Gastrointestinal Conditions: Constipation & Diarrhea Flashcards
Bulk-forming laxative
ie; soluble fiber such as psyllium + dietary fiber = 1st line, and drug of choice in pregnancy
absorb water in intestine, add bulk to stool. inc peristalsis and dec stool transit times
Osmotic laxatives
ie. Polyethylene Glycol (PEG)
draw fluid into bowel lumen via osmosis, distends cold and inc peristalsis
Stimulant laxatives
ie. Senna, Bisacodyl
directly stimulate neurons in colon, causing peristaltic activity
Stool softener
ie: docusate
Emollients that reduce surface tension of stool oil-water interface, allowing more water and fat to mix with stool.
softening your shit and making it easier to go.
Lubricant laxatives
ie. mineral oil
coat bowl and stool in waterproof film
keeps moisture in stool, makes pooping easier
OTC recommendation for constipation in most adults
fiber
OTC recommendation for constipation in iron induced or hard stools
tool softener or bulk-forming drug
OTC recommendation for constipation in opioid-induced patients
stimulant or osmotic laxative
OTC recommendation for constipation in pregnancy
fiber
OTC recommendation for constipation if fast relief is req
adults: bisacodyl or glycerin suppository
children: glycerin suppository
Bulk forming drugs
Psyllium = Metamucil
Calcium polycarbophil = FiberCon
Methylcellulose = Citrucel
Wheat Dextrin = Benefiber
Bulk forming side effects
flatulence
abdominal cramping
bloating
bowel obstruction
Bulk forming drug notes
onset 12-72hrs
req adequate fluids
Osmotic laxatives
Magnesium hydroxide = Milk of magnesia
Polyethylene glycol 3350 = miralax
Glycerin = Fleet
Lactulose = Constulose, Enulose
Sodium phosphates = Fleet enema
Sorbitol = enema
Osmotic laxatives side effects
electrolyte imbalance
abdominal cramping
flatulence
dehydration
osmotic laxatives notes
30min - 96hrs onset
magnesium containing = caution renal impairment
lactulose = used in hepatic encephalopathy
glycerin supp = used commonly in children
Stimulant laxatives
Senna = Senokot, Ex-lax
Senna + decussate = Senna S, Senokot S
Bisacodyl = Dulcolax
Stimulant laxative warnings
avoid use with stomach pain, N/V, or sudden change in bowel movements in last > 2wks
Stimulant laxative side effects
abdominal cramping, electrolyte imbalance, rectal irritation
Stimulant laxative notes
onset 6-12hrs for oral, 15-60min rectal
take at bedtime to induce movement in morning
often given with chronic opioids
Emollients (stool softeners)
Docusate sodium = Colace
Docusate + Senna = Senna S/ Senokot S
stool softener CI and Side effects
CI: abdominal pain, N/V, using with mineral oil OTC use > 1wk
SE: abdominal cramping
Stool softener notes
onset 12-72hrs for oral
preferred when straining should be avoided ie post partum/hemorrhoids
use when stool hard/dry
Lubricant laxatives
Mineral oil
Mineral oil info
CI: Age < 6, pregnancy, bedridden
SE: abdominal cramping, nausea, incontinence, rectal discharge
RX medications for constipation
Lubiprostone = Amitiza
Linaclotide = Linzess
Plecanatide = Trulance
Alvimopan = Entereg
Prucalopride = Motegrity
methylnaltrexone = Relistor
Naloxegol = Movantik
Lubiprostone (Amitiza) info
CI: mechanical bowel obstruction
MOA: chloride channel activator
SE: N, diarrhea, abdominal pain, headache
Notes: take w/ food/water to dec nausea
Linaclotide (Linzess) info
Boxed warning: dont usein pediatric pts, high risk of dehydration
MOA: Guanylate Cyclase C agonists
CI: < 6yrs old, mechanical GI obstruction
SE: diarrhea, abdominal pain, farting
Alvimopan (Entereg) info
Boxed warnings: potential risk of MI w/ long-term use, only short term inpatient with REMS
CI: Therapeutic doses of opioids for > 7 consecutive days
SE: Dyspepsia
Prucalopride (Motegrity) info
CI: GI obstruction
Warning: suicidal ideation
SE: Diarrhea, nausea, abdominal pain
Laxatives used for whole bowel prep
PEG solution = GoLytely, Colyte
Sodium Phosphates = OsmoPrep
Sodium sulfate, potassium sulfate, mag sulfate = Suprep Bowel Prep Kit
Osmoprep boxed warnings
Nephropathy
Osmoprep contraindications
acute phosphate nephropathy, gastric bypass or stapling surgery
whole bowel prep irrigation laxative notes
prep regimen usually start night before, and morning of procedure
usually clear liquid diet req day prior
dont consume w/ solid or semi-solid foods, anything with red/blue/purple food dye
most common cause of diarrhea
most cases are viral
E.coli causes most
Anti-diarrhea drugs
bizmut subsalicylate = Pepto-Bismol
Loperamide = Imodium
Diphenoxylat/atropine = Lomotil
Dicyclomine = Bentyl
Eluxadoline = Vibrezi
Pepto-Bismo Contraindications
Salicylate allergy
taking other salicylates
GI ulcer
bleeding
black/bloody stool
Pepto-Bismo warnings
children and tens recovering from flu/chicken pox or other viral infections shouldn’t use
Pepto-Bismol side effects
black tongue/stool
salicylate toxicity if used too much
nausea
Loperamide (Imodium) dosing instructions
take 2 tablets by mouth at first episode, then take 1 tablet by mouth each episode following. max 4 tablets per day (8mg) self care or 8 tabs (16mg) hospital
Loperamide boxed warnings
Torsades de pointes
cardiac arrest and sudden death with higher than recommended dose
Dont use children < 2yrs old
Loperamide contraindications
acute dysentery = bloody diarrhea/fever
C.diff
Loperamide Side effects
constipation
abdominal cramping
nausea
QT prolongation
max time you should use loperamide for self treatment?
48hrs
Diphenoxylate/atropine (Lomotil) contraindications
risk of respiratory and CNS depression in kids, dont use if < 2yrs of age ( < 6yrs for tab)
Diphenoxylate/atropine (Lomotil) notes
liquid formulation recommended < 13 yrs old
Diphenoxylate/atropine (Lomotil) side effects
possible anticholinergic effects
mild euphoria
Dicyclomine (Bentyl) warnings and Side effects
warnings:
anticholinergic, caution > 65yrs old
can use in toxic megacolon or paralytic ileum
SE: dizziness, dry mouth, nausea, blurred vision, somnolence, weakness
Eluxadoline (Vibrezi) contraindications
pts without gallbladder
alcoholic or > 3 drinks/day
hx of severe constipation
Eluxadoline (Vibrezi) warnings and side effects
Warning: CNS depression
Side effects: constiaption, nausea, abdominal pain
