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OTC > Constipation and Hemorrhoids > Flashcards

Constipation and Hemorrhoids Flashcards

1
Q

Some lifestyle modifications for constipations

A

Increase fiber intake
Increase fluid intake
“Bowel Training”
Squatty Potty

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2
Q

What are types of fiber and what food contain them?

A

Soluble
Beans, oat bran, barley, citrus fruits, apples, carrots, etc.

Insoluble
Whole grain breads, prunes, corn, etc.

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3
Q

What are first line treatments for constipation?

A

Bulk-forming agent

Hyperosmotic agent

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4
Q

Bulk-forming agents MOA

A

promoting evacuation by dissolving or swelling to form emollient gels that facilitate passage of stools and stimulate peristalsis (bulk)

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5
Q

Bulk-forming agents products

A

Psyllium (Metamucil™) – natural source/allergy alert

Methylcellulose (Citrucel™) – synthetic so least GAS

Polycarbophil (FiberCon™) - extremely hygroscopic

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6
Q

Bulk-forming agents things to remember

A

MUST take with water to avoid obstruction

Avoid in individuals with swallowing difficulties

Most common side effect – flatulence

May interfere with the absorption of concomitant oral medications – separate by at least 2 hours

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7
Q

Hyperosmotic agent MOA

A

Large poorly absorbed ions draw water into colon or rectum to stimulate bowel movement

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8
Q

Hyperosmotic agent products

A

Polyethylene Glycol 3350 (Miralax™)

Glycerin

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9
Q

Miralax things to remember

A

Also used in bowel prep regimens for colonoscopy in addition to constipation

Odorless and tasteless and only 0.2% absorbed

No clinically significant drug interactions

Very well tolerated

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10
Q

Glycerin things to remember

A

Used for lower bowel evacuation

Quick onset (15 to 30 minutes)

Drug interactions are not clinically important

As enema, not recommended due to irritation (sodium sterate component)

Minimal side effects

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11
Q

Emollient agents MOA and also called?

A

“Stool softener”

Increase wetting efficacy of intestinal fluid and soften fecal mass

Primarily to prevent straining and painful defecation

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12
Q

Emollient agent product

A 
Docusate sodium (50 or 100mg)
Docusate calcium
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13
Q

Emollient agent things to remember

A

Minimal side effects

Generally well-tolerated

Will increase absorption of mineral oil so combination should be avoided

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14
Q

Lubricant agent MOA, products and things to know

A

Mineral oil

MOA: softens fecal contents by coating stool and preventing colonic absorption of fecal water

To prevent straining and painful defecation
(Safer agents (emollients) preferred)

Many safety concerns – not preferred

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15
Q

Saline laxative agents MOA

A

Ions in intestinal wall draw in water, increasing intraluminal pressure and intestinal motility

Occasional relief of constipation or when acute evacuation of bowel is required

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16
Q

Saline laxative agents products

A

Magnesium citrate

Magnesium hydroxide (MOM™)

Dibasic sodium phosphate/Monobasic sodium phosphate (Fleet™)

Magnesium sulfate (Epsom salt™)

17
Q

Saline laxative agents things to remember

A

May cause serious electrolyte imbalances with long-term use and at higher doses!

Patients who cannot tolerate fluid loss should not use saline laxatives!

18
Q

What is the recommended second line for constipation?

A

Stimulant agents

19
Q

Stimulant agents MOA

A

Increase intestinal motility and secretion of water and electrolytes

20
Q

Stimulant agents product

A

Sennosides (Senna™) - anthraquinone (8.6mg)

Bisacodyl (Dulcolax™) - diphenylmethane

21
Q

How many days until pt should call PCP?

A

7 days

22
Q

Nonpharmacologic treatment for hemorrhoids

A

Good perianal hygiene

Avoid prolonged toilet sitting time (~ > 10 minutes)

Avoid lifting heavy objects/sitting for long periods

Sitz bath – bid-qid for 10-20 minutes

23
Q

What is sitz bath?

A

A sitz bath is a warm, shallow bath that cleanses the perineum, which is the space between the rectum and the vulva or scrotum.

A sitz bath can also provide relief from pain or itching in the genital area.

24
Q

Local anesthetics ingredients

A

benzocaine, dibucaine, lidocaine, pramoxine, benzyl alcohol, dyclonine, tetracaine

25
Q

Local anesthetics things to know

A

MOA: reversibly block transmission of nerve impulses

External use only – typically 3-6 times per day

May mask pain of more severe anorectal disorder – use with caution

Allergic reactions similar to anorectal symptoms may occur

26
Q

Pharmacologic treatments for hemorrhoids

A

Local anesthetics

Vasoconstrictors **
Avoid in pts with diabetes, hyperthyroidism, hypertension, angina pectoris, enlarged prostate, or antidepressant meds

Protectants** (glycerin is external only)

Astringents** (witch hazel is external only)

Keratolytics

Analgesics/Anesthetics/Antipruritics

Corticosteroids

27
Q

Vasocontrictors things need to know and caution

Hemorrhoids

A

MOA: constricts arterioles to reduce swelling and produce anesthetic effect (mechanism unknown)

External and internal use – Up to 4 times per day

Caution/avoid with diabetes, thyroid disease, HTN, angina pectoris, or enlarged prostate, and with antidepressants, antihypertensives, and cardiac medications – consult PCP

28
Q

Vasoconstrictors for hemorrhoids ingredient

A

ephedrine, epinephrine, phenylephrine

29
Q

Protectants for hemorrhoids ingredients

A

kaolin, ALUMINUM HYDROXYDE, COCOA BUTTER, GLYCERIN, hard fat, LANOLIN, MINERAL OIL, white pet, CALAMINE, shark liver oil, ZINC OXIDE, topical starch, cod liver oil

30
Q

Protectants for hemorrhoids things need to know

A

MOA: prevent fecal matter from causing perianal irritation, and soften the dry anal canal by decreasing water loss

External and internal use – up to 6 times per day
Glycerin = external only

Systemic absorption minimal, ADRs uncommon

31
Q

Astringents for hemorrhoids ingredients. ext? int?

A

Witch hazel = external only

Calamine and zinc oxide = both int. and ext.

32
Q

Astringents for hemorrhoids things needs to remember

A

MOA: promote coagulation of skin cells to protect underlying tissue and make area drier

External and internal use –up to 6 times per day

33
Q

Analgesics, Anesthetics, Antipruritics for hemorrhoids ingredients

A

menthol, juniper tar, camphor

34
Q

Analgesics, Anesthetics, Antipruritics for hemorrhoids

A

MOA: temporary relief of pain, itching, burning, or discomfort by producing a local sensation to distract from these complaints

External use only – up to 6 times per day

Rectum has no nerve fibers – no internal benefits
Use sparingly and do not ingest orally

35
Q

Corticosteroids for hemorrhoids

A

1% hydrocortisone is only corticosteroid approved for nonprescription use in anorectal preps

Act as a vasoconstrictor and antipruritic

External use only – 3 to 4 times per day

May cause skin atrophy with prolonged use and rare skin reactions

36
Q

Preparation H oinment Active Ingredients:

A

Available in ointment, cream, gel, and suppository product forms.
The Ointment contains Petrolatum 71.9%, Mineral Oil 14%, Shark Liver Oil 3% and Phenylephrine HCl 0.25%

OTC (3 decks)

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