Constipation & Diarrhea Rx Flashcards
What are the common Constipation tx (7)
“Pts with Constipation need BOODLES of help !”
- Bulk Laxatives - Dietary Fiber & [Metamucil Psyllium]
- [Osmotic Laxatives-NonAbsorbable Sugars]
- [Osmotic Laxatives-Saline vs. Mg Salts]
- Detergents
- Lubricants
- Enemas - Large Volume
- Stimulant Laxatives
Bulk Laxatives
A: Indication
B: Examples (2)
C: MOA
D: Onset time
CONSTIPATION TX
B:
- Dietary Fiber
- [Metamucil Psyllium - fiber additive]
C: INC fluid retention in stool –> Bulks Up stool–> INC peristalsis
D: 12-24 hour onset with several day Effect
Bulk Laxatives
A: SE (2)
B: Cx
A:
(x) Flatulence (stool is more bulky now but is not quite ready to come out)
(x) Dehydration in pts who are not drinking enough fluids
B: Cx = contraindication
-Any pt who can NOT adequatley intake fluid
[Osmotic Laxatives - NonAbsorbable Sugars]
A: Indication
B: Examples (2)
C: MOA
D: SE (2)
CONSTIPATION TX
B: Non-Absorbable Sugars
- Lactulose
- Sorbitol
C: [INC Stool Osmotic Pressure AND Acidifies stool] –> INC fluid retention –> Facilitates Peristalsis
D:
(x) [crampy/bloaty/flatulent] since bacteria can degrade these non-absorbable sugars
(x) [Sickly Sweet Taste]
[Osmotic Laxatives-Saline & Mg salt]
A: Indication (2)
B: Examples (5)
C: MOA (2)
CONSTIPATION TX
B:
- [Mg Citrate] - also used for Bowel Prep
- [Milk Of Magnesia - Mg Hydroxide]
- [Na+ Phosphate] - also used for Bowel Prep
- Saline itself
- Polyethylene Glycol: [Miralax / Glycolax] vs. [Colyte-also used for Bowel Prep] - ALL NON ABSORBABLE
C:
- INC fluid retention –> Facilitates Peristalsis
- Mg stimulates CCK release –> Facilitates Peristalsis
[Osmotic Laxatives-Saline vs. Mg salt]
A: SE (3)
B: Cx (4)
- Ischemic Colitis (rare) - so much fluid is being pulled from vessels perfusing colon –> hypOtension–> Ischemia
- [Na+ Phosphate] SE = [Acute Phosphate Nephropathy] = [Intratubular Ca+ phosphate deposition] especially when taking [NSAID/Angiotensin blockers/Diuretics]
- [High Dose Mg Citrate] -> Rapid Bowel Evacuation
B: Pts w/
(x) : Bowel Obstruction - will INC size of an already obstructed fecal impaction–> Perforation–> Sepsis
(x) : [Heart / Renal / Liver Failure]
(x) : Dehydration
(x) Electrolyte abnormalities
* Image shows [Intratubular Ca+ phosphate deposition (blue dots)]–> Exacerbation or new onset Renal Failure*
[Stimulant Laxatives]
A: Indication
B: Examples (2)
C: MOA
D: SE (2)
CONSTIPATION (especially opiate-mediated) TX
B:
- Senna - Direct via Myenteric Plexus (requires colonic metabolite conversion before active)
- [Dulcolax Bisacodyl] - InDirect via Parasympathetic stimulation
C: Directly or InDirectly stimulates Peristalsis
D:
(x) Melanosis Coli (shown in image: Intestinal Lamina Propria retain a brown pigment –> Brown appearing Bowel)
(x) Cramping
[DetergenT Laxatives]
A: Indication
B: Examples
C: MOA
D: SE
CONSTIPATION TX
B: DocusaTe
C: Contains Surfactant –> allows water to penetrate stool by EMULSIFY feces / water / fat –> Softer Stool
D: None
[Lubricants]
A: Indication
B: Examples (2)
C: MOA (2)
D: Onset Time
CONSTIPATION (especially from FECAL IMPACTION) TX
B:
- [Glycerin Suppository Enema]= [Lubricates & Softens stool] and Stimulates rectal contraction
- [Mineral Oil Enema]= [Lubricates & Softens stool] and Coats Feces
D: 30 minutes
A: Which drug causes Lipoid Pneumonitis?
B: How?
A: [Mineral Oil Enema] - BY MOUTH
B: When ingested, if pt is debilitated or sick they may incidentally aspirate Mineral Oil –> Fat In liver!
[Enema - Large Volume]
A: Indication
B: MOA
CONSTIPATION (espc. from FECAL IMPACTION) TX
B: [Distends Distal Colon] and [softens stool by INC water content] –> Facilitates Peristalsis
A: Fecal Impaction
B: What does the attached image delinate?
A: Mass of Stool that is causing a Bowel Obstruction by NOT PASSING
B: Rectal Fecal Impaction –> Bladder Distension (anterior to the Rectum) –> Urinary Retention –> Urinary Stasis –> UTI
Which Constipation Palliations should be used as the LAST RESORT? (2)
- Saline
- Mg Citrate
Metoclopramide
A: Indication (2)
B: MOA (2)
A:
-Chemotherapy NV
-[Gastroparesis or Stasis/DysMotility] (including from DM)
B: [Dopamine Blocker]-
- Blocks incoming signals to APCTZ-[Area Postrema Chemoreceptor Trigger Zone]*
- Blocks GI Tract Dopamine Receptors –> enables cholinergic parasympathetic-mediated motility (prokinetic stomach action)*
Metoclopramide
A: SE (5)
B: What’s the tx for these SE
A: PATTT
1) [Tardive Dystonia]
2) Akathisia: Agitation & Restlessness
3) Parkinsonism (be careful with Parkinson Dz pts)
4) Trismus
5) Torticollis
B: Diphenhydramine
Prochlorperazine
A: Indication (2)
B: MOA (2)
Note: This AntiEmetic is NOT as potent
A:
-Opiod NV
-Gastroenteritis NV
B:
- Dopamine Blocker
- Vagus N. Blocker
Promethazine
A: Indication (2)
B: MOA
C: SE
A:
-Inner Ear NV
-Motion Sickness Tx/Px
B: [Histamine H1 Blocker] - Blocks Incoming signals to the Vestibular System
C: Sedation
Ondansetron
A: Indication (2)
B: MOA
C: SE (2)
A:
- Chemotherapy NV tx/px
- Radiation NV tx/px
B: [Potent 5HT3 Serotonin Blocker] - Block Incoming signals to the [Peripheral NV System] AND APCTZ-[Area Postrema Chemoreceptor Trigger Zone]
C:
1) HA
2) Prolonged QT –> Torsades de Pointes
Scopolamine
A: Indication
B: MOA
C: SE (4)
A:
-Motion Sickness
B: [ANTI-CHOLINERGIC]: Blocks Incoming signals to Vestibular System and Vomiting Center
C: CUND
1) Confusion
2) Urinary Retention
3) [Narrow angle Glaucoma-Acute]
4) Dry Mouth
How should you approach a Nausea / Vomiting Pt? (5)
Evaluate VOMIT!
- Vestibular system (Scopolamine / Promethazine)
- Obstructed Bowels (Laxatives)
- DysMotility of Upper GI tract (Metoclopramide)
- Infection/Inflammation (Prochlorperazine)
- Toxins stimulating APCTZ-[Area Postrema Chemoreceptor Trigger Zone] (Ondansetron vs. Prochlorperazine)
