Diarrhea & Constipation (Exam 2) Flashcards
acute diarrhea
less than 14 days
resolves within 72 hours
persistent diarrhea
more than 14 days
chronic diarrhea
over 30 days
frequent attacks over an extended period
diarrhea can be caused by disease ______________ the intestines
inside or outside
secretory diarrhea
stimulating substance either increases secretion or decreases absorption of large amounts of water and electrolytes
does fasting alter stool volume in secretory diarrhea?
no
osmotic diarrhea
poorly absorbed substances retain intestinal fluids
gut adjusts osmolarity by increasing water and electrolyte influx into the lumen
does fasting alter stool volume in osmotic diarrhea?
yes
ceases diarrhea
exudative diarrhea
inflammatory diseases of the GI tract
presence of mucus, serum proteins or blood
exudative diarrhea affects other _____________________ functions increasing stool volume
absorptive, secretory or motility
altered intestinal motility
reduction of contact time in the small intestine
premature emptying of the colon
bacterial overgrowth
signs and symptoms of diarrhea
abrupt onset of N/V, headache, fever, chills and malaise
abdominal pain and cramps
signs and symptoms of chronic diarrhea
history of previous bouts, weight loss, anorexia, and chronic weakness
how to prevent travelers diarrhea
antibiotics and pepto bismol
treatment of drinking water
caution with consumption of fresh vegetables
therapeutic goals of diarrhea
manage diet
prevent excessive water, electrolyte, and acid base disturbances
provide symptomatic relief
treat curable diseases
manage secondary disorders
treating acute diarrhea when there is no fever or systemic symptoms
fluid/electrolyte replacement
loperamide, diphenoxylate or absorbent
diet
treating acute diarrhea when there is fever or systemic symptoms
check feces for WBC/RBC and parasites
when feces/parasites come back negative for acute diarrhea, treat with
symptomatic therapy
when feces/parasites come back positive for acute diarrhea, treat with
use appropriate antibiotic and symptomatic therapy
for persistent diarrhea, first you have to
identify the possible causes
when there is no diagnosis in persistent diarrhea, treat with
symptomatic therapy
replete hydration
discontinue potential inducer
adjust diet
loperamide or absorbent
nonpharmacologic treatment for diarrhea
dietary management
water and electrolyte replacement
oral rehydration solutions are recommended with
a lower osmolarity, sodium content, and glucose content
Imodium (loperamide) MOA
delay transit of intraluminal contents
prolong contact and absorption
indications for loperamide
acute, chronic, traveler’s diarrhea
loperamide has a ______________ with higher doses because it can lead to ______________
black box warning
torsades, cardiac arrest, sudden death
contraindications when using loperamide
bloody diarrhea and high fever
diarrhea caused by bacteria/infectious source
adverse effects for loperamide
dizziness
constipation
recommended dose for loperamide
4mg orally followed by 2mg after each loose stool
up to 16 mg/day
diphenoxylate/atropine (LOMOTIL) MOA
delay transit of intraluminal contents
prolong contact and absorption
do not use lomotil in
children under 2 years (liquid)
children under 6 years (tabs)
adverse effects of LOMOTIL
blurred vision
dry mouth
decreased urination
clinical pearls of LOMOTIL
schedule V
formulated with a small amount of atropine to discourage abuse
Pepto-bismol (bismuth subsalicylate)
binds to toxins and bacteria in the gut
antisecretory, anti-inflammatory, antibacterial
indications pepto-bismol
indigestion
abdominal cramping
diarrhea
contraindications for pepto-bismol
salicylate allergy
taking other salicylates
GI ulcer
bleeding
black/bloody stool
adverse effects of pepto-bismol
black tongue/stool
salicylate toxicity
drug interactions with pepto-bismol
anticoagulants
antiplatelets
probiotics MOA
restore normal GI flora and suppresses growth of pathogenic organisms (controversial)
atropine blocks _____________ and prolongs ___________
vagal tone
gut transit time
what is useful for diarrhea secondary to lactose intolerance?
lactase enzyme
what to monitor when a patient has diarrhea
changes in frequency and character of bowel movements
vital signs
body weight, serum osmolality, electrolytes, CBC, urinalysis, and culture results
constipation varies from person to person, but it is most commonly
less than 3 bowel movements per week
constipation is more common in
women and older adults
primary constipation
normal transit
slow transit
pelvic floor dysfunction
secondary constipation
constipating drugs
lifestyle factors
medical disorders
signs and symptoms of constipation
hard, small, and dry stools
straining
feeling of incomplete evacuation
Rome 4 criteria for constipation
at least 2 of the signs and symptoms apply to a minimum of 25% of bowel movements
for at least 3 months
alarm symptoms of constipation
sudden onset above age 50
hematochezia/melena
family history of colon cancer or IBD
anemia
anorexia
N/V
constipation refractory to treatment
therapeutic goals for constipation
relieve symptoms
reestablish normal bowel habits
improve quality of life
how to treat opioid induced constipation (over 4 weeks)
osmotic/stimulant laxative
lubiprostone or opioid receptor antagonists
how to treat acute constipation ( 3-6 months)
add osmotic laxative if no relief (2-4 weeks)
add stimulant laxative if no BM 2 days or no relief
how to treat chronic constipation (over 6 months)
trial of intestinal secretagogue
nonpharmacologic treatment for constipation
increase fiber in diet
gradually increase daily fiber intake to 20-30g
trial for 1 month
agents that cause softening of feces in 1-3 days
bulk-forming agents/osmotic laxatives
emollients
PEG 3350
agents that result in soft or semi-fluid stool in 6-12 hours
bisacodyl
Senna
magnesium solfate (low dose)
agents that cause watery evacuation in 1-6 hours
magnesium salts
sodium phosphate
bisacodyl supp
PEG-electrolyte preparations
bulk forming agents examples
psyllium (Metamucil)
methylcellulose (citrucel)
polycarbophil (fiber con)
MOA of bulk forming agents
increase stool bulk and promotes peristalsis
adverse effects of bulk forming agents
flatulence
abdominal bloating
distention
bowel obstruction - rare
when on bulk forming agents, the patient should
drink adequate fluid
docusate salts (Colace) MOA
mixing of aqueous and fatty materials within the intestinal tract
docusate salts (Colace) adverse effects
diarrhea
nausea
abnormal taste
cramps
example of am emollient/stool softeners
docusate salts(Colace)
examples of osmotic laxatives
lactulose
sorbitol
polyethylene glycol (PEG; Miralax)
osmotic laxatives MOA
retains fluid in the colon through an osmotic effect
adverse effects of osmotic laxatives
flatulence
nausea
vomiting
abdominal cramping
bloating
PEG solutions with electrolytes are used as
bowel prep before GI procedures
stimulant laxatives examples
bisacodyl (dulcolax)
Senna (senokot)
stimulant laxatives MOA
stimulate the mucosal nerve plexus
alters fluid and electrolyte transport
adverse effects of stimulant laxatives
severe abdominal cramping
electrolyte imbalances
stimulant laxatives are reserved for
intermittent use
patients who fail bulking and osmotic laxatives
magnesium salts are used as
bowel preparations prior to diagnostic procedures
why shouldn’t magnesium salts be used on a routine basis
may cause fluid and electrolyte depletion
magnesium/sodium accumulation in patients with renal failure
examples of insulin secretagogues
lubiprostone (amitiza)
linaclotide (linzess)
MOA of insulin secretagogues
increases intestinal fluid secretion to soften stool and accelerate GI transit time
adverse effects of linzess
diarrhea
flatulence
abdominal pain
adverse effects of amitiza
nausea
headache
diarrhea
lubiprostone is used for
chronic constipation that failed first line therapies
opioid induced constipation
IBS-C
linzess is used for
constipation
IBS-C
how do you take linzess?
amitiza?
on an empty stomach
with food and water
examples of opioid receptor antagonists
alvimopan (entereg)
methylnaltrexone (relistor)
naloxegel (movantik)
ADRs of alvimopan
potential risk for MI with long term use
dyspepsia
ADRs of methylnaltrexone
abdominal pain
flatulence
nausea
ADRs of naloxegel
diarrhea
flatulence
N/V
alvimopan is used for
accelerating recovery of bowel function after bowel resection
methylnaltrexone and naloxegel are used for
OIC
