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afsha - GI > constipation drugs > Flashcards

constipation drugs Flashcards

1
Q

name 4 bulk forming laxatives

A

○ Bran
○ Ispaghula husk
○ Methylcellulose
○ Sterculia

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2
Q
  • MOA for bulk forming
A

○ Relieve constipation by increasing faecal mass which stimulates peristalsis

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3
Q

How to remember treatment of constipation and in pregnancy - BOSS

A

bulk
add or switch to osmotic if still hard stools
if soft stools but difficult to pass, stimulant
can also add stool softener e.g. docusate

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4
Q

why is it important to drink enough fluids and avoid taking it immediately before bed - bulk forming

A

can cause intestinal obstruction

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5
Q

how long does lactulose take

A

48h

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6
Q

which osmotic to offer first - macrogol or lactulose

A

macrogol

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7
Q

onset of action glycerol suppositories

A

15-30mins

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8
Q

name the stimulant laxatives: BSSCC

A

bisacodyl
Senna
sodium picosulfate
co danthrumer
co danthrusate

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9
Q

what colour does Senna colour urine

A

red brown

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10
Q

which bulk forming laxative has stool softening properties

A

methylcellulose

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11
Q

onset of action for stimulant laxatives

A

6-12hours

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12
Q

onset of action for Senna

A

8 hours - overnight

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13
Q

name 3 osmotic laxatives

A

Macrogols
Lactulose
Magnesium hydroxide (traditional remedy, less commonly used)

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14
Q

SE lactulose name 4

A

Flatulence
Abdomial crams
Nausea
Bloating - avoid in IBS! Can make symptoms worse

can be troublesome in the first few days but it does settle

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15
Q

other stimulants (not BSSCC)

A

glycerol (lubricant and rectal stimulant)
docusate (softener and weak stimulant)

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16
Q

MHRA - new pack size restrictions for stimulant laxatives OTC - B,S,S

A

should only be used for short term occasional constipation if dietary and lifestyle measure and bulk and osmotic ineffective

GSL: adults only! 18+

limited to pack size of 2 short treatment courses.

max pack size: 20 tabs or 100ml liquid

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17
Q

true or false - Senna can only be bought OTC for adults

A

false
GSL is 18+ only

but P: 12-17 year olds under advice of pharmacist

under 12 - prescriber !!

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18
Q

prolonged or excessive use can cause…

A

hypokalaemia

19
Q

avoid this near term or in history of unstable pregnancy

A

Senna, other stimulants - they can stimulate uterine contractions

20
Q

how many tablets are you allowed to buy for Senna GSL

A

1 pack of 20 tablets

max strength tabs: 1 pack of 10

21
Q

how many tabs of Senna can you buy (P med) for children and adults 12+

A

up to 100 under pharmacist supervision

22
Q

minimum ml of water to take ispahgula husk with

A

150ml

23
Q

pt and carer advice isphagula husk - when to take

A

Preps that swell in contact with liquid should always be carefully swallowed with water and should not be taken immediately before going to bed

24
Q

how long does fybogel take to work

A

2-3 days

25
Q

how do osmotic laxatives work

A

increase the amount of water in large bowel either by drawing fluid from the body into bowel or by retaining the fluid they were administered with

26
Q

how long does macrogol take to work

A

1-2 days

27
Q

is lactulose absorbed from the GIT

A

no

28
Q

is lactulose ok in pregnancy

A

yes

29
Q

how do stimulants work

A

increase intestinal motility/peristalsis and often cause abdominal cramp

30
Q

how long do bisacodyl tabs take to work

A

10-20 hours

31
Q

how long do bisacodyl suppositories take to work

A

20-60 mins

32
Q

onset of action of sodium picosulfate

A

6-12 hours

33
Q

how do faecal softeners e.g. docusate and glycerol and arachnis oil enemas and liquid paraffin work

A

Claimed to act by decreasing surface tension and increasing penetration of intestinal fluid into faecal meds

34
Q

Liquid paraffin has also been used as a lubricant for the passage of stools but manufacturer advised that it should be used with caution because of its adverse effects e.g.

(3)

A

Anal seepage
Risks granulomatous disease of GIT
Lipoid pneumonia on aspiration

35
Q

how do enemas containing arachis oil (ground nut oil, peanut oil)

A

lubricate and soften impacted faeces and promote a bowel movement

36
Q

how long does oral docusate take to work

A

1-2 days

37
Q

how long does rectal docusate take to work

A

within 20 mins

38
Q

advice about taking glycerol suppositories

A

Moisten suppositories with water before insertion

39
Q

what to use 1st line in opioid induced constipation (+ an alternative, not the opioid receptor antagonists)

A

Lactulose and Senna

The osmotic laxative will draw water and soften hard stores
The stimulant laxative increases peristalsis which counteracts the anti motility effects of opioids
Alternative: docusate which is a stimulant with stool softening properties

40
Q

name 2 opioid receptor antagonists that are licensed for opioid induced constipation when other laxatives fail

and how do they work

A

Methylnaltrexone
Naloxegol

They are peripherally acting opioid receptor antagonists and block the constipating effects of opioids without causing central effects

41
Q

What is the carcinogen in co-danthrumer and co danthusate

A

Danton

42
Q

why should you avoid Bisacodyl and Senna at term or if Hx unstable pregnancy

A

they can simulate uterine contractions

43
Q

how much ml to add to macrogol and ispahgula husk

A

M = 100
IH = 150

afsha - GI (31 decks)

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