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GI 363 > Constipation & Diarrhea > Flashcards

Constipation & Diarrhea Flashcards

1
Q

What’s the tx duration for constipation, as per FDA?

A

OTC laxatives should be limited to 7 days unless under medical supervision

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2
Q

What’s the recommended first-line tx for constipation?

A

Bulk-forming laxatives that contain either;

Psyllium
Methylcellulose or
Polycarbophil

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3
Q

What’s another commonly used laxative?

A

Stool softener (Docusate)

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4
Q

What’s the stool softener (Docusate) especially helpful for?

A

Iron-induced constipation

Bcuz iron causes compact, hard stools which are difficult to pass

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5
Q

List medical conditions where constipation is common

A

Cerebrovascular events

Parkinson dx

Spinal cord tumors

Diabetes

Hypothyroidism

Multiple sclerosis

Irritable bowel syndrome (constipation-predominant)

Anal disorders (anal fissures, fistulae, rectal prolapse)

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6
Q

List main meds that are constipating

A

Opioids

Anticholinergic drugs

Verapamil

Iron (use Docusate to avoid hard, compact stools)

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7
Q

List other meds that are constipating

A

Antihistamines, phenothiazines, tricyclic antidepressants, antispasmodics, urge incontinence drugs, esp darifenacin (Enablex)

Non-DHP CCBs

Clonidine

Bismuth

Aluminum antacids (Mg often in combo with Al to counter this effect)

Tramadol, tapentadol

Colesevelam

Milnacipran

Ranolazine

Varenicline

5-HT3 receptor antagonist e.g. Ondansetron

Phentermine/topiramate

Aripiprazole

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8
Q

What drugs are the worst offenders of constipation?

A

Opioids

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9
Q

Whats usually scheduled with an opioid?

A

A stimulant laxative (usually senna) is given first with or without stool softener (docusate)

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10
Q

What factors should a pharmacist dispensing opioids consider?

A

Dose

Frequency

Pt at baseline

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11
Q

What’s used if the pt is constipated now and req tx?

A

Options are different from those used to prevent

Lactulose

Sorbitol

Milk of magnesia (MOM)

Magnesium citrate

Polyethylene glycol

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12
Q

What’s does a successful colonoscopy entails?

A

Requires a complete and thorough bowel prep

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13
Q

Issues with sodium phosphate?

A

Sodium phosphate can cause:

Fluid and electrolyte abnormalities (particularly risky in pts with renal or cardiac dx)

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14
Q

Why do some bowel prep agents req MedGuide?

A

Because of fluid and electrolyte abnormalities

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15
Q

What types of pts should extra caution be used in wrt concurrent use of bowel prep agents?

A

Pts with cardiovascular dx

Renal insufficiency

Pts on diuretics (loops, due to additional fluid loss)

NSAIDs

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16
Q

What’s ok to consume prior to bowel prep?

A

“Clear liquid diet” ONLY

E.g. Water, clear beef/chicken broth, fat-free consommé, juices (Apple, prune, grape, cranberry and cider), coffee or tea (without milk or cream), clear gelatin (without fruit pieces), Popsicles (without fruit pieces or cream) fruit ices (no fruit pieces)

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17
Q

List bulk-producing laxatives

A

Psyllium (Metamucil, others)

Calcium polycarbophil (FiberCon, others)

Methylcellulose (Citrucel)

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18
Q

What’s the brand name of Psyllium (bulk-producing laxatives)?

A

Metamucil

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19
Q

What’s the brand name of Calcium polycarbophil (bulk-producing laxatives)?

A

FiberCon

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20
Q

What’s the brand name of Methylcellulose (bulk-producing laxatives)?

A

Citrucel

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21
Q

What’s the first-line tx of constipation and drug of choice in pregnancy?

A

Bulk-producing laxatives:

Psyllium (Metamucil, others)

Calcium polycarbophil (FiberCon, others)

Methylcellulose (Citrucel)

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22
Q

How should bulk-producing laxatives (Psyllium (Metamucil); Calcium polycarbophil (FiberCon); Methylcellulose (Citrucel)) be used with other drugs?

A

2 hrs before/after drugs

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23
Q

List agents under emollients, lubricants (stool softeners)?

A

Docusate Sodium (Colace)

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24
Q

What’s the brand name of Docusate sodium (emollients, lubricants, stool softeners)?

A

Colace

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25
Q

What’s the caution when recommending agents?

A

Take caution when recommending pdts by brand name, as many brand names can refer to multiple pdts

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26
Q

List agents under stimulants and irritants

A

Senna (Ex-Lax)

Bisacodyl (Dulcolax)

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27
Q

Whats the brand name of Senna (agents under stimulants and irritants)?

A

Ex-Lax

28
Q

Whats the brand name of Bisacodyl (agents under stimulants and irritants)?

A

Dulcolax

29
Q

When is SE of senna increased?

A

When high doses are used

30
Q

What’s the caution in recommending brand name of senna?

A

Same brand names can refer to multiple pdts

31
Q

List rx agents for constipation

A

Lubiprostone (Amitiza)

Linaclotide (Linzess)

32
Q

What’s the brand name of Lubiprostone (rx agents for constipation)?

A

Amitiza

33
Q

Whats the main SE of Lubiprostone (Amitiza)?

A

Nausea

34
Q

What’s the black box warning associated with Linaclotide (Linzess)?

A

Don’t use in pts < 18 yrs

35
Q

What’s the SE of Linaclotide (Linzess)?

A

Diarrhea

36
Q

Which rx agents should be dispensed with a MedGuide?

A

Linaclotide (Linzess)?

37
Q

MOA of stimulants/irritants?

A

They work by reducing water and electrolyte absorption by stimulating colonic neurons and irritating the mucosal lining of the colon

38
Q

MOA of Osmotic laxatives?

A

Cause fluid to be retained in the bowel lumen, with a net increase of fluid secretions in the small intestines

39
Q

List acute (stat) tx and bowel preps

A

Bisacodyl rectal

Osmotics (mg salts eg MOM; lactulose; sorbitol)

Sodium phosphates (Fleet enema, OsmoPrep)

Nonabsorbable soln (PEG)

40
Q

List osmotic agents used in constipation

A

Magnesium salts (MOM)

Lactulose

Sorbitol

41
Q

What’s warning ass with sodium phosphates (Fleets enema, OsmoPrep)?

A

Don’t use sodium phosphates in CHF, renal dx, low Calcium or high PO4

42
Q

List Nonabsorbable solutions; also used for bowel prep

A

Polyethylene glycol (Golytely, MiraLax, Carbowax)

43
Q

What should be avoided for bowel prep?

A

Red or blue/purple drinks

44
Q

List agents used in opioid-induced constipation tx

A

Methylnaltrexone (Relistor)

Alvimopan (Entereg)

45
Q

What’s the brand name of Alvimopan (opioid-induced constipation tx)?

A

Entereg

46
Q

When is Methylnaltrexone (Relistor) used?

A

Only in pts on opioid who have failed DSS + laxative (senna, bisacodyl)

47
Q

How should Methylnaltrexone (Relistor) be used?

A

Don’t use routinely

48
Q

What’s the black box warning of Alvimopan (Entereg)?

A

REMS drug

Short-term hospital use only (max 7 days - no more than 15 doses)

49
Q

What’s the CI of Alvimopan (Entereg)?

A

Pts who have taken therapeutic doses of opioids for more than 7 consecutive days prior to use

50
Q

What’s diarrhea?

A

Diarrhea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal

51
Q

List main meds that can cause diarrhea

A

Antacids containing magnesium

Antibiotics esp. broad spectrum ABs and Clindamycin, Erythromycin

52
Q

List other meds that can cause diarrhea

A

Colchicine

Laxatives

Metoclopramide

Misoprostol

Quinidine

Etc

53
Q

What’s the cause of most cases of diarrhea?

A

Most cases are viral

54
Q

Whats the most common bacterial cause of diarrhea?

A

E.coli

55
Q

MOA of bismuth subsalicylate in diarrhea?

A

Exhibits both antisecretory and Antimicrobial effects when used as an antidiarrheal

56
Q

List antidiartheals agents

A

Bismuth subsalicylate (Pepto-Bismuth, others)

Loperamide (Imodium, Anti-Diarrheal, Diamode, others)

Diphenoxylate 2.5mg + Atropine 0.025mg (Lomotil)

57
Q

What’s the brand name of Bismuth subsalicylate (antidiartheals agents)?

A

Pepto-Bismol

58
Q

What’s the brand name of Loperamide (antidiartheals agents)?

A

Imodium

Anti-diarrheal

Diamode

59
Q

What’s the brand name of Diphenoxylate 2.5mg + Atropine 0.025mg (antidiartheals agents)?

A

Lomotil

60
Q

Which antidiartheals is a C V?

A

Diphenoxylate 2.5mg + Atropine 0.025mg (Lomotil)

61
Q

SE of bismuth subsalicylate (Pepto-bismol)?

A

Black tongue/stool

62
Q

What’s the counseling note for loperamide (Imodium, Anti-Dirrheal, Diamode)?

A

Don’t self-treat for > 2 days

63
Q

What should diarrhea tx include?

A

Fluid and electrolytes

Imp for all, but esp in children

64
Q

When’s Imodium and Lomotil not recommended?

A

C. Difficle infections

65
Q

What may be done b4 starting antidiartheals?

A

Rule out lactose intolerance as a cause of the diarrhea by stopping use of diary pdts

66
Q

What’s constipation?

A

Infrequent or hard stools or difficulty passing stools

No bowel movements after more than 3 days

GI 363 (10 decks)

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