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GI pharm > Constipation > Flashcards

Constipation Flashcards

1
Q

Rome III Criteria ofr constipation must include two or more of what symptoms?

A

o Straining >25%
o Lumpy or hard stools >25%
o Sensation of incomplete evacuation >25%
o Sensation of anorectal obstruction/blockage >25%
o Manual maneuvers to facilitate defecations >25% (e.g., digital evacuation, support of pelvic floor)
o Fewer than 3 defecations per week

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2
Q

In constipation, Loose stools are rarely present without use of _____

A

laxatives

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3
Q

to diagnose constipation, there must be Insufficient criteria for ___

A

IBS

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4
Q

Constipation is often a result of change In what?

A

diet, exercise, medications, etc

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5
Q

If it is _____ constipation it is a change in bowel without anything else causing ití like IBS, etc.

A

functional

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6
Q

drug classes that can cause constipation

A

analgesics
anticholinergics
cation-containing agents
neurally active agents

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7
Q

General Approach to Therapy for constipation

A
  • Patient education
  • Diet
  • Exercise
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8
Q

what two things should you educate your pt on in regards to their diet for constipation?

A

o Fiber– Increase in fiber and decrease processed food

o Fluids– Increase fluid intake

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9
Q

should you taper laxative when possible?

A

yes

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10
Q

Bulk Forming Laxatives- 4 drugs

A
  • Psyllium (Metamucil)
  • Methylcellulose (Citrucel)
  • Calcium polycarbophil (FiberCon)
  • Wheat dextran (Benefiber)
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11
Q

MOA of Bulk Forming Laxatives

A

hydrophilic colloids that form gels in intestine causing water retention and intestinal distension which increases peristalsis

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12
Q

onset of action for Bulk Forming Laxatives

A

12-72 hours

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13
Q

Bulk Forming Laxatives ADRs

A

gas, bloating

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14
Q

drug names of osmotic agents (7)

A
  • Polyethylene glycol (PEG) [Miralax (OTC), Golytely, Nulytely, et al.]
  • Magnesium citrate
  • Magnesium hydroxide (Milk Of Magnesia)
  • Magnesium sulfate
  • Lactulose (Enulose)
  • Glycerin suppositories
  • Sorbitol
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15
Q

Which osmotic agent is Rx only?

A
  • Lactulose (Enulose)
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16
Q

osmotic agents MOA

A

cause fluid retention in intestine

  • Pulling fluid from surrounding tissue into the gut
  • More liquid in bowels= stool becomes liquified
17
Q

do osmotic agents or fiber supplements have a faster onset?

A

osmotic agents are faster

18
Q

ADRs of osmotic agents

A

o Nausea, bloating, cramping, flatulence

o Electrolyte imbalances if used improperly

19
Q

Surfactants (Stool Softeners) drug name

A

Docusate sodium (different salt forms) (Colace)

20
Q

Surfactants (Stool Softeners) MOA

A

become emulsified in stool and lower surface tension which allows water in

21
Q

why don’t Surfactants (Stool Softeners) work well as a whole?

A

Typically do NOT increase stool frequency just consistency

22
Q

how long can it take for Surfactants (Stool Softeners) to work?

A

can take weeks to work

23
Q

Stimulant Laxatives drug names

A 
o	Bisacodyl (Correctol, Dulcolax)
o	Senna (Ex-Lax, Sennokot)
24
Q

are Stimulant Laxatives OTC?

A

yes

25
Q

Stimulant Laxatives MOA

A

work by directly stimulating enteric nerves and/or smooth muscle to increase peristalsis

26
Q

why is there Caution with chronic use of Stimulant Laxatives

A

hypokalemia, protein-losing enteropathy, salt overload

27
Q

Stimulant Laxatives ADRs

A

cramping, bloating, etc.

28
Q

when someone has constipation what do you start them with?

A

Start with dietary change and lifestyle- eat more fiber, drink fluids, exercise.

29
Q

after the patient has implemented dietary change and lifestyle changes and still have constipation, what is next?

A

fiber supplements

30
Q

when fiber supplements do not work, what is the next step in treating constipation?

A

osmotic agent

31
Q

when osmotic agents fail, what can be used to treat constipation?

A

stimulant laxative

32
Q

what is the Chloride Channel Activator drug’s name used to treat constipation

A

Lubiprostone (Amitiza)

33
Q

what is Lubiprostone (Amitiza) MOA

A

activates chloride channels in intestine which increases fluid secretion and motility

34
Q

uses for Lubiprostone (Amitiza)

Chloride Channel Activator

A
  1. Chronic idiopathic constipation (CIC)–Goes on for months, can’t figure out cause.
  2. IBS with constipation in adult women (IBS-C)
35
Q

can Lubiprostone be used in both men and women?

A

no only women

36
Q

Guanylate Cyclase-C Receptor Agonist drug names

A 
o	Linaclotide (Linzess)
o	Plecanatide (Trulance)
37
Q

MOA of Guanylate Cyclase-C Receptor Agonist drug names

A

agonizing guanylate cyclase-C receptors causes increased cGMP which stimulates chloride and bicarbonate secretion into intestinal lumen

38
Q

Guanylate Cyclase-C Receptor Agonist uses (2)

A

o CIC

o IBS-C

GI pharm (11 decks)

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