constipation and diarrhea Flashcards
“methylcellulose (Citrucel®)
polycarbophil (FiberCon®)
psyllium (Metamucil®)
Wheat dextrin (Benefiber®)”
“Bulk-Forming ““Laxatives””
AKA Fiber”
“Bulk-Forming ““Laxatives””
AKA Fiber”
can improve ___ and ___
glucose, LDLs
AEs: Bloating, flatus, distention, abdominal cramping (especially in those with slow transit constipation). Colonbacteria growth can be increased. POSSIBLE impaction (particularly if a stricture in intestines)
“Bulk-Forming ““Laxatives””
AKA Fiber”
pt education for “Bulk-Forming ““Laxatives””
AKA Fiber”
MUST increase fluid intake when using fiber (otherwise things might get clogged). 240 mL water/fluid (9 ounces) WITH the fiber. Separate drugs > 2 hrs
"Lactulose (Enulose®) Polyethylene glycol (MiraLax®, GlycoLax®) with electrolytes (GoLYTELY®) (PEG) Magnesium hydroxide (Milk of Magnesia®) and magnesium citrate"
Osmotics
MOA: Non-absorbable salts. Increase and retainwater in theintestines byosmosis
osmotics
contras for osmotics
“Enulose: pt w/ an ileus
mag citrate: renal failure; caution in renal insuffiency”
Docusate sodium (Colace®,Sof-Lax®), Mineral oil (oral or rectal), glycerin suppositories
Lubricants (stool softener)
MOA: Promote penetration of water & lipids to coat the stool stool softening. Lubricate intestinal tract
Lubricants (stool softener)
“Senna (sennosides, Senokot®, Ex-Lax®) - oral tablets/pills/syrup
Bisacodyl (Dulcolax®) – oral, rectal suppository”
Stimulant laxatives
MOA:Direct stimulation of the enteric nervous system to increase peristaltic activity. Motility & colonic electrolyte and fluid secretion
Stimulant laxatives
contra for senna
pregnancy
AE of senna
gasping syndrome in babies if in large amounts
pt education for stimulant laxes
Take at night for bowel movement in AM. PRN only- these are NOT for daily use. “Laxative bowel”
Fleet’s enema: saline or Na phosphate
saline agents
Caution: can cause elecgrolyte abnormalities in elderly
Fleet’s enema: saline or Na phosphate
“Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)”
Intestinal secretagogues
“Methylnaltrexone Bromide (Relistor)
Naloxegol (Movantik)
Naldemedine (Symproic)”
Peripheral acting µ-opioid receptor antagonists (PAMORAs)
do PAMORAs affect central opioid anagesic affect
no
Methylcellulose (Citrucel®), calcium polycarbophil (FiberCon®), psyllium (Metamucil®)
Adsorbents and bulk agents
contras for Adsorbents and bulk agents
Do not use if patient is dehydrated or fluid restricted
pt education for Adsorbents and bulk agents
Administer with a full glass of water
safest anti-diarrheals for long term use
Adsorbents and bulk agents
Loperamide (Imodium A-D®) - OTC, Diphenoxylate (Lomotil®) - Rx
Anti-peristaltic (antimotility) agents
contra for Anti-peristaltic (antimotility) agents
C diff
Bismuth subsalicylate (Pepto Bismol®, Kaopectate®)
Antisecretory agents
MOA: Inhibits prostaglandin and Cl secretion in intestine to reduce liquid content of stools (promotes absorption of fluids). Anti-microbial effects. PK: salicylate absorbed systemically
Antisecretory agents
AEs: Tinnitus, nausea and vomiting. Black stools, darkening of tongue
Antisecretory agents
contra for Antisecretory agents
Caution in patients with salicylate allergy! (aka aspirin)
contras for Tegaserod maleate (Zelnorm®)
“Severe renal or hepatic impairment
History of MI, stroke, transient ischemic attack, angina”
contra for Rifaximin (Xifaxan®)
Caution: with severe hepatic failure
BBW for Alosetron (Lotronex®)
BBW: ischemic colitis
Alosetron (Lotronex®)
in which gender only
F
contra/pt education for Eluxadoline (Viberzi®)
> 3 alcoholic beverages/day due to pancreatitis risk
