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Pharm Exam 3 > GI Disorders I > Flashcards

GI Disorders I Flashcards

1
Q

questions to ask pts about quality of stool

A

frequency
quality (size,consistency)
frequency and duration of constipation
quality of diet and exercise (fiber, fluid, timing of meals)
laxative use (brand, frequency of use) & other meds

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2
Q

timing of meals and colonic motility

A

colonic motility increases 2-3 times after waking and after a meal, particularly breakfast

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3
Q

bristol stool chart

A

Type 1: separate hard lumps like nuts (hard to pass)
Type 2: sausage-shaped but lumpy
Type 3: like a sausage but with cracks on surface
Type 4: like a sausage or snake, smooth or soft
Type 5: soft blobs with clear cut edges
Type 6: fluffy pieces with ragged edges, a mushy stool
Type 7: watery, no solid pieces, entirely liquid

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4
Q

causes of constipation

A
  1. underlying dz:
  2. low fiber, fluid, inactive
  3. drug induced
  4. pregnancy
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5
Q

what underlying disease can cause constipation

A
  • IBS
  • metabolic disorder (DM)
  • endocrine disorder (hypothyroidism)
  • neurological (MS, Parkinsons, anxiety, depression)
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6
Q

what type of drugs can cause constipation

A

opiates

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7
Q

types of drugs that cause constipation

A
  • opiods (morphine, cocaine)
  • anticholinergics (diphenhydramine)
  • antacids with aluminum or calcium
  • antiparkinsonian agents
  • phenothiazines
  • barium
  • CCBs
  • diuretics
  • iron & calcium supps
  • NSAIDS
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8
Q

goals for constipation

A
  1. increase frequency of bowel movements
  2. titrate dose to soft stool
  3. prevent recurrence
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9
Q

non drug tx of constipation

A

prevention
good habits: hydration (8-12 glasses water/day)
balanced diet
exercise (walking/swimming)

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10
Q

types of food with lots of fiber

A

apples
oranges
peas

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11
Q

types of food with little to no fiber

A

cheese, meats, processed foods

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12
Q

drug tx of constipation

A
  • most OTC

- usually take at bedtime

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13
Q

drug tx of constipation MOA’s

A
  1. soften stool
  2. ease passage (lubricants)
  3. add bulk to stool
  4. stimulate GI tract
  5. stimulate GI secretory process
  6. increase GI motility
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14
Q

stool softeners MOA

A

anionic sufactants - detergents mixing aqueous and fatty substances - softens fecal mass

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15
Q

when to us stool softeners

A

preventative: avoids straining - post MI, surgery, if hemorrhoids flare up
- used as combo

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16
Q

onset of stool softeners

A

1-3 days

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17
Q

downside of stool softeners

A

does it actually work?

does not get bowels moving

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18
Q

example of stool softener

A

Docusate (Colace)

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19
Q

how do lubricants work for constipation

A

coats stool and prevents absorption of water

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20
Q

positive for lubricants

A

easier passage of stool

quick onset: 24 hrs

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21
Q

example of lubricant used for constipation

A

Glycerin suppositories

  • good for any age
  • 30 min onset
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22
Q

bulking agents for constipation - how does it work

A
  • adds bulk, promotes peristalsis

- preventative

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23
Q

downsides to bulking agents

A
  • bloating and gas
  • need to drink
  • need to be mobile - cant use on bedridden pts
  • can bind other meds: separate other meds by 1-2 hrs
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24
Q

onset of bulking agents

A

1-3 days

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25
example of bulking agents
Psyllium (FIbercon, Metamucil) | Benefiber, Bran
26
osmotics for constipation - what is it & how does it work
nonabsorbable sugars - pull water into colon, softens stool, increases volume - prevention and tx of chronic constipation
27
downside to osmotics
may cuase cramping, diarrhea, electrolyte imbalance
28
example of osmotics
Lactulose | 33% Sorbitol is sodium polystyrene sulfonate-Kayexalate
29
onset of lactulose
1-3 days
30
onset and downside of 33% sorbital
quick effects | lowers K+
31
saline cathartics for constipation - what is it and how does it work
non absorbable cations and anions pull fluid into GI tract
32
onset of saline cathartics
6 hrs
33
mode of admission of saline cathartics
oral and rectal
34
examples of saline cathartics
Mg citrate, Mg hydroxide, Mg sulfate, sodium phosphate - Magnesium hydroxide (Phillips Milk of Magnesia) - Sodium phosphate (Fleet enema, liquid, or tablets)
35
when to use saline cathartics
``` not on a regular basis occasional use (every few weeks) ```
36
downside of saline cathartics
-take in adequate fluid to maintain hydration
37
electrolyte solutions for constipation - what is it
non absorbable osmotically active sugar
38
how does electrolyte solutions work
draws water into intestinal lumen
39
what does electrolyte solutions contain and what does this prevent
Na2SO4, NaCl, NaHCO3, KCl: prevents electrolyte shifts into colon
40
example of electrolyte solutions
Polyethylene Glycol (PEG)
41
what electrolyte solutions can be used for colonic cleansing prior to diagnostic procedures
GoLYTELY, NuLYTLEY (1 gallon jug onset 1-6 hrs)
42
what electrolyte solutions can be used as tx for constipation
Miralax, PEG 3350 (17gm with 8oz beverage - onset 1-3 hrs)
43
what is the most popular electrolyte solution for constipation - why?
PEG 3350 - powder to be mixed - fewer SE (bloating/cramping) - cheaper - give with narcotics - OTC - may be seen used as first line
44
stimulants for constipation - MOA
directly stimulates intestinal mucosa - increase intestinal propulsive peristaltic activity thru local mucosal irritation
45
SE of stimulants for constipation
cramping and diarrhea
46
onsets of stimulants for constipation
orally - onset 6-12 hrs | rectal 15-60 min
47
when to use stimulants for constipation
for pts on chronic constipating meds, daily use is ok | -give with narcotics
48
examples of stimulants for constipation
1. Diphenylmethan derivative (Ducolax - tabs or suppositories) 2. Anthraquinone derivative (Senokot, Exlax)
49
secretories for constipation - ex
castor oil
50
how does it work - secretories
stimulates secretion of fluid into gut
51
downsides for secretories
strong purgative action | not for regular use
52
onset of secretories
1-3 hrs
53
motility stimulant for constipation - MOA
increase colonic motility and shorten transit time
54
motility stimulant downsides
prescription | variable results
55
onset of motility stimulants
6-48 hrs
56
example of motility stimulant
dopamine antagonist (metoclopramide)
57
define constipation
reduced number of bowel movements (
58
what is OIC
opiod induced constipation
59
who gets OIC
1. 95% of pts with cancer pain | 2. 80% of pts with non malignant pain
60
which opiods can be constipating
all
61
OIC is a result of what?
opioid actions on u-opioid receptors in GI tract
62
affects of opioids on GI tract
decre GI motility incr absorption of fluid from gut decr intestinal secretion decr defecation reflux
63
targeted therapies for constipation - examples
``` 1. u-opioid receptor antagonists Methylnaltrexone (Relistor) Movantik (Naloxegol) 2. chloride channel activators Lubprostone (Amitiza) ```
64
how does u-opioid receptor antagonists work
inhibit peripheral receptors without affecting analgesic u-opioid actions -don't cross BBB "wake up the bowel"
65
when is Methylnaltrexone (Relistor) indicated
second - line tx (after laxatives) of OIC when osmotic laxatives or sitmulants are not enough
66
how is methylanltrexone administered, onset?
SQ injection | -onset within 4 hrs - complete evacuation - very predictable
67
about Movantik (Naloxegol): - administration - when is it taken - where is it metabolized
- new oral product - minimal risk of counteracting analgesic effects of opioids - everyday in the morning on empty stomach, renal dosing - metabolized by CYP 3A4 - grapefruit juice
68
how does chloride channel activators work
stimulates type 2 chloride channels in small intestine increases chloride-rich fluid secretion that stimulates intestinal motility waking up the bowel
69
when is lubiprostone (amitiza) indicated
chronic idiopathic constipation, IBS with constipation in women used for OIC
70
onset of lubiprostone (amitiza)
within 24 hrs
71
downside to Lubiprostone
% nausea high if delayed emptying
72
define diarrhea
increase in stool frequency and decrease in stool consistency as compared with a person's normal bowel pattern -imbalance in absorption and secretion of water and electrolytes in GI tract
73
pt eval for diarrhea
-determine onset (acute
74
meds that cause diarrhea
- PPI - antacids with magnesium - digoxin - quinidine - ABX - ACE - misoprolol - colchicine - NSAIDS - CHEMO - laxatives
75
goals of tx for diarrhea
- stopping diarrhea not always the goal - esp if infectious cause - ID and tx potential cause (ABX) - symptomatic relief - correct fluid and electrolyte loss - manage diet
76
monitoring for diarrhea tx
- resolution of symptoms | - assess dehydration (weight, serum osmolality, electrolytes, CBC, urinalysis)
77
tx of diarrhea
1. control diet - low residue diet if tolerable (saltine crackers, soups, broths) - avoid solid foods, diary, spicy foods, caffeine - replenish fluids and electrolytes - increase diet as tolerated 2. BRAT diet 3. hold laxatives, other contributing meds
78
what is the brat diet
bananas, rice, applesauce, toast = little calories, protein, fat

Pharm Exam 3 (1 decks)

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