GI - Constipation, Diarrhea, N/V

Question 1

Laxatives are used prophylactically for

Answer 1

• bedridden (immobile, drugs, gravity)
• have neuro issues
• before/after surgery
• before diagnostic

Question 2

Types of Laxatives

Answer 2

1 bulk-forming
2 surfactant lax
3 stimulant lax
4 osmotic lax

Question 3

bulk-forming lax

drug name + MOA

Answer 3

psyllium husk (Metamucil)

-contains fiber, absorbs water

Question 4

*bulk-forming lax

RN/teaching

Answer 4

• need to drink water (8ox+++)
• slow acting
• for chronic conditions

Question 5

surfactant lax

drug name + MOA

Answer 5

docusate sodium
““stool softener””
-lowers surface tension so water + fats can penetrate
-made defecation more comf

Question 6

stimulant lax

drug + MOA

Answer 6

bisacodyl, senna, DSS (ducolax)

incr peristalsis by irritating bowel mucosa

Question 7

stimulant lax

RN/teaching

Answer 7

• watch for hypokalemia

* no milk w/in 1 hr of bisacodyl (can cause burning sensation)

Question 8

osmotic lax/lactulose

drug + MOA

Answer 8

Mg hydroxide, Mag citrate, Na Phosphate

• draws water into mass of stool, stretched muscles, incr peristalsis
• strongest

Question 9

osmotic lax / lactulose

indication

Answer 9

• bowel prep,
• PEG
• lactulose
• sorbitol
• ion exchange resins - kayexalate

Question 10

Pro-Kinetics

drug

Answer 10

metoclopramide

—dopamine antagonist

Question 11

metoclopramide (pro kinetic)

MOA

Answer 11

augments action of ACH

—causes incr in upper GI motility

Question 12

metoclopramide (pro kinetic)

CI

Answer 12

• GI obstruction/perforation
• hx of seizure
• ETOH
• pheochomocytoma
• parkinson’s

Question 13

metoclopramide (pro kinetic)

indications

Answer 13

• diabetic gastroparesis
• constipation
• manage GERD
• emesis

Question 14

metoclopramide (pro kinetic)

A/E

Answer 14

• tardive dysknesia
• EPS
• NMS
• sedation
• diarrhea
• low BP
• anti Ach effects

Question 15

metoclopramide (pro kinetic)

interactions

Answer 15

digoxin

Question 16

metoclopramide (pro kinetic)

admin

Answer 16

PRN IVP

Question 17

metoclopramide (pro kinetic)

RN/teaching

Answer 17

• type of anti-emetic

- singultus (incr tone of LES)

Question 18

Antidiarrheals

drugs

Answer 18

1 diphenoxylate + atropine (opioid)

2 loperamide

Question 19

diphenoxylate + atropine

MOA

Answer 19

-activates opioid receptors in colon to induce constipation

Question 20

diphenoxylate + atropine

CI

Answer 20

• electrolyte imbalance
• dehydration
• blood
• infection

Question 21

diphenoxylate + atropine

indications

Answer 21

reduce sympt of diarrhea (freq + fluid content)

Question 22

diphenoxylate + atropine

A/E

Answer 22

atropine added so patients don’t take high doses of this drug

Question 23

diphenoxylate + atropine

interactions

Answer 23

ETOH + other CNS depressants

Question 24

diphenoxylate + atropine

admin

Answer 24

PO

-if no result in 36-48 hrs then see Dr

Question 25

diphenoxylate + atropine

RN/teaching

Answer 25

• schedule 5 substance
• monitor dehydration
• avoid ETOH, caffeine, rehydrating w plain water

Question 26

loperamide

MOA

Answer 26

analog of meperidine (an opioid) but loperamide IS NOT A CONTROLLED SUBSTANCE

Question 27

loperamide

CI

Answer 27

• UC
• bloody stools
• if diarrhea w high fever
• diarrhea caused by ABX

Question 28

loperamide

indications

Answer 28

diarrhea

• often used to reduce amt of stools in people w ileostomy
• often to keep the stoma clean + healthy

Question 29

loperamide

A/E

Answer 29

QT prolonation

SJS (stevens johnsons syndrm)

Question 30

loperamide

RN/teaching

Answer 30

dehydration (DONT DRINK TONIC WATER or GRAPEFRUIT JUICE - it 4x the concentration in the blood! Report rash)

Question 31

anti-emetics

Answer 31

1 serotonin antagonist (ondansetron)
—-has aspartame (CI in PKU), AE prolonged QT
2 anticholinergic med (scopolamine)
—-AE obv anti-ACH > always watch BPH/glaucoma

Question 32

scopolamine vs ondansetron

Answer 32

O=chemo

S=motion sickness