Constipation and Diarrhea Flashcards by Grace Whitham

What medical conditions can cause constipation

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

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What is chronic idiopathic constipation?

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

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What are non-drug therapies for constipation?

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

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What medications cause constipation?

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

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What OTC medication is recommended for constipation in most adults

increased fiber

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

docusate (stool softener)

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What OTC medication is recommended for constipation in opioid-induced

Senna or bisacodyl (stimulants) can add docusate

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What OTC medication is recommended for constipation in Pregnancy

Fiber or bulk forming (psyllium)

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

Adults: bisacodyl or glycerin suppository
Children: glycerin suppository

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What medications are bulk-forming for constipation?

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

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What medications are osmotics for constipation?

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

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What medications are stimulants for constipation?

Senna (Ex-Lax, Senokot)

Bisacodyl (Dulcolax)

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What medications are stool softeners for constipation

docusate

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What medications are lubricants for constipation

mineral oil

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Bulk-forming laxatives SE and notes

SE: flatulence, abdominal cramping, bloating

Adequate fluid required

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Osmotic laxaives SE and notes

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

Stimulant laxative SE and notes

SE: abdominal cramping
Notes: take at bedtime

Emollient laxative notes

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

Lubricant laxatives CI

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

What medication classes are prescription laxatives?

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

What medications are chloride channel activators?

Lubiprostone (Amitiza)

What medications are Guanylate Cyclase C Agonists

Linaclotide (linzess)

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

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

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

Therapeutic doses of opioids for >7 consecutive days

When are laxatives for whole bowel irrigation used?

Before a colonoscopy

What medications are laxatives used for whole bowel irrigation?

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

Whole bowel irrigation BBW and CI

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

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

E. coli - bacterial | Also caused by viral organisms

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

IBS-D

What are non-drug therapies for diarrhea?

``` Rehydration Electrolyte repletion (Pedialyte) ```

What are potential drug therapies for diarrhea?

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

What medications can cause diarrhea?

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

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

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

Loperamide BBW, CI, SE

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

Diphenoxylate/atropine (Lomotil) CI and nots

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

Dicyclomine warnings, SE, and indication

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

Eluxadoline MOA and CI

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

What antidiarrheals are controlled?

Diphenoxylate/atropine (Lomotil) - CV | Eluxadoline (Viberzi) - CIV