Constipation and Diarrhea Flashcards
what conditions can cause constipation
sp cord injury
IBS-C
anal fissures, fistulas, hemorrhoids, rectal prolapse
cerebrovascular events
parkinsons
DM
hypothyroidism
what drugs can cause constipation
opioids
antacids
antidiarrheals
colesevelam
anticholinergics
verapamil
Aluminum products
aripiprazole
non pharm tx for constipation
recommended for all
fluids (64 oz a day)
increase fiber foods
inc physical activity
avoid caffeine and alcohol
what are the bulk forming laxatives? which patients are these recommended in?
psyllium (metamucil)\
fiber (FiberCon, Benefber etc.)
methylcellulose
recommended as first line for all patients
#1 in pregnancy
recommended for iron-induced constipation as well
osmotic laxatives includes …
PEG
lactulose
glycerin
MOM
fleet enema
PEG dosing
17g PO daily
MOM dosing
2.4-4.8mg hs
lactulose dosing for constipation
10-20g daily po
fleet enema active ingredient
sodium phosphates
miralax (PEG) is CI in
GI obstruction
osmotic laxatives (glycerin, MOM, PEG, lactulose, fleet enema) are recommended in which condition
opioid-induced constipation (OIC)
what are the stimulant laxatives? when are these recommended?
senna
bisacodyl (Dulcolax)
recommended in opioid-induced constipation
senna dosing
17.2-50 grams daily-BID
bisacodyl (dulcolax) dosing
waht dosage forms are available
5-15mg daily
PO and PR
stimulant laxatives should be taken
at night to induce a BM in the morning
what is the main stool softener
docusate (Colace)
docusate
brand name
dosing
dosage forms
use/recommendation
Colace
50-360mg daily or DIV
PO or PR
preferred in situations where need to avoid strain (post-partum, post-MI, hemorrhoids, fistulas, fissures)
recommended in iron-induced constipation
lubiprostone
brand
MOA
indications
Amitiza (lubiprostone)
Cl- channel activator
indicated for CIC, IBS-C in adult women, OIC
Linaclotide
brand
MOA
indications
Linzess
guanylate cyclase agonist that increases bicarb and Cl- secretion into intestine
indicated for CIC and IBS-C
match brand to generic
linaclotide Entereg
alvimopan Amitiza
lupiprostone Linzess
lubprostone - Amitiza
linaclotide - Linzess
alvimopan - ENtereg
alvimopan
brand
MOA
indication
Entereg
peripheral mu opioid receptor antagonist (PAMORA)
only for hospitalized surgery patients post op to prevent ileus
what is the role of methylnaltrexone (Relistar) and naloxegol (Movantik) in management of constipation
indicated for OIC only
OIC =
opioid induced constipation
CIC =
chronic idiopathic constipation
what are tx options for diarrhea
loperamide
BSS
diphenoxylate/atropine
doxylamine
BSS
dosing
MDD
max duration
SE
524mg q30-60 min
MDD 4200 g /d
max is x2 days
SE: black/tarry tongue or stool, salicylate HSR, bleed risk with anticoag/ASA/NSAIDs/antiplatelets, nausea
BSS suspension concentration
262mg/15mL
BSS OTC tab strength
262mg
loperamide
brand
dosing
MDD
Imodium -AD
4mg with first loose stool then 2mg with ea subsequent loose stool up to
8mg OTC
16mg if Rx or supervised healthcare setting
loperamide ADE
BBW: torsades, cardiac arrest, sudden death, not for <2 yo
loperamide is CI in
acute dysentery
c diff
bacterial enterocolitis
diphenoxylate/atropine
brand
CI
SE
Lomotil
CI resp dep risk and c diff
SE: anticholinergic
when experiencing constipation or diarrhea, when should a HCP be contacted
< 6 mo old
pregnant
>101 F
severe abdominal pain
hematochezia
OTC used x1 week with no improvement
