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constipation drugs Flashcards

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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
stimulant laxative moa
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
26
stimulant laxative warnings/usage
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
27
stimulant laxative onset
6-12 hr
28
senna ae
melanosis coli, abdominal pain, electrolyte abnormalities
29
bisacodyl ae
diarrhea & abdominal pain (decreases over time)
30
linaclotide moa
guanylate cyclase c agonist
31
linaclotide indication
chronic idiopathic constipation, IBS-C
32
linaclotide onset
5-7 days
33
linaclotide counseling
take on empty stomach 30 min before first meal
34
linaclotide AE
diarrhea, abdominal pain, flatulence
35
linaclotide contraindications
patients <18, mechanical GI obstruction
36
plecanatide moa
guanylate cyclase c agonist
37
plecanatide counseling
take po tablet without regards to food
38
plecanatide onset
24h
39
plecanatide ae
abdominal distension/tenderness, diarrhea, flatulence, nausea
40
plecanatide contraindications
patients <18, GI obstruction
41
plecanatide box warning
severe dehydration in pediatric patients
42
lubiprostone moa
type 2 chloride channel activator: moves water into intestinal lumen to improve intestinal transit and stool passage
43
lubiprostone indications
chronic idiopathic constipation, IBS-C (females), OIC (non cancer)
44
lubiprostone shows safety up to __
48 weeks
45
lubiprostone drug interaction
decreases effectiveness of methadone
46
lubiprostone onset
24 hours
47
lubiprostone counseling
take with food
48
lubiprostone ae
nausea, diarrhea, headache
49
lubiprostone contraindication
patients <18, GI obstruction
50
prucalopride moa
5HT-4 receptor agonist, promotes cholinergic and non-adrenergic neurotransmission to stimulate peristalsis
51
prucalopride indications
chronic idiopathic constipation
52
prucalopride counseling
take po tablet without regards to food
53
prucalopride dosing
adjustments CrCL<30 half dose, avoid in ESRD
54
prucalopride onset
24h
55
prucalopride AE
abdominal pain, nausea, diarrhea, headache
56
prucalopride contraindications
patients <18, GI obstruction, pregnancy/lactation
57
pamoras contraindication
intestinal instruction/malignancy
58
warning for pamoras
must stop all maintenance laxatives prior to initiation
59
methylnaltrexone indications
OIC with cancer (SQ), OIC non cancer (SQ or PO)
60
methylnaltrexone pearl
must be renally dose adjusted if CrCL<60
61
methylnaltrexone onset
30-60 min
62
methylnaltrexone ae
diarrhea, abdominal pain
63
alvimopan indication
short term treatment of post-operative ileus
64
alvimopan counseling
take po tablet without regards to food, avoid high fat meals
65
alvimopan rems
short term use only 15 doses due to increased risk for MI
66
alvimopan ae
hypokalemia
67
alvimopan contraindications
history of MI, use of opioids at therapeutic doses for >7 consecutive days
68
naloxegol indication
non cancer OIC
69
naloxegol dosing pearl
must be renally dosed if CrCL<60 or ESRD (half dose)
70
naloxegol counseling
swallow po tablet whole on empty stomach 1 hour before or 2 hours after first meal of the day
71
naloxegol ae
diarrhea, abdominal pain
72
naloxegol contraindiations
GI obstruction, use with strong CYP3A4 inhibitors like ketoconazole
73
naloxegol is a major substrate of __
CYP3A4 and p-gp
74
naldemedine indication
non cancer OIC
75
naldemedine counseling
take po tab w/o regards to food
76
naldemedine contraindications
GI obstruction
77
naldemedine is a major substrate of __
CYP3A4 and p-gpp\

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