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constipation drugs Flashcards

1
Q

magnesium onset of action

A

30 min-6hr

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2
Q

PEG, lactulose, sorbitol onset of action

A

24-48 hr

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3
Q

osmotic moa

A

draws water into intestinal lumen to soften stool in order to induce peristalsis

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4
Q

PEG AE

A

not absorbed and not metabolized by colonic bacteria so won’t have systemic AE,, maybe some cramping/gas

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5
Q

lactulose and sorbitol exposure systemic?

A

not absorbed but are metabolized by colonic bacteria

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6
Q

lactulose AE

A

bloating, cramping, nausea, diarrhea

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7
Q

when to caution lactulose

A

lactose intolerance

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8
Q

sorbitol AE

A

bloating, cramping, nause

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9
Q

avoid use of what with sorbitol

A

lamivudine (decreases conc of HIV med) and sodium or calcium polystyrene sulfonate (inc toxicity)

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10
Q

magnesium AE

A

DIARRHEA, hypermagnesemia (lethargy, hypotension, respiratory depression) leading to ileus & worsen constipation

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11
Q

avoid magnesium in ___

A

renal failure

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12
Q

magnesium drug interactions

A

HIV integrase inhibitors, tetracyclines, quinolones, levothyroxine, sodium/calcium polystyrene

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13
Q

bulking agents moa

A

water absorption into the intestines to soften stool which increases bulk to aid in peristalsis

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14
Q

rule with bulking agents

A

start low and go slow to prevent bloating and GI distress. eventual goal is 25-30 g fiber/day

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15
Q

bulking agent drug interactions

A

HIV integrase inhibitors, tetracyclines, quinolones, levothyroxine (take bulking agents 2 hours after or 6 hours before other agents)

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16
Q

bulking agents onset

A

12-72h

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17
Q

downside of soluble fiber

A

more AE: gas/bloating, abdominal distention. severe: esophageal or intestinal obstruction

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18
Q

bulking agents are _____ to manage acute constipation alone

A

not recommended (due to time of onset)

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19
Q

bulking agents contraindication

A

fecal impaction, GI obstruction

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20
Q

bulking agents administration warning

A

take with an adequate/large amount of water (8 oz). if not taken with enough water, can cause esophageal and intestinal tears

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21
Q

stool softeners

A

reduce surface tension of oil-water interface in the stool resulting in enhanced incorporation of water & fat leading to softened stools and easier defecation

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22
Q

stool softeners onset

A

24-72 hr

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23
Q

stool softeners AE

A

none

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24
Q

stool softeners drug interactions

A

inc. intestinal absorption of other agents when given concurrently, therefore dec. concentration

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25
Q

stimulant laxative moa

A

stimulate peristaltic activity via DIRECT ACTION on intestinal mucosa thereby promoting intestinal motility and increasing fluid secretion into the bowel. kinda like punching the gut

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26
Q

stimulant laxative warnings/usage

A

avoid long term use in older patients. not first line–must have adequate trial of fiber and osmotic laxatives first. often reserved for intermittent use

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27
Q

stimulant laxative onset

A

6-12 hr

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28
Q

senna ae

A

melanosis coli, abdominal pain, electrolyte abnormalities

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29
Q

bisacodyl ae

A

diarrhea & abdominal pain (decreases over time)

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30
Q

linaclotide moa

A

guanylate cyclase c agonist

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31
Q

linaclotide indication

A

chronic idiopathic constipation, IBS-C

32
Q

linaclotide onset

A

5-7 days

33
Q

linaclotide counseling

A

take on empty stomach 30 min before first meal

34
Q

linaclotide AE

A

diarrhea, abdominal pain, flatulence

35
Q

linaclotide contraindications

A

patients <18, mechanical GI obstruction

36
Q

plecanatide moa

A

guanylate cyclase c agonist

37
Q

plecanatide counseling

A

take po tablet without regards to food

38
Q

plecanatide onset

A

24h

39
Q

plecanatide ae

A

abdominal distension/tenderness, diarrhea, flatulence, nausea

40
Q

plecanatide contraindications

A

patients <18, GI obstruction

41
Q

plecanatide box warning

A

severe dehydration in pediatric patients

42
Q

lubiprostone moa

A

type 2 chloride channel activator: moves water into intestinal lumen to improve intestinal transit and stool passage

43
Q

lubiprostone indications

A

chronic idiopathic constipation, IBS-C (females), OIC (non cancer)

44
Q

lubiprostone shows safety up to __

A

48 weeks

45
Q

lubiprostone drug interaction

A

decreases effectiveness of methadone

46
Q

lubiprostone onset

A

24 hours

47
Q

lubiprostone counseling

A

take with food

48
Q

lubiprostone ae

A

nausea, diarrhea, headache

49
Q

lubiprostone contraindication

A

patients <18, GI obstruction

50
Q

prucalopride moa

A

5HT-4 receptor agonist, promotes cholinergic and non-adrenergic neurotransmission to stimulate peristalsis

51
Q

prucalopride indications

A

chronic idiopathic constipation

52
Q

prucalopride counseling

A

take po tablet without regards to food

53
Q

prucalopride dosing

A

adjustments CrCL<30 half dose, avoid in ESRD

54
Q

prucalopride onset

A

24h

55
Q

prucalopride AE

A

abdominal pain, nausea, diarrhea, headache

56
Q

prucalopride contraindications

A

patients <18, GI obstruction, pregnancy/lactation

57
Q

pamoras contraindication

A

intestinal instruction/malignancy

58
Q

warning for pamoras

A

must stop all maintenance laxatives prior to initiation

59
Q

methylnaltrexone indications

A

OIC with cancer (SQ), OIC non cancer (SQ or PO)

60
Q

methylnaltrexone pearl

A

must be renally dose adjusted if CrCL<60

61
Q

methylnaltrexone onset

A

30-60 min

62
Q

methylnaltrexone ae

A

diarrhea, abdominal pain

63
Q

alvimopan indication

A

short term treatment of post-operative ileus

64
Q

alvimopan counseling

A

take po tablet without regards to food, avoid high fat meals

65
Q

alvimopan rems

A

short term use only 15 doses due to increased risk for MI

66
Q

alvimopan ae

A

hypokalemia

67
Q

alvimopan contraindications

A

history of MI, use of opioids at therapeutic doses for >7 consecutive days

68
Q

naloxegol indication

A

non cancer OIC

69
Q

naloxegol dosing pearl

A

must be renally dosed if CrCL<60 or ESRD (half dose)

70
Q

naloxegol counseling

A

swallow po tablet whole on empty stomach 1 hour before or 2 hours after first meal of the day

71
Q

naloxegol ae

A

diarrhea, abdominal pain

72
Q

naloxegol contraindiations

A

GI obstruction, use with strong CYP3A4 inhibitors like ketoconazole

73
Q

naloxegol is a major substrate of __

A

CYP3A4 and p-gp

74
Q

naldemedine indication

A

non cancer OIC

75
Q

naldemedine counseling

A

take po tab w/o regards to food

76
Q

naldemedine contraindications

A

GI obstruction

77
Q

naldemedine is a major substrate of __

A

CYP3A4 and p-gpp\

GI (15 decks)

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