Constipation and diarhoea Flashcards by Aisha Farah

What is constipation

infrequent or difficult evacuation of faecs

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Causes of diarrhoea

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

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non-drug treatment of constipation

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

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Drug treatment of Constipation

Laxatives–> to accelerate movement of food through GIT

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Classes of laxatives

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

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Which are the Bulk-forming agents

Ispaghula husk
agar
methylcellulose

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Which are the osmotic agents

MgSO4
Mg(OH)2
Lactulose
PEG
Glycerine

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Which are the irritants

Castor oil
senns
Bisacodyl
Sodium Picosulphate

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Which are the irritants

Castor oil
senna
Bisacodyl
Sodium Picosulphate

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Which are the lubricants

Liquid paraffin
Mineral oil
Glycerine

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Which are the stool softeners

Docusate sodium
Lactulose
Sorbitol

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Which are the Enemas

Isotonic saline solution
soaps

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Which are the Propulsives

Linaclotide
Prucalopride
Lubiprostone

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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)

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Indications of Bulk-forming agnets

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

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Onset of action of Bulk-forming agents

up to 72hrs

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CI of Bulk-forming agents

intestinal obstruction
Stenosis
ulcerations

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DI of Bulk-forming agents

decr. absorption of Digoxin
Antidiabetics
Carbamazepine
Lithium

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AEs of Bulk-forming agents

Abd. distention
Cramps
Flatulence

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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

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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

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I of Osmotic agents

Acute and chronic constipation
Bowel prep

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Indications for Lactulose

acute/chronic constipation
Hepatic Encephalopathy

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Cautions with Lactulose

Pregnancy+Lactation

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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

Cautions with Magnesium salts

Hypermagnesaemia Renal insufficiency

CIs of Magnesium salts

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

AEs of Magnesium salts

electrolyte imbalance- may worsen abd. cramps

I of Sodium Phosphate

pre-operative pre-radiography endoscopic bowel evacuation

Cautions with Sodium Phosphate

risk of phosphate nephropathy severe dehydration HF

CIs of Sodium Phosphate

bowel obstruction/perforation

AEs of Sodium Phosphate

electrolyte imbalance bloating nausea abd. pain

MOA of Bisacodyl

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

I of Bisacodyl

short-treatment without any pre-existing abdominal issues

Onset of action of Bisacodyl

6-8 hrs orally 15-60mins rectally

DIs of Bisacodyl

Digoxin: decr. serum conc.

CIs of Bisacodyl

intestinal obstruction undiagnosed abd. pains

AEs of Bisacodyl

abd. cramps

MOA of Senna

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

onset of action of Senna

6-8hrs

Indications of Senna

acute constipation bowel prep

DIs of Senna

Digoxin: decr. serum conc.

CIs of Senna

GI obstruction IBD

AEs of Senna

abd. pain excessive bowel activity Hypokalaemia dehydration

MOA of Sodium Picosulphate

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

Onset of action of Sodium Picosulphate

6-12hrs

Indications of Sodium Picosulphate

severe constipation bowel prep

CIs of Sodium Picosulphate

GI obstruction toxic colitis GI perforation appendicitis

AEs of Sodium Picosulphate

abd cramps hypocalaemia hypokalaemia

MOA of Castor oil

Onset of action of Castor oil

2-6hrs

Is of Castor oil

acute constipation colonic evacuation

CIs of Castor oil

GI obstruction/perforation Appendicitis UC

AEs of Castor oil

Abd. cramps electrolyte imbalance/disturbance hypotension

MOA of Lubricant Laxatives

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

I of Lubricant Laxatives

acute constipation

onset of action of Lubricant Laxatives

6-8hrs orally

CIs of Lubricant Laxatives

abd. pain appendicitis GI obstruction/perforation UC

AEs of Lubricant Laxatives

abd cramps intestinal malabsorption Lipid pneumonitis

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

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

I of Stool softeners

acute/chronic constipation

Onset of action of Stool softeners

24-72hrs

CIs of Stool softeners

abd pain appendicitis GI obstruction/perforation

AEs of Stool softeners

abd cramps excessive bowel activity Throat irritation

MOA of Linaclotide

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

I of Linaclotide

IBS-C Chronic idiopathic constipation

CIs of Linaclotide

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

AEs of Linaclotide

Abd. pain severe diarrhoea

MOA of Prucalopride

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

I of Prucalopride

chronic idiopathic construction

CIs of Prucalopride

GI obstruction IBD

AEs of Prucalopride

abd pain headache anxiety

MOA of Lubiprostone

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

I of Lubiprostone

Chronic idiopathic constipation opiod-induced constipation IBS-C

CI of Lubiprostone

GI obstruction IBD

AEs of Lubiprostone

Abd pain Headache Anxiety