Constipation and diarhoea Flashcards
What is constipation
infrequent or difficult evacuation of faecs
Causes of diarrhoea
Incorrect diet habits: low-fibre diet
Diseases: obstructive bowel lesions, IBS
Drug-induced: opiods, anatcids, iron supplements, antidepressants, anticholinergics/antispasmodics
non-drug treatment of constipation
Exercise, incr. bran and fluid intake, discourage continupus use of laxatives
Drug treatment of Constipation
Laxatives–> to accelerate movement of food through GIT
Classes of laxatives
Bulk-forming agents
Osmotic agents
Irritants
Lubricants
Stool softeners
Enemas
Propulsives/Prokinetic agents
Which are the Bulk-forming agents
Ispaghula husk
agar
methylcellulose
Which are the osmotic agents
MgSO4
Mg(OH)2
Lactulose
PEG
Glycerine
Which are the irritants
Castor oil
senns
Bisacodyl
Sodium Picosulphate
Which are the irritants
Castor oil
senna
Bisacodyl
Sodium Picosulphate
Which are the lubricants
Liquid paraffin
Mineral oil
Glycerine
Which are the stool softeners
Docusate sodium
Lactulose
Sorbitol
Which are the Enemas
Isotonic saline solution
soaps
Which are the Propulsives
Linaclotide
Prucalopride
Lubiprostone
MOA of the Bulk-forming agents
(isapaghula husk{psyllium}, Sterculia, Methylcellulose)
indigestible polysaccharides that absorb fluid from GIT–> soft bulky stool formation–> stimulation of bowel action (peristalsis)
Indications of Bulk-forming agnets
Long-term prophylaxis and treatment of Constipation
IBS-C
Diverticular disease
Onset of action of Bulk-forming agents
up to 72hrs
CI of Bulk-forming agents
intestinal obstruction
Stenosis
ulcerations
DI of Bulk-forming agents
decr. absorption of Digoxin
Antidiabetics
Carbamazepine
Lithium
AEs of Bulk-forming agents
Abd. distention
Cramps
Flatulence
What to do when taking Bulk-forming agents + other medications
Medications should be taken 3hrs before or after
Adequate fluid intake is advised to avoid possibility of Intestinal compaction
MOA of Osmotic agents
are poorly absorbed agents that draws water into bowel lumen via osmotic action (incr. osmotic pressure)–> water retention in stools–> incr. stool frequency
I of Osmotic agents
Acute and chronic constipation
Bowel prep
Indications for Lactulose
acute/chronic constipation
Hepatic Encephalopathy
Cautions with Lactulose
Pregnancy+Lactation
CI of Lactulose
Galactosaemia
DI of Lactulose
Warfarin (incr. anticoagulation)
AEs of Lactulose
Flatulence
abd. distention+cramping
I of Polyethylene Glycol (PEG)
acute constipation
Bowel prep
Cautions with Polyethylene Glycol (PEG)
pts>60 yrs
may cause apthpus ulceration
Unconscious patients (ris of regurgitation/aspiration)
CIs of Polyethylene Glycol (PEG)
GI obstruction
Bowel perforation
Toxic megacolon
Onset of action of Polyethylene Glycol (PEG)
24-96 hrs
AEs of Polyethylene Glycol (PEG)
flatulence
abd. distention+cramping
colonic mucosal aphthpus ulceration
Ischarmic colitis
I of Magnesium salts
rapid bowel evacuation