ConstipationDABPFC Flashcards
Medical Conditions Associated w/ Constipation
Cerebrovascular events
Parkinson disease
Spinal cord tumors
Diabetes
Hypothyroidism
Multiple sclerosis
Irritable Bowel Syndrome
Anal disorders
Medications Associated w/ Constipation
Opioids
Anticholinergics
Antihistamines, phenothiazines, tricyclic antidepressants, antispasmodics, urge incontinence drugs
NonDHP CCBs (especially verapamil)
Clonidine
Metals
Bismuth
Iron, aluminum
Alkaloids, oxaliplatins, taxanes
Opioids and Constipation ppx
Prevention: regular use of senna/biscodyl (stimulant) + stool softener (docusate), laxative should be recommended with scheduled Opioids
opioid const tx
Treatment: lactulose, sorbitol, Milk of Mag. (MOM), Mag. citrate, or Miralax
Fecal Impaction: Enema, may require digital evacuation
Bowel Prep why is pt doing it? And what can they eat?
A screening colonoscopy is used to detect colorectal cancer, Crohn’s disease, and other GI conditions
OK to consume: “clear liquid diet”
Do not consume: anything with red or blue food coloring, milk, cream, tomato, orange or grapfruit juice (no liquids that cannot be “seen through”); alcohol, and no solid or semisolid foods
Bulk Laxatives moa
Creates gellike matrix in stool; soaks up fluid in loose stool, adds bulk to hard stools
bulk laxatives names and role in tx
Wheat bran, calcium polycarbophil (FiberCon), psyllium (Metamucil), methylcellulose (Citrucel)
Usual firstline therapy for constipation
bulk lax se
SE: increased gas, bloating, Bowel obstruction, choking
counsel bulk laxatives
Counseling: increase bulk slowly; adequate fluid intake; take 2 hours before/after drugs (esp w/ carbamazepine, lithium, digonxin!!)
Emollients, Lubricants (Stool Softeners) MOA and names
Lubricates and softens Fecal mass, docusate sodium (Colace), docusate calcium, mineral oil
SE emollients and lubrcants
SE: bitter taste
counseling emolients and lubricants
Counseling: do not take docusate with mineral oil; not to be used more than 2 weeks
mineral oil and multivitamin separation
mineral oil: take A multivitamin at A different time to avoid vitamin depletion
Stimulants and Irritants MOA and names
Reduce water and electrolyte absorption by stimulating colonic neurons and irritating the colon mucosal lining
Bisacodyl (Dulcolax), senna (ExLax), cascara
dulcolax & exlax
bisacodyl and senna
se of stimulants and irritants
SE: stomach upset, cramping, electrolyte imbalance with overdose
can u you crush or chew bisacodyl
Do not crush or chew Bisacodyl
separate bisacodyl and senna from milk or antacids by how many hours?
Do not take within 1 hour of milk or antacids
GutOpioidReceptor Blocker MOA and names
Blocks opioid receptors in the gut only for use with Opioids
Methylnaltrexone (Relistor), SQ every other day
se of methynatrexone, CI, role in tx, renal dosing?
SE: abdominal pain, nausea, diarrhea
Contraindicated if any GI blockage
only for patients who failed DSS + laxative
Reduce dose if CrCl is <30
Alvimopan (Entereg)
Blocks muopioid receptor, similar to Methylnaltrexone but oral, and used shortterm for hospitalized patients, to increase postsurgical GImotility
Entereg needs to registered with? And max dose?
REMS drug (EASE programs) , max 15 doses (1 tab BID so ~7 days).
ci of alvimopan
CI: patients who have taken opioids for more than 7 consecutive days
Osmotics MOA
Salts lead to retained fluid in the Bowel lumen, with A net increase of fluid secretions in the small intestines
names of osmotics
lactulose, magnesium Salts (MOM), sorbitol
se osmotics
SE: electrolyte imbalance, excessive gas, hypermagnesemia, hypcalcemia, hyperphos
Fleets MOA
Causes reflex evacuation
fleets generic
PhosphoSoda
SE of fleets
SE: dehydration
other than constipation, another use for fleets
Also used for Bowel prep
what pts not to use phosphosoda ?
Do not use PhosphoSoda in CHF, renal disease, decreased calcium, increased phos
Nonabsorbable Solutions
Hyperosmotic
PEG brands
Polyethylene glycol (Golytely, MiraLAX, Carbowax, NuLytely, Trilyte, HalfLytely, MoviPrep) KNOW
PEG SE
SE: nausea, abdominal fullness, bloating
Prepopik
Combination of stimulant laxative and osmotic, enables lower fluid intake for Bowel prep
prepopik generic
Picosulfate, magnesium oxide, and andhydrous citric acid
se of prepopik
SE: headache, hypokalemia, hypochloremia, hyponatremia, nausea, increase SCr
Lubiprostone (Amitiza) MOA
Activates chloride channels in the gut, leading to increased fluid in gut and movement
se of amitiza
SE: nausea, abdominal pain, distention
how must amitiza be taken
Take with food KNOW b/c of the nausea. taken BID
Medications Associated w/ Diarrhea
Antacids containing magnesium
Antibiotics
Colchicine
Laxatives
Metoclopramide
Misoprostol
Quinidine, lithium, theophylline
Medications Used for Diarrhea
psyllium
Bismuth subsalicylate (BSS or PeptoBismol)
Loperamide (Imodium)
Diphenoxylate/atropine (Lomotil)
Bismuth subsalicylate (BSS or PeptoBismol)
Antisecretory and antimicrobial
ci of pepto
CI: children with viral infections, history of severe GI bleed or coagulopathy
SE of pepto
SE: black tongue/stool, hearing loss, tinnitus 2 tabs every hr up to 8 doses a day. MAX 2 days for IBD….
Loperamide (Imodium)
Acts on intestinal muscles to inhibit peristalsis and to slow intestinal motility
ci loperamide
CI: abdominal pain without diarrhea, acute dysentery, acute ulcerative colitis, C. diff.
se lopearmide
SE: abdominal cramping, constipation, nausea. Max 2 days for self treating!!
Diphenoxylate/atropine (Lomotil)
Constipating meperidine congener, and atropine to discourge abuse. QID BEFORE meals (ac ante meals)
ci lomotil
CI: <2 year old, C. diff., obstructive jaundice
se lomotil
SE: sedation, constipation, urinary retention, tachycardia, blurred vision, xerostomia, dizziness, depression
laxative unsafe in whichpatients
heart failure, renal disease, hypocalcemia or hyperphosphatemia. It can be fatal if used in patients who cannot tolerate the phosphate load…ie fleets phosphosoda. so basically think of issues where phosphate overload wud suck.
docusate if use longer than x time for self tx try to find the cause
2 weeks.
danger w/ peptobismol
increase risk of bleeding. salicylates increase the risk of bleeding.
best agent for iron induced constipation is
docusate
preffered agent in pregnancy
fiber. psyllium first line.
