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Pharm N895 > GI: Laxatives > Flashcards

GI: Laxatives Flashcards

1
Q

Intestinal fluid absorption

A

Majority of water uptake is in small intestine (duodenum, jejunum, ileum)

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2
Q

Causes of Constipation

A
  • Lack of fiber
  • Drugs: anticholinergics, opiates, iron, SSRIs, antiHTNs (nondihydropyridine CCBs – verapamil & diltiazem)
  • Endocrine / metabolic
  • Neurogenic d/o
  • Organic causes
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3
Q

Management of Constipation

A
  • ID & Tx underlying cause
  • Nonpharm methods: ­ increase dietary fiber, fluid, & exercise; respond to the urge to defecate
  • Pharmacologic Tx: individualize
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4
Q

Pregnancy & Constipation: Mgmt

A
  • 1st line: adequate dietary fiber & fluid intake, light physical activity, bulk forming laxative
  • Other safe options: lactulose (chronulac), docusate (colace), polyethylene glycol (Miralax)
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5
Q

Agents to treat constipation

A

bulk forming laxatimes, stool surfactants, osmotic laxatives, stimulant laxatives

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6
Q

Types of bulk forming laxatives

A

Fiber: soluble and insoluble

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7
Q

Significance of fiber in constipation

A

FIber: Resists enzymatic digestion and reaches the colon unchanged

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8
Q

FIber: ADRs

A

Gas, bloating, impaction above colonic strictures

(bulk forming laxatives)

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9
Q

Fiber: dosing considerations

A
  • Start at ½ or less the recommended dose to decrease gas and bloating
  • Take w/8oz water: Risk of choking + help w/constipation

(bulk forming laxatives)

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10
Q

Fiber & colon cancer

A

Hx of colon cancer, don’t recommend fiber first line

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11
Q

Soluble fiber: agents

A

Wheat dextrin (Benefiber) QD

Psyllium (Metamucil) divided doses

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12
Q

Soluble fiber: MOA

A
  • Undergoes fermentation via colonic bacteria resulting in: short chain FA production, increased bacterial mass
  • absorbs water in the intestine to form a viscous liquid which promotes peristalsis and reduces transit time. UTD
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13
Q

Insoluble fiber: agents

A
  • Methylcellulose (Citrucel): 3-6x/day
  • Calcium Polycarbophil (Fibercon) 1-4x/day
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14
Q

Insoluble fiber​: MOA

A

Unfermented fiber that attracts water and increases stool bulk

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15
Q

Stool surfactants: Agents

A

Docusate (Colace) *more common

Mineral oil

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16
Q

Stool Surfactants: MOA

A

Decreases stool surface tension

Softens stool allowing easier defecation

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17
Q

Docusate (Colace): Dosing

A

1-4 divided doses

(stool surfactants)

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18
Q

Docusate (Colace): ADRs

A
  • Diarrhea
  • Abdominal cramping

(stool surfactant)

19
Q

Mineral oil: dosing

A

1-3 divided doses

20
Q

Mineral Oil: ADRs

A
  • Lipid pneumonitis w/aspiration
  • Anal leakage
  • Decreased fat soluble vitamin absorption (A,D,E,K)
  • Diarrhea

Side effects are major limiting factor

(stool surfactants)

21
Q

Osmotic Laxatives: Agents

A

Polyethylene glycol (MiraLax)

Magnesium containing

  • Magnesium sulfate (Epsom salt)
  • Magnesium hydroxide (Milk of magnesia)
  • Magnesium citrate (Citroma)

Phosphate salts: Fleet Enema

Lactulose (Chronulac)

22
Q

Osmotic Laxatives: MOA

A

Nonabsorbable agents that cause colonic osmotic water retention

23
Q

Polyethylene glycol (MiraLax): ADRs

A

Bloating, cramping, flatulence, diarrhea

24
Q

Polyethylene glycol (MiraLax): mixing agents

A

Mix powder w/water, juice, soda, tea

25
Q

Polyethylene glycol (MiraLax): pregnancy & pedi

A

Safe in pregnancy

Pedi: >6mths

26
Q

Osmotic laxatives: Magnesium containing agents

A
  • Magnesium sulfate (Epsom salt)
  • Magnesium hydroxide (Milk of magnesia)
  • Magnesium citrate (Citroma)
27
Q

Osmotic laxatives: Magnesium containing agents

ADRs

A

Abdominal pain, gas, N/V

Caution: renal insufficiency –> hypermagnesemia

28
Q

Osmotic Laxatives: phosphate salts

Agents

A

Fleet enema

29
Q

Phosphate salts: ADRs

A

Electrolyte abnormalities:

increased­ (PO4, Na), decreased (Ca, K)

(Osmotic laxatives)

30
Q

Phosphate salts: caution in

A

elderly, renal insufficiency, cardiac dz

(Osmotic laxatives)

31
Q

Oral Sodium Phosphate BBW

A

12/11/2008 FDA safety alert – assoc w/AKI and RF; OTC Fleet Phospho Soda removed from market, Rx products still available (Osmoprep)

(Osmotic laxatives)

32
Q

Lactulose (Chronulac): MOA

A

Colonic bacteria hydrolyze short chain FAs –> osmotically draws water into the intestinal lumen

(Osmotic laxatives)

33
Q

Lactulose (Chronulac): ADRs

A

Abdominal discomfort, flatulence, diarrhea

34
Q

Stimulant laxatives: Agents

A
  • Anthraquinone derivatives (Sennosides / Senekot)
  • Diphenylmethane derivatives (Bisacodyl /Dulcolax)
35
Q

Stimulant laxatives​: MOA

A

Not well understood. Thought to have direct effects on:

Enterocytes, enteric neuron, GI smooth muscle
Induce limited low-grade inflammation –> water accumulation & peristalsis

36
Q

Stimulant laxatives​:​ PK

A

poorly absorbed, undergo colonic hydrolysis to active metabolites

37
Q

Stimulant laxatives​:​​ ADRs

A

Cramps, nausea, rectal burning, vomiting

38
Q

Anthraquinone derivatives (Sennosides / Senekot): Formulation & Dosing

A

Tablets, syrup, liquid

Daily, divided doses prn

(stimulant laxatives)

39
Q

Anthraquinone derivatives (Sennosides / Senekot)​: ADRs

A

Stimulant laxative ADRs + melanosis coli (senna) – just color. goes away

40
Q

Diphenylmethane derivatives (Bisacodyl / Dulcolax): Formulations and dosing

A

Rectal suppository, tablet

Once daily

(stimulant laxatives)

41
Q

Assessment question: preferred for constipation w/opiates

A

rec’d combo of senna and dulcolax

42
Q

Laxatives: Onset of action of 1-3 days

which laxatives & stool characteristics

A

Softened stool

  • Bulk forming: *psyllium, methylcellulose, calcium polycarbophil
  • Surfactant/osmotic: *docusate, polyethylene glycol (PEG), lactulose
43
Q

Laxatives: Onset of action of 6-8h

which laxatives & stool characteristics

A

Soft or semifluid stool

*Stimulants (irritants): *bisacodyl (PO), Senna (PO)

44
Q

Laxatives: Onset of action of​ 1-3h

which laxatives & stool characteristics

A

watery evacuation

  • Osmotic (high dose)*: sodium phosphate, magnesium sulfate, milk of magnesia, magnesium citrate
  • Stimulants: *bisacodyl suppository

Pharm N895 (13 decks)

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