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
What is the indication for local anesthetics
temporary relief of EXTERNAL anal symptoms
How long do local anesthetics last for
depends on the agent
usually 4 hours
what are the side effects that can occur with local anesthetics
allergic reaction
dermatitis
What is the dosing of local anesthetics
apply 3-6 times a day depending on the agent
*check label for specific directions
Who should avoid local anesthetics
those with severe anorectal disorders
those with open lesions
What is the MOA of vasoconstrictors such as ephedrine, epinephrine, and phenylephrine
stimulation of alpha-receptors to constrict arterioles and decrease swelling
What is the indication for vasocnstrictors
relief of discomfort, itching and reduction of swelling
*ephedrine and phenylephrine: internal and external relief
*epinephrine: external relief only
How long does it usually take for vasoconstrictors to start working
within 5-10 minutes
How long do vasoconstrictors last for
approximately 6 hours
What are the side effects of vasoconstrictors
mild pain
stinging if skin is raw or bleeding
Who should talk with their HCP before using vasoconstrictors
pt has history of cardiac events, diabetes, BPH, pr thyroid conditions
What is the dosing of vasoconstrictors
can be applied 4 times a day but check label for specific instructions
What is the MOA of protectants
provide a physical protective barrier
What is the indication of protectants
temporary relief of discomfort, irritation and burning
*glycerin is only externally
How long do protectants usually last for
4 hours or longer
What is the dosing for protectants
petrolatum is as needed
all others is up to 6 times a day or after each bowel movement
What is the MOA of astringents such as calamine, zinc oxide, witch hazel
help coagulate surface proteins to protect lower tissue
decrease cell volume and provide thin protective layer
What is the indication for astringents
temporary relief of itching , burning, irritation or anorectal d/o
What is the dosing of astringents
apply up to 6 times a day
What is the MOA of keratolytics such as alcloxa
cause sloughing of epidermal surface cells via the breaking down of keratin
What is the indication of keratolytics
treat pain and itching caused by minor skin irritations
What is the dosing for keratolytics
apply up to 6 times a day
What should you avoid using with keratolytics
harsh soaps
What is the MOA of analgesics, anesthetics, and antipruritics(menthol, juniper tar, camphor)
temporary relief of burning, pain or itching
EXTERNAL ONLY
What is the dosing of analgesics, anesthetics, and antipruritics
apply up to 6 times daily
Where should you avoid the use of analgesics, anesthetics, and antipruritics
irritated or damaged skin
What is the MOA of corticosteroids
lysosomal membrane stabilization and antimitotic activity
What is one of he main side effects of corticosteroid use
skin atrophy
thinning of the skin
What is the indication for corticosteroids
temporary relief of minor external anal itching
What is the onset and duration of corticosteroids
onset within 30-60 minutes
duration is up to 6-8 hours
What should you avoid doing with corticosteroids
prolonged use
use for max of 7 days
What is motion sickness
when eyes see movement, inner ear senses movement but the body is still
what is the dosing for corticosteroids
apply up to 3-4 times a day
Who is at the highest risk of experiencing motion sickness
women and children ages 2-12
What factors increase the risk of experiencing motion sickness
family history
hormonal birth control
inner ear conditions
menstrual periods
migraines
parkinson’s disease
pregnancy
What are the presenting symptoms for motion sickness
cold sweats
dizziness
headache
inability to concentrate
increased salivation, nausea, vomitting
rapid breathing
When would you not self-treat motion sickness
when a person feels “motion sickness” but isn’t traveling
What are the goals of therapy
provide symptom relief
prevent episodes/ recurrence
What are some non-pharmacologic/ complementary options to prevent and/or treat motion sickness
looks at the horizon
avoid phone/tablet/book
lay back and close eyes
drink water slowly
eat low-fat, bland, starchy foods prior to travel
fresh air/air vents toward you
accupressure wristband
ginger
avoid alcohol
What OTC treatment options are available
1st gen antihistamines
What is the MOA of 1st gen antihistamines
blockage of H1 receptors
What is the indication of 1st gen antihistamines
prevention or nausea, vomiting, or dizziness associated with motion sickness
What is the onset and duration of 1st gen antihistamines
onset is 30-60 minutes
duration depends on the agent
What are the side effects associated with 1st gen antihistamines
drowsiness
dry mouth
confusion
dizziness
constipation
Who should avoid taking 1st gen antihistamines
those with glaucoma, BPH and older adults
What is gastroenteritis
inflammation of the stomach and intestines due to viral, bacterial or protozoan infection which causes vomiting and diarrhea
What are the most common symptoms that present with gastroenteritis
nausea
vomiting
fever
acute, watery diarrhea
When should someone be referred if they have gastroenteritis
-less than 6 months of age
-less than 17.5 pounds in weight
-persistent fever
-visible blood, pus or mucus in stool
-persistent vomiting
-signs of sever dehydration
-severe abdominal pain/distress such as tenderness or distention
-risk for important complications
-pregnancy
-chronic or persistent diarrhea
-suboptimal response to ORS already administered
-no improvement or worsening after 48 hours of self-care
What is the general treatment approach when it comes to gastroenteritis
fluid and electrolyte replacement via ORS
antidiarrheal drugs in selected individuals
What is the MOA of loperamide
stimulates peripheral micro-opioid receptors on intestinal circular muscles to slow motility so water and electrolytes can be absorbed
*reduces peristalsis, lengthens intestinal transit time
What is the indication for loperamide
symptomatic relief of acute, nonspecific diarrhea
What is the onset and duration of loperamide
onset is within 1 hour
duration is up to 3 days
What are the side effects of loperamide
occasional dizziness, constipation and euphoria is misused/abused
What are the drug interactions that exist with loperamide
quinidine
ketoconazole
ritonavir
protease inhibitors
cyclosporine
erythromycin
clarithromycin
saquinavir
st. john’s wort
What is the adult dosing of loperamide
Caplets: 4mg initially, then 2 mg after each loose stool. MDD of 8mg/24 hours
Liquid: 4mg(30mL) initially, then 2mg(15mL) after each loose stool. MDD 8mg/24 hours
What is the loperamide dosing for children aged 6-8 years
caplets: 2 mg initially, then 1 mg after each loos stool. MDD 4mg in 24 hours
liquid: 2 mg(15mL) initially, then 1mg(7.5mL) after each loose stool. MDD 4mg in 24 hours
What is the loperamide dosing for children 9-11 years of age
caplets: 2 mg initially, then 1 mg after each loos stool. MDD 6mg in 24 hours
liquid: 2 mg(15mL) initially, then 1mg(7.5mL) after each loose stool. MDD 6mg in 24 hours
What is the adult dosing of pepto
tablet/caplet: take 525mg every 30-60 minutes. MDD 4200mg/day
liquid(262mg/15mL): take 30mL every 60 minutes. MDD 240mL/day
liquid(525mg/15mL): take 30mL every 60 minutes. MDD 120mL/day
What is the max amount of time you can take pepto
48 hours of use
