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NAPLEX Review > Constipation and Diarrhea > Flashcards

Constipation and Diarrhea Flashcards

1
Q

What medical conditions can cause constipation

A 
IBS-C
Anal disorders
MS
Cerebrovascular events
Parkinson disease
Spinal cord tumors
Diabetes
Hypothyroidism
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2
Q

What is chronic idiopathic constipation?

A

Constipation that lasts for several weeks or longer and cause is unknown

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3
Q

What are non-drug therapies for constipation?

A

Increase fluid intake (64oz/d)
Limit caffeine and alcohol intake
Increase physical activity
High fiber foods

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4
Q

What medications cause constipation?

A 
Antacids
Clonidine
Colesevelam
Anticholinergic medications
Iron
non-DHP CCB (esp verapamil)
Opioids
Sucralfate
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5
Q

What OTC medication is recommended for constipation in most adults

A

increased fiber

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6
Q

What OTC medication is recommended for constipation in iron-induced or hard stool

A

docusate (stool softener)

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7
Q

What OTC medication is recommended for constipation in opioid-induced

A

Senna or bisacodyl (stimulants) can add docusate

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8
Q

What OTC medication is recommended for constipation in Pregnancy

A

Fiber or bulk forming (psyllium)

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9
Q

What OTC medication is recommended for constipation in patients who need relief ASAP

A

Adults: bisacodyl or glycerin suppository
Children: glycerin suppository

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10
Q

What medications are bulk-forming for constipation?

A

psyllium (Metamucil)
Calcium polycarbophil (Fibercon)
Methylcellulose (Citrucel)
Wheat dextrin (Benefiber)

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11
Q

What medications are osmotics for constipation?

A 
Polyethylene glycol (miralax)
Mg hydroxide (milk of mag)
Glycerin
Lactulose
Sodium phosphate (Fleet)
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12
Q

What medications are stimulants for constipation?

A

Senna (Ex-Lax, Senokot)

Bisacodyl (Dulcolax)

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13
Q

What medications are stool softeners for constipation

A

docusate

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14
Q

What medications are lubricants for constipation

A

mineral oil

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15
Q

Bulk-forming laxatives SE and notes

A

SE: flatulence, abdominal cramping, bloating

Adequate fluid required

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16
Q

Osmotic laxaives SE and notes

A

SE: electrolyte imbalance, abdominal cramping
Notes: Mg-containing caution with renal impairment; glycerin suppository used commonly in children who need to defecate quickly

17
Q

Stimulant laxative SE and notes

A

SE: abdominal cramping
Notes: take at bedtime

18
Q

Emollient laxative notes

A

Preferred when straining should be avoided (postpartum, post MI, anal fissures, hemorrhoids)

19
Q

Lubricant laxatives CI

A

Age <6, pregnancy, bedridden patients, elderly, use > 1x/w, difficulty swallowing

20
Q

What medication classes are prescription laxatives?

A

Chloride channel activotors
Guanylate cyclase C agonists
Peripherally-acting Mu-opioid receptor antagonists (PAMORAs)
Sodium/Hydrogen exchanges (NHE3) inhibitor
Serotonin 5HT-4 receptor agonists

21
Q

What medications are chloride channel activators?

A

Lubiprostone (Amitiza)

22
Q

What medications are Guanylate Cyclase C Agonists

A

Linaclotide (linzess)

23
Q

What medications are peripherally-acting Mu-opioid receptor antagonists (PAMORAs)

A

Alvimopan (Entereg)
Methylnaltrexone (Relistor)
Naloxegol (Movantik)

24
Q

Peripherally-acting mu-opioid receptor antagonist (PAMORA) CI

A

Therapeutic doses of opioids for >7 consecutive days

25
Q

When are laxatives for whole bowel irrigation used?

A

Before a colonoscopy

26
Q

What medications are laxatives used for whole bowel irrigation?

A

PEG (Colyte, GoLytely, NuLytely)
Sodium phosphate (OsmoPrep)
Sodium sulfate, potassium sulfate and magnesium sulfate (Suprep Bowel Prep Kit)

27
Q

Whole bowel irrigation BBW and CI

A

BBW: Osmoprep - nephropathy
CI: Osmoprep - acute phosphate nephropathy, gastric bypass or stapling surgery

28
Q

What are the most common causes of traveler’s diarrhea?

A

E. coli - bacterial

Also caused by viral organisms

29
Q

What is chronic or recurring abdominal discomfort that is relieved by defication?

A

IBS-D

30
Q

What are non-drug therapies for diarrhea?

A 
Rehydration
Electrolyte repletion (Pedialyte)
31
Q

What are potential drug therapies for diarrhea?

A

Bismuth subsalicylate (Pepto-Bismol)
Loperamide (Immodium A-D)
Diphenoxlate/atropine (Lomotil)

32
Q

What medications can cause diarrhea?

A 
Antacids containing magnesium
Antibiotics
Antidiabetics
Antineoplastics
Colchicine
Drugs for constipation
Misoprostol
Mycophenolate
Prokinetic drugs
Protease inhibitors
Quinidine
Roflumilast
33
Q

Bismuth subsalycilate (Pepto-Bismol) CI, warnings, SE

A

CI: Salicylate allergy, taking other salicylates, GI ulcer, bleeding problems, black/bloody stool
Warnings: children and teenagers recovering from flu, chickenpox, or other viral infections (Reye’s syndrome)
SE: Black tongue/stool, salicylate toxicity, nausea

34
Q

Loperamide BBW, CI, SE

A

BBW: torsades, cardiac arrest, sudden death with high doses; do not use in children <2 years
CI: acute dysentery (bloody diarrhea), pseudomembranous colitis, bacterial endocolitis
SE: constipation
Do not use for >48 hours

35
Q

Diphenoxylate/atropine (Lomotil) CI and nots

A

CI: do not use in children <2 for liquid or <6 for tablets d/t respiratory and CNS depression
Liquid formulation recommended for children <13 years
Anticholinergic effects d/t atropine

36
Q

Dicyclomine warnings, SE, and indication

A

Warnings: Anticholinergic (caution in >65 years), can cause toxic metacolon or paralytic ileus in ulcerative colitis
SE: Nausea, anticholinergic
Indication: spasms

37
Q

Eluxadoline MOA and CI

A

MOA: peripherally-acting Mu-opioid Receptor Agonist
CI: pts without a gallbladder

38
Q

What antidiarrheals are controlled?

A

Diphenoxylate/atropine (Lomotil) - CV

Eluxadoline (Viberzi) - CIV

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