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Pharmacology 2 > Exam 4 - GI Constipation > Flashcards

Exam 4 - GI Constipation Flashcards

1
Q

Definition of constipation?

A

Less than 3 BMs per week

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2
Q

Diet and exercise that helps with BMs? Colonic motility?

A

Fiber, fluid, exercise. Colonic motility increases 2-3x after exercise and meal.

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3
Q

4 broad disorder categories which can cause constipation?

A
  1. GI disorders (IBS)
  2. Metabolic disorders (DM)
  3. Endocrine disorders (hypothyroidism)
  4. Neurological disorders (MS, Parkinsons, anxiety, depression
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4
Q

Hydration goal for constipation tx?

A

8-12 glasses of water per day

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5
Q

Diet and lifestyle issues that can cause constipation? (Hint: 4)

A 
Low fiber
Low fluid
Inactive lifestyle
Preggers
Drug induced (opiated)
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6
Q

TCAs, Diphenhydramine, and Antipsychotics are in what class? What can they cause?

A

Anticholinergics. Cause constipation.

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7
Q

Tx goals for constipation? (Hint: 3)

A
  1. Increase frequency of stool movement
  2. Soften stools
  3. Prevent recurrence
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8
Q

General rule about constipation meds?

A

Take a bedtime

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9
Q

When are constipation meds taken?

A

At night

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10
Q

What class if first-line treatment and prevention of constipation?

A

Polyethene Glycol PEG

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11
Q

MOA of Stool Softeners? When/who to use in?

A

Anion surfactant- detergents mixing aqueous and fatty substances to soften fecal mass.

Used to avoid straining s/p MI, surgery, hemorrhoid flare.

“All mush, no push.”

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12
Q

Stool Softener onset? Preventative or treatment or constipation? Example?

A

1-3 days onset. Prevention of constipation.

Ex: Docusate/Colace

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13
Q

MOA of Lubricants? Onset? Examples? Treatment or prevention of constipation?

A

Coats stool and prevents absorption of water allowing easier passage. 24h onset. Treatment.

Glycerin, Mineral Oil

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14
Q

Glycerin class? How given? Who to give to? Onset?

A

Lubricant. Suppository to children. 30 minute onset.

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15
Q

Mineral Oil class? DDI? Don’t give to who?

A

Lubricant. Can affect fat-soluable vitamins and Warfarin. Don’t give to bed-ridden patient due to aspiration pneumonia.

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16
Q

Bulk Forming MOA? Need to take with what? Time separation when taking other meds? Onset? Who not to use in? SE?

A

Promote Peristalsis. Must drink water. 1-3 day onset. 1-2 hour separation with other meds. Not in bed-ridden patients. Bloating and gas side-effects.

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17
Q

Are Bulk Forming meds preventative or treatment? Examples? What happens if not eat, drink, and move while on?

A

Preventative. Psyllium (Fibercon, Metamucil). If no move/eat/drink then turds turn into brick.

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18
Q

MOA of Osmotics? Side-effects? Treatment or prevention of constipation?

A

Nonabsorbable sugars which pull water into colon, soften stool and increase volume. Increases peristalsis. Cramping, diarrhea, electrolyte imbalance. Prevention and treatment

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19
Q

Major side-effect of Osmotics?

A

Electrolye imbalance

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20
Q

Example of Osmotic and time to onset? Notable side-effect of one of them?

A

Lactulose=1-3 days

33% Sorbitol=onset quick but lower K

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21
Q

Saline Cathartic MOA? Onset? Routes?

A

Nonabsorbable cation and anions pull fluid into GI tract. 6 hour onset. PO and rectal. Use infrequenty!

Magnesium Hydroxide (Milk of Magnesia). Sodium Phosphate.

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22
Q

Saline Cathartic frequency of use? Treatment or prevention of constipation?

A

Use infrequently (single use in hospital). Treatment of constipation.

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23
Q

What important to do while taking Saline Cathartics? Examples of Saline Cathartics?

A

Must maintain hydration.

Milk of Magnesia. Sodium Phosphate.

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24
Q

People with Renal impairment, Heart failure, or on Diuretics shouldn’t take which med class?

A

Saline Cathartics (Milk of Magnesia, Sodium Phosphate)

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25
Q

Saline Cathartics not safe in what three conditions or meds?

A
  1. Renal impairment
  2. Heart failure
  3. Diuretics
26
Q

MOA of Electrolyte Solutions? Can prevent what common ADR?

A

Nonabsorbable osmotically active sugar draws water into intestinal lumen and increases intestinal motility. Contains electrolytes to prevent imbalance. PEG.

27
Q

Which Electrolyte Solutions used prior to colonoscopy and which for treatment of constipation? Onsets?

A

Colonoscopy: GoLYTELY, NuLYTELY 1-6 hour onset

Treatment: Miralax PEG 3350, 1-3 day onset

28
Q

Stimulant MOA? For who?

A

Directly stimulates intestinal mucosa to increase propulsive activity.
For patients on daily meds which make them chronically constipated.

29
Q

Stimulant daily use? Given when patient on what other med? Examples?

A

OK for daily use. Given with narcotics.

Ex: Bisadocyl (Ducolax), Senna (Senokot, Ex-Lax), Cascara Sagrada

30
Q

What is good for patients on chronic constipating meds?

A

Stimulants

31
Q

Secretory MOA? Onset?

A

Stimulates secretion of fluid into gut. Strong purgative action. Onset 1-3h.

32
Q

Secretory side-effect? Duration of use? Example?

A

Electrolyte imbalance. Not for regular use. Castor Oil.

33
Q

Motility Stimulant MOA? Onset? Rx needed? Example?

A

Increases colonic motility and shorten transit time. Dopamine antagonist. 6-48h onset.
Ex: Metoclopramide

34
Q

Motility Stimulant MOA? Indications?

A

Increase motility time and shorten transit time. Indicated in gastroperesis and DM.

35
Q

Which class of constipation med to give to Gasteroperesis and DM?

A

Motility Stimulant

36
Q

Motility Stimulant onset? Rx? Example?

A

Onset=6-48h
Rx needed.
Ex: Metoclopramide (dopamine antagonist)

37
Q

What causes Opioid-Induced Constipation? What are the effects?

A

Opoids binding to Mu-receptors in GI tract. Decreases GI motility, decreases fluid absorption from gut, decreases intestinal secretion, and decreases defecation reflex.

38
Q

What causes decreased GI motility, fluid absorption from gut, intestinal secretion, and defecation reflex.

A

Opoids binding to Mu-receptors in GI tract

39
Q

What are first-line classes for Opioid-Induced Constipation? (Hint: 2)

A

Osmotic Laxatives, Stimulants

40
Q

What class is second-line therapy for Opioid-Induced Constipation?

A

Mu-Opioid Receptor Antagonists

41
Q

What are the two Mu opioid antagonists?

A
  1. Methylnaltrexone (Relistor)

2. Naloxegol (Movantik)

42
Q

Naloxegol/Movantik MOA? Route? Caution with which fruit juice?

A

Mu-Opioid Receptor Antagonist in intestines. Oral! CYP 3A4- grapefruit juice.

42
Q

MOA of Mu-Opioid Receptor Antagonists?

A

Inhibit peripheral Mu-Opioid Receptors without affecting analgesic Mu-Opioid actions. Does not cross BBB.

44
Q

Methylnaltrexone (Relistor™) MOA, indication?

A

Mu-opioid receptor antagonist. Second-line when stimulants and osmotic laxatives fail.

44
Q

Methylnaltrexone (Relistor™) route and onset?

A

SC. 4 hour onset.

46
Q

Naloxegol (Movantik™) MOA, indication?

A

Mu-opioid receptor antagonist. Second-line(?) for OIC.

47
Q

Naloxegol (Movantik™) route? Renal and liver concerns?

A

PO.
Renal dosing.
Grapefruit juice CYP3A4 interaction.

48
Q

What second-line meds to use for someone on opiates and laxitives don’t work.

A

Mu opioid antagonists. Methylnaltrexone or Naloxegol

49
Q

Chloride-Channel Activator MOA?

A

Stimulates Type 2 Chloride Channels in Small Intestine increasing Cl- rich secretions which stimulates intestinal motility.
“Waking up the bowel.”

49
Q

Lubiprostone (Amitiza™) MOA? Onset?

A

Chloride-channel activator to stimulate intestinal motility.
24h onset.

51
Q

Lubiprostone (Amitiza™) indications (hint:3)? Which is gender-specific?

A
  1. Women with IBS constipation.
  2. Chronic idiopathic constipation.
  3. Opioid-induced constipation.
52
Q

Lubiprostone (Amitiza™) adverse-effect and due to what?

A

Nausea due to delayed emptying.

53
Q

What does Ca++ supplementation, Oxycodone, and Seroquel to do pooping?

A

Causes constipation

54
Q

If a PT has difficulty swallowing or is unable to drink fluids what two things to avoid?

A
  1. Metamucil
  2. Fiber
    Causes a brick to form.
54
Q

What to avoid with intestinal obstruction? What to use instead?

A

Avoid oral/PO. Use suppository or enema.

56
Q

Two classes and specific meds to use when PT on opioids?

A
  1. Electrolyte Solution=PEG

2. Stool Softener=Docusate

57
Q

Which category/med to avoid with electrolyte abnormalities? Which 3 to use instead?

A 
Lyte abnormalities avoid Saline Cathartic (ex milk of mag). 
Use:  
1. PEG/Miralax- Lyte Solution 
2. Senna- stimulant
3. Colace- stool softener
58
Q

What med/class used to prevent straining after surgery or MI?

A

Docusate (Colace™), a Stool Softener

59
Q

PT w/cancer on methadone taking Docusate and Senna but still infrequent and hard stools. What are two possible meds to option switch her to?

A

Change to Methylnaltrexone or Naloxegol. (Mu-receptor antagonists.)

60
Q

Saline Cathartic cause Lyte abnormalities (ex milk of mag). What three to use instead?

A
  1. PEG/Miralax- Lyte Solution
  2. Senna- stimulant
  3. Colace- stool softener

Pharmacology 2 (17 decks)

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