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Constipation and diarhoea Flashcards

1
Q

What is constipation

A

infrequent or difficult evacuation of faecs

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2
Q

Causes of diarrhoea

A

Incorrect diet habits: low-fibre diet
Diseases: obstructive bowel lesions, IBS
Drug-induced: opiods, anatcids, iron supplements, antidepressants, anticholinergics/antispasmodics

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3
Q

non-drug treatment of constipation

A

Exercise, incr. bran and fluid intake, discourage continupus use of laxatives

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4
Q

Drug treatment of Constipation

A

Laxatives–> to accelerate movement of food through GIT

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5
Q

Classes of laxatives

A

Bulk-forming agents
Osmotic agents
Irritants
Lubricants
Stool softeners
Enemas
Propulsives/Prokinetic agents

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6
Q

Which are the Bulk-forming agents

A

Ispaghula husk
agar
methylcellulose

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7
Q

Which are the osmotic agents

A

MgSO4
Mg(OH)2
Lactulose
PEG
Glycerine

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8
Q

Which are the irritants

A

Castor oil
senns
Bisacodyl
Sodium Picosulphate

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9
Q

Which are the irritants

A

Castor oil
senna
Bisacodyl
Sodium Picosulphate

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10
Q

Which are the lubricants

A

Liquid paraffin
Mineral oil
Glycerine

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11
Q

Which are the stool softeners

A

Docusate sodium
Lactulose
Sorbitol

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12
Q

Which are the Enemas

A

Isotonic saline solution
soaps

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13
Q

Which are the Propulsives

A

Linaclotide
Prucalopride
Lubiprostone

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14
Q

MOA of the Bulk-forming agents
(isapaghula husk{psyllium}, Sterculia, Methylcellulose)

A

indigestible polysaccharides that absorb fluid from GIT–> soft bulky stool formation–> stimulation of bowel action (peristalsis)

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15
Q

Indications of Bulk-forming agnets

A

Long-term prophylaxis and treatment of Constipation
IBS-C
Diverticular disease

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16
Q

Onset of action of Bulk-forming agents

A

up to 72hrs

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17
Q

CI of Bulk-forming agents

A

intestinal obstruction
Stenosis
ulcerations

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18
Q

DI of Bulk-forming agents

A

decr. absorption of Digoxin
Antidiabetics
Carbamazepine
Lithium

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19
Q

AEs of Bulk-forming agents

A

Abd. distention
Cramps
Flatulence

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20
Q

What to do when taking Bulk-forming agents + other medications

A

Medications should be taken 3hrs before or after
Adequate fluid intake is advised to avoid possibility of Intestinal compaction

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21
Q

MOA of Osmotic agents

A

are poorly absorbed agents that draws water into bowel lumen via osmotic action (incr. osmotic pressure)–> water retention in stools–> incr. stool frequency

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22
Q

I of Osmotic agents

A

Acute and chronic constipation
Bowel prep

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23
Q

Indications for Lactulose

A

acute/chronic constipation
Hepatic Encephalopathy

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24
Q

Cautions with Lactulose

A

Pregnancy+Lactation

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25
Q

CI of Lactulose

A

Galactosaemia

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26
Q

DI of Lactulose

A

Warfarin (incr. anticoagulation)

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27
Q

AEs of Lactulose

A

Flatulence
abd. distention+cramping

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28
Q

I of Polyethylene Glycol (PEG)

A

acute constipation
Bowel prep

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29
Q

Cautions with Polyethylene Glycol (PEG)

A

pts>60 yrs
may cause apthpus ulceration
Unconscious patients (ris of regurgitation/aspiration)

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30
Q

CIs of Polyethylene Glycol (PEG)

A

GI obstruction
Bowel perforation
Toxic megacolon

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31
Q

Onset of action of Polyethylene Glycol (PEG)

A

24-96 hrs

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32
Q

AEs of Polyethylene Glycol (PEG)

A

flatulence
abd. distention+cramping
colonic mucosal aphthpus ulceration
Ischarmic colitis

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33
Q

I of Magnesium salts

A

rapid bowel evacuation

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34
Q

Cautions with Magnesium salts

A

Hypermagnesaemia
Renal insufficiency

35
Q

CIs of Magnesium salts

A

intestinal obstruction/perforation
undiagnosed abd pain
existing electrolyte imbalance
mycocardial damage

36
Q

AEs of Magnesium salts

A

electrolyte imbalance- may worsen
abd. cramps

37
Q

I of Sodium Phosphate

A

pre-operative
pre-radiography
endoscopic bowel evacuation

38
Q

Cautions with Sodium Phosphate

A

risk of phosphate nephropathy
severe dehydration
HF

39
Q

CIs of Sodium Phosphate

A

bowel obstruction/perforation

40
Q

AEs of Sodium Phosphate

A

electrolyte imbalance
bloating
nausea
abd. pain

41
Q

MOA of Bisacodyl

A

direct stimulation of intestinal SM, colonic intramural plexus –> incr. peristalsis; incr. intestinal fluid accumulation and relaxation by altering water+electrolyte secretion

42
Q

I of Bisacodyl

A

short-treatment without any pre-existing abdominal issues

43
Q

Onset of action of Bisacodyl

A

6-8 hrs orally
15-60mins rectally

44
Q

DIs of Bisacodyl

A

Digoxin: decr. serum conc.

45
Q

CIs of Bisacodyl

A

intestinal obstruction
undiagnosed abd. pains

46
Q

AEs of Bisacodyl

A

abd. cramps

47
Q

MOA of Senna

A

direct stimulation of intestinal SM–> incr. GI motility; incr. water+electrlytes accumulation in bowel lumen

48
Q

onset of action of Senna

49
Q

Indications of Senna

A

acute constipation
bowel prep

50
Q

DIs of Senna

A

Digoxin: decr. serum conc.

51
Q

CIs of Senna

A

GI obstruction
IBD

52
Q

AEs of Senna

A

abd. pain
excessive bowel activity
Hypokalaemia
dehydration

53
Q

MOA of Sodium Picosulphate

A

metabolised by colonic bacteria=active metabolite of Bisacodyl–> stimulation of intestinal SM–> incr GI motility–> incr. water+electrolyte accumulation in bowel lumen

54
Q

Onset of action of Sodium Picosulphate

55
Q

Indications of Sodium Picosulphate

A

severe constipation
bowel prep

56
Q

CIs of Sodium Picosulphate

A

GI obstruction
toxic colitis
GI perforation
appendicitis

57
Q

AEs of Sodium Picosulphate

A

abd cramps
hypocalaemia
hypokalaemia

58
Q

MOA of Castor oil

59
Q

Onset of action of Castor oil

60
Q

Is of Castor oil

A

acute constipation
colonic evacuation

61
Q

CIs of Castor oil

A

GI obstruction/perforation
Appendicitis
UC

62
Q

AEs of Castor oil

A

Abd. cramps
electrolyte imbalance/disturbance
hypotension

63
Q

MOA of Lubricant Laxatives

A

lubricate intestine–> decr. water absorption from colon–> easy passage of stool

64
Q

I of Lubricant Laxatives

A

acute constipation

65
Q

onset of action of Lubricant Laxatives

A

6-8hrs orally

66
Q

CIs of Lubricant Laxatives

A

abd. pain
appendicitis
GI obstruction/perforation
UC

67
Q

AEs of Lubricant Laxatives

A

abd cramps
intestinal malabsorption
Lipid pneumonitis

68
Q

MOA of Stool softeners
(Docusate Sodium- a surfactant lubricant)

A

Lowers surface tension at faecal oil-water interface–> incr. water absorption by stool–> faecal softening (allows incorpartion of water and fat into stools)

69
Q

I of Stool softeners

A

acute/chronic constipation

70
Q

Onset of action of Stool softeners

71
Q

CIs of Stool softeners

A

abd pain
appendicitis
GI obstruction/perforation

72
Q

AEs of Stool softeners

A

abd cramps
excessive bowel activity
Throat irritation

73
Q

MOA of Linaclotide

A

is GC agonist
= incr. intracellular cGMP–> stimulates sectretion of Cl and Bicarbonate into GI lumen–> incr. fluid and accelerated transit of GI contents

74
Q

I of Linaclotide

A

IBS-C
Chronic idiopathic constipation

75
Q

CIs of Linaclotide

A

pts<6yrs (serious risk of dehydration)
GI obstruction

76
Q

AEs of Linaclotide

A

Abd. pain
severe diarrhoea

77
Q

MOA of Prucalopride

A

selective 5-HT4 Receptor agonist
=illicits GI prokinetic action–> chronic peristalsis–> incr. GI motility

78
Q

I of Prucalopride

A

chronic idiopathic construction

79
Q

CIs of Prucalopride

A

GI obstruction
IBD

80
Q

AEs of Prucalopride

A

abd pain
headache
anxiety

81
Q

MOA of Lubiprostone

A

locally acting (on apical portion of intestine) Chloride channel activator= incr. intestinal fluid secretion and motility

82
Q

I of Lubiprostone

A

Chronic idiopathic constipation
opiod-induced constipation
IBS-C

83
Q

CI of Lubiprostone

A

GI obstruction
IBD

84
Q

AEs of Lubiprostone

A

Abd pain
Headache
Anxiety

Pharmacology (50 decks)

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