Gas/hemorrhoids/motion sickness/gastroenteritis Flashcards
What are the causes of intestinal gas
-swallowing food/air/saliva
-smoking
-gum chewing
-sucking on hard candy
-carbonated beverages
-anxiety and hyperventilating
-sugar alcohols in food
-fiber in diet
-some medical conditions
-genetics
-altered gut bacteria
-food intolerances
-medications
What are some medical conditions that are associated with increased intestinal gas
-irritable bowel syndrome
-lactose intolerance/ malabsorption
-celiac disease
-pancreatic insufficiency
What are some medications that contribute to intestinal gas
-meds that affect the gut biome(lactulose, antibiotics)
-agents that affect metabolism of glucose and dietary supplements(acarbose, metformin, orlistat)
-drugs that can affect GI motility (narcotics, anticholinergics, calcium channel blockers, psyllium, cholestyramine)
What are the presenting symptoms of intestinal gas
eructation(belching of swallowed air)
bloating(uncomfortable fullness)
indigestion
abdominal pain/cramping
borborygmi(audible bowel sounds)
flatulence
When should you not self-treat for intestinal gas
-symptoms persist for more than a few days
-symptoms occur several times a month
-symptoms so severe they are debilitating
-sudden change in the location of abdominal pain or significant increase in frequency or severity of symptoms
-New onset of symptoms in people older the age of 40
-significant discomfort or sudden bowel function change(diarrhea or constipation)
-gas occurs in conjunction with other symptoms such as severe or persistent diarrhea or constipation, GI bleeding, fatigue , fatigue, unintentional weight loss, or frequent symptoms at night
Why is it especially important for people over the age of 40 experiencing a new onset of symptoms of intestinal gas to not self-treat
incidence of colon cancer increases after the age of 40
What are our goals of therapy when treating intestinal gas
reduce symptoms (frequency/intensity/duration)
minimize gas impact on persons lifestyle
NOT eliminate gas since it’s a normal part of GI tract function
What are some complementary/non-pharmacologic options that can be suggested to help with intestinal gas
probiotics(14-day trial)
fermented foods with live active cultures
herbal carminatives (fennel seed, japanese mint, peppermint, spearmint)
*Insufficient evidence, no gurantee
Why should pt with GERD avoid carminatives
Lower the LES tone and pressure and can cause an increase of acid reflux
Who should avoid fennel seed
those that are pregnant or lactating
What are some OTC options to prevent gas
alpha-galactosidase
lactase enzyme
*follow up in a week to see if MD visit is needed
What are some OTC options for the treatment of gas
simethicone
activated charcoal
*follow up in a week to see if MD visit is needed
What is the MOA of alpha-galactosidase (beano)
hydrolyzes oligosaccharides into component parts
What is the indication of beano
prevention of intestinal gas
How long does it take for beano to start working and how long do the effects last for
onset within 30 minutes of taking
duration: at least 5 hours
What is a possible side effect
allergic reaction is possible(rash, swelling, hives, etc…)
Who should avoid taking beano
people with galactosemia(don’t have the enzyme to break down galactose into glucose)
people who have mold allergies
What is the dosing for beano in adults
300-450 units per food serving
*should ask HCP for child usage
What is the MOA of the lactase enzyme (lactaid)
replacement enzyme that breaks down lactose into glucose and galactose
What is lactaid indicated for
dairy intolerance
How fast lactaid start working and how long does it last
onset is immediate
lasts the entire time dairy product is being digested
Who should avoid taking lactaid
people with galactosemia
What is the dosing for lactaid
*dosing for all ages
Original strength: 3 caplets at first bite
Extra strength: 2 caplets””
Ultra strength: 1 caplet (max of 2) “”
What is the MOA of simethicone (gas-x)
defoaming agent
reduces the surface tension of gas bubbles in GI tract mucus
makes it so it is eliminated more easily
What is the onset of action and the duration of Gas-X
onset is within 30 minutes
the duration is up to 4 hours
What is the dosing of Gas-X
*after meals and at bedtime
-Adults and adolescents: 40-125 mg qid prn
-Children 2-12 yr: 40-50mg qid prn
-children younger than 2: 20mg qid prn
What is the suspected MOA of activated charcoal
adsorb gas given charcoal large surface area
What drug interactions exist with activated charcoal
it may decrease drug absorption so avoid taking within one hour of medications
What is the dosing of activated charcoal
500-520mg after meals as needed
may repeat hourly
What is a hemorrhoid
-inflamed, swollen blood vessels in the rectum and anus that protrude during bowel movements
-can be internal(can’t see or feel and almost never any discomfort)
-can be external(under skin around the anus, usually have symptoms)
What are the presenting symptoms for internal hemorrhoids
rare discomfort
stool passage may cause painless bleeding
What are the presenting symptoms for an external hemorrhoid
itching
general discomfort/irritation
burning
inflammation
swelling
When should you not self-treat hemorrhoids
-pt younger than 12 years
-UC or Crohn’s
-family history of colon cancer
-anorectal disorder previously diagnosed by MD
-acute onset of severe pain
-bleeding, seepage, black tarry stools
-severe symptoms
-minor symptoms not responding to 7 days of self-care
What are the goals of therapy with hemorrhoid treatment
resolve symptoms
keep stool soft to prevent straining
maintain remission of symptoms
prevent complications
What are some complementary and non-pharmacologic options available for someone with hemorrhoids
-avoid alcohol, caffeine, citrus foods, fatty foods
-ensure adequate fiber intake
-avoid lifting heavy objects
-ensure proper bowel habits
What OTC treatments are available for hemorrhoids
-local anesthetics
-vasoconstrictors
-protectants
-astringents
-keratolytics
-analgesics, anesthetics, antipruritics
-corticosteroids
What is the general follow up recommendations when trying an OTC treatment option for hemorrhoids
try something and if not better after 7 days of self-treatment then refer to MD
What is the MOA of local anesthetics such as benzocaine, lidocaine, dyclonine
they block the transmission of nerve impulses