopectate

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20
Q

Emollients Efficacy

A

more effective for prevention of constipation

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21
Q

Emollients Safety/AEs

A
  • very safe

- diarrhea or abdominal cramps possible

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22
Q

Disaccharides MOA

A
  • metabolized to low molecular weight acids
  • increase peristalsis
  • osmotic agent
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23
Q

Disaccharides Generics

A
  • sorbitol

- lactulose

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24
Q

Lactulose Trade Name

A

-cephulac

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25
Q

Disaccharides Efficacy

A
  • very effective for chronic constipation

- may also be used to decrease serum ammonia

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26
Q

Disaccharides Safety/AEs

A
  • expensive
  • flatulence, belching
  • cramps
  • N/V/D
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27
Q

Glycerin MOA

A

lubricant and osmotic effect

28
Q

Glycerin Trade Name

A
  • Fleet

- Babylax

29
Q

Glycerin Efficacy

A
  • mild action

- ideal for children and infants

30
Q

Glycerin Safety

A

very safe

31
Q

Lubricants MOA

A
  • coats stool and allows easier passage
  • decreases absorption of water
  • lubricant
32
Q

Lubricant Generics

A

-mineral oil

33
Q

Lubricant Trade Names

A
  • agoral

- kondremul

34
Q

Lubricant Efficacy

A

-effective for impaction and temporary relief

35
Q

Lubricant Safety

A
  • may decrease absorption of fat soluble vitamins with prolonged use
  • risk of aspiration if given at bedtime
36
Q

What is the purpose of treating a hepatic encephalopathy patient with lactulose?

A

-purposely inducing diarrhea to decrease serum ammonia levels and reverse the encephalopathy sxs

37
Q

Diphenylmethane Derivatives MOA

A

-stimulation of gut motility

38
Q

Diphenylmethane Derivatives Generic

A

Bisdacodyl PO

39
Q

Bisacodyl Trade Name

A

Dulcolax

40
Q

Bisacodyl Dose

A

10 mg PO x1 (also PR)

41
Q

Diphenylmethane Derivatives Efficacy

A

-very effective for tx of acute constipation, prevention of opioid-induced constipation

42
Q

Diphenylmethane Derivatives AEs

A

abd cramping possible

43
Q

Anthraquinone Derivatives MOA

A

stimulant

44
Q

Anthraquinone Derivatives Generics

A
  • senna

- casantranol

45
Q

Anthraquinone Derivatives Efficacy

A
  • senna moderately effective

- casanthranol also in combo with docusate

46
Q

Anthraquinone Derivatives AEs

A

abd cramping possible

47
Q

Polyethylene Glycol MOA

A

osmotic

48
Q

Polyethylene Glycol Trade Name

A

Miralax

49
Q

Polyethylene Glycol AEs/Safetu

A
  • appears better tolerated than other laxatives

- more costly

50
Q

PEG Solution Trade Name

A
  • Go-Lytely

- CoLyte

51
Q

PEG Solution Efficacy

A

effective for whole bowel irrigation and prep for surgery

52
Q

PEG Solution Safety

A
  • reserve for refractory constipation

- requires 4L oral administration over 3 hours

53
Q

Saline Cathartics MOA

A
  • osmotic retention of fluid in intestine

- also increases peristalsis

54
Q

Saline Cathartics Generics

A
  • magnesium hydroxide

- magnesium citrate

55
Q

Saline Cathartics Trade Name (for magnesium hydroxide)

A

Milk of Magnesia

56
Q

Saline Cathartics Efficacy

A

reserve for bowel evacuation

57
Q

Saline Cathartics Safety

A
  • may result in electrolyte disturbances

- abdominal cramping and HTN possible

58
Q

How long for bulk-forming drugs to take effect?

A

1-3 days

59
Q

How long for emollient drugs to take effect?

A

1-3 days

60
Q

How long for diphenylmethane derivative drugs to take effect?

A

6-12 hours

61
Q

How long for disaccharide drugs to take effect?

A

1-3 days

62
Q

How long for polyethylene glycol to take effect?

A

1-6 hours

63
Q

How long for glycerin drugs to take effect?

A

1-3 days

64
Q

How long for anthraquinone derivative drugs to take effect?

A

6-12 hours

65
Q

How long for saline cathartic drugs to take effect?

A

1-6 hours

66
Q

How long for lubricant drugs to take effect?

A

1-3 days

Fall 2014 - Pharm GI/ENT (14 decks)

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