GI - Laxatives Flashcards
Bulk-forming Laxatives
Brand/Generic
Brand: Metamucil, Citrucel, FiberCon
Generic: Methylcellulose, psyllium, calcium polycarbophil
Bulk-forming Laxatives Indication
Short term therapy for patients on low-fiber diets, postpartum women, older adults and patinets with colostomies, IBS, diverticulosis.
Bulk-forming Laxatives Special Populations
Diabetes, carb, or calorie restrictions: sugar-free agent
Phenylketonuria - avoid sugar-free products
Hypercalcemia - avoid calcium carbophyl
Bulk-forming Laxatives Time to Effect/Length of Therapy
Time to Effect: 12- 24 hours, maybe up to 72 hours
Length of Therapy ?
Bulk-forming Laxatives Common Side Effects
Abdominal cramping, flatulence (may be due to exceeding recommended dose
May swell in throat if not taken with enough liquid
Bulk-forming Laxatives Serious Side Effects and Precautions/Warnings
Bronchospam, anaphylaxis
Seek medical attention: chest pain, vomiting, difficulty swallowing/breathing
DDI: decrease absorption of digoxin, anticoagulants, salycilate - sep. dose by 2 hrs
Bulk-forming Laxatives Contraindications
Avoid in pts with swallowing difficulties, esophageal strictures, fluid restricted, intestinal obstruction, intestinal ulceration, stenosis, disabling adhesions
Younger than 6 y/o - no methylcellulose, calcium polycarbophil
Younger than 12 y/o - no psyllium
Bulk-forming Laxatives Administration
Hyperosmotic Laxatives Brand/Generic
Brand: Miralax, Pedia-Lax
Generic: PEG 3350, glycerin
Hyperosmotic Laxatives MOA
Large, poorly absorbed ions or moleculs that draw water into the colon or rectum through osmosis to stimulate bowel movement
Hyperosmotic Laxatives Common Indications
Constipation
Hyperosmotic Laxatives Administration
Mix 1 capful or 1 packet of liquid
Hyperosmotic Laxatives Time to Effect/Length of Therapy
PEG 3350: 12-72 hours, may be up to 96 hours
Glycerin suppositories: 15-30 minutes
Hyperosmotic Laxatives Common Side Effects
PEG 3350: bloating, abdominal discomfort, cramping, flatulence
Glycerin: rectal irritaiton with overdosage
Hyperosmotic Laxatives Contraindications
IBS
Renal disease (unless under supervision)
PEG3350 - no if <17 y/o (except w/ PCP supervision)
Glycerin - no if <6 y/o (except w/ PCP supervision)
Emollient Laxatives Brand/Generic
Brand - Colace
Generic - Docusate
Emollient Laxatives Common Indications
Constipation
Emollient Laxatives MOA
Anionic surfactants that act in small and large intestine to increase the wetting efficiency of intestinal fluid, facilitating a mixture of aqueius and fattty sibstance to soften the fecal mass
Emollient Laxatives Time to Effect/Length of Therapy
Time to Effect - 12-72 hours, may take up to 3-5 days
Poor evidence for efficacy:
100 mg BID ineffetive
240 mg qd increase BMs by 1/week in one study
Another study found 240 mg qd ineffective
Emollient Laxatives Common Side Effects
Larger than recommended doses may result in weakness, sweating, muscle cramps, arrhythmia
Emollient Laxatives Contraindications
Docusate Sodium - no age restriction
Docusate calcium - no if <12 y/o (unless under PCP supervision)
DDI: enhances absorption of mineral oil
Lubricant Laxatives Brand/Generic
Mineral oil
Lubricant Laxatives MOA
Softens fecal contents by coating the stool and preventing colonic absorption of fecal water
Lubricant Laxatives Time to Effect/ Length of Therapy
Oral: 6-8 hours
Rectal: 5-15 minutes
Lubricant Laxatives Common Side Effects
Abdominal cramps, diarrhea, nausea, oily rectal leakage, vomiting, hemorrhoids (large doses)
Lubricant Laxatives Serious Side Effects and Precautions/Warnings
Lipid pneumonia following aspiration
Repeated and prolonged dosing: droplets may reach the mesenteric lymph nodes, intestinal mucosa, liver and spleen and cause foreign body reaction
DDI: decreases absorption of vitamins A, D, E, K
increases absorption of mineral oil
Lubricant Laxatives Contraindications
Risk for aspiration
<6 y/o
Pregnant women
Bedridden adults
Older adults
Difficulty swallowing