Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacotherapy > Hemorrhoids and Gas > Flashcards

Hemorrhoids and Gas Flashcards

1
Q

describe hemorrhoids (piles)

A
  • Pillow like cluster of veins lies beneath mucus membranes lining the lowest part of the rectum and anus
  • Composed of connective tissue, an arteriovenous plexus and suspensory smooth muscle
  • normal anatomic feature that helps with continence
  • diseased when tissue weakens: distal displacement of hemorrhoidal cushions, venous
    distension, bleeding, tissue prolapse, and potential
    thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

hemorrhoids presentation

A 
Itching / burning
 Pain
 Swelling / inflammation
 Blood - In stool or on toilet tissue after defecating
 Encopresis (fecal soiling)
 Thrombosis - clots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how are hemorrhoids classified (generally)

A

External hemorrhoids
 Originate just below the skin of the anus
 Can cause pain
 More likely a source of self-care questions

Internal hemorrhoids
 Higher, in the rectum (just above the pectinate line)
 No pain unless there are complications
 No nerve fibers in this area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

classify internal hemorrhoids (4)

A

Grade I
 No protrusion of hemorrhoids

Grade II
 Protruding hemorrhoids that spontaneously reduce

Grade III
 Protruding hemorrhoids where it is possible to push them back in manually

Grade IV
 Protruding hemorrhoids that can no longer be pushed back manually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

hemorrhoids - risk factors

A

Constipation / straining while defecating - blocking venous return from anal canal leading to swollen veins
- shearing of small firm stools causes loosening of underlying connective tissue
 Diarrhea - straining to pause defecation
 Pregnancy - increased ab pressure, increased const
 Spinal cord injury
 Increased abdominal pressure
 Physical exertion or type of work
 Advanced age - tissue tends to weaken and stretch
 Diet - high in white flour, sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hemorrhoids - red flags

A 
 Severe pain
 Rectal bleeding / melena (black tarry stool)
 Fecal soiling / seepage
 Less than 12 years of age
 Family history of colon cancers
 Patients with Grade III or IV hemorrhoids
 Severe prolapse
 No response after 7 days of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

goals of therapy (3)

A
  • relieve symptoms
  • prevent complications
  • promote good bowel habits, anal hygiene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

hemorrhoids non-pharm

A
  1. avoid constipation - most important
    - review diet, fiber supplementation, fluids
  2. bowel habits
    - Avoid remaining on the toilet for longer than 1-2 minutes (and avoid straining)
    - Any prolapsed hemorrhoids must be replaced using a
    moistened tissue. After each bowel movement, the anorectal area should be cleaned with mild soap and water and gently wiped with a wet toilet tissue.
  3. Sitz bath 3-4 times daily
    - relieve irritation, itch
    - tub of warm water, sit for 15 minutes at a time, fitted over toilet seat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to increase fiber?

A

grains and cereals:

  • include at least 1 serving of whole grain
  • brown rice, whole grain bread, 5 g of fiber in cereal

legumes and beans
- kidney beans

fruits and veggies

  • fresh fruit, eat peel
  • no juice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

hemorrhoids pharm

  • purpose?
  • name 5 types of ingredients in combination pdts
  • what are some dosage forms that can be used?
A
  • short term relief of pain, burning, itch, discomfort, not cure
- Combination products include:
 local anesthetics
 Astringents
 anti-inflammatory agents
 Protectants
 Vasoconstrictors

Available as:
 Creams
 Ointments
- creams and ointments preferable to supp.
 Foams - rapid absorption, may not remain on affected area, diff conc in bubbles
 Suppositories
 Prescription, schedule 2 and unscheduled
 Generally use each morning and evening and after each bowel movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

protectants

  • name 2
  • how does it work?
A
  • glycerin, petrolatum
  • Form a physical barrier on the skin to prevent irritation, itching, pain, and burning
  • May have a lubricating effect
  • Very safe!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

local anesthetics
name 3
AE?

A
  • benzocaine, dibucaine, petrolatum
  • Offers temporary relief of symptoms by blocking nerve
    transmission
  • Is relatively safe if used for up to 7 days
  • Low absorption unless the skin is abraded

Cautions / adverse effects:
 Evidence of efficacy is lacking
 Can mask the pain of more severe anorectal disorders
 Greater absorption may lead to CNS and CV effects
 May produce local reactions. These may be similar to
hemorrhoid symptoms. Pramoxine has a lower
incidence of this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

astringents

name 2
how does it work?
how should zinc be used vs witch hazel?

A
  • Zinc sulfate, witch hazel
     Produce a drying effect, which helps to relieve symptoms, especially itching and burning
     Form a protective layer by coagulating proteins in skin cells of the perianal skin or lining of the anal canal
     Zinc can be used internally or externally on hemorrhoids, while witch hazel should only be used externally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

corticosteroids

name 1
AE?

A

Hydrocortisone

  • Rx available in combination products
  • Onset can take up to 12 hours but effect lasts longer than other therapies

Cautions / adverse effects
 Do not recommend longer than 7 days, however if finding
improvement can use longer (i.e., 2 weeks)
 Long term use could lead to mucosal atrophy.
 Local adverse effects could include skin atrophy with
prolonged use, may mask symptoms of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

hemorrhoids - common OTCs

2 types

A

Preparation H - creams and ointments
- has protectants, vasoconstrictor (limit bleeding short term with phenylephrine) and sometimes anesthetic
Anusol - creams, suppositories, ointments
- has zinc sulfate, sometimes anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

rectal products (4)

A
  • Lubricated suppositories for insertion
  • Applicator for creams, entire cream tube is inserted
  • Liner - leakage, fecal soilage
  • TUCKS - witch hazel, cleanse area and provide relief
17
Q

other treatments (not tested)

A

framacytin antibiotics
pain relief
procedures, hemorrhoidectomy most effective

18
Q

New NHPs for hem

Hemoval

A

Hemoval
- diosmin

Phlebotonic

  • unknown MOA, may strengthen vessel walls, increase tone, suppress inflamm mediators
  • reduce pain, edema, bleeding
  • 600mg PO TID x 4 days then 600 mg PO BID x 3 days
  • AE: abdominal pain, diarrhea, headache, nausea
19
Q

New NHPs for hem

Venixxa

A
  • citrus bioflavonoid - antiplatelet/coagulant effects
  • reduce frequency, duration, intensity of symptoms for grade I or II acute internal hem, chronic too
  • acute: 3 tabs BID for 4 days, then 2 tabs BID for 3 days
  • chronic 1 tab BID
  • AE: allergy, GI, discomfort, dizziness, headaches, malaise
20
Q

Pregnancy hem

what is preferred?

A
  • non-drug, avoid constipation
  • external preps better
  • protectants/astringents preferred
21
Q

monitoring

relief in how long?

A
  • relief of itch, swelling, burning within 1 week

- refer in no relief, symptoms worsen

22
Q

Gas pathophys

A
  • Excess gas in the GIT can be found in the
    esophagus, stomach, small intestine, or large
    intestine
  • Removed via flatulence or eructation (belching)
  • Average person passes gas 10-25
    times daily. More than 25 times is considered
    excessive
  • nitrogen, hydrogen, carbon dioxide, methane and
    oxygen
23
Q

Causes of gas for belching, abdominal discomfort and flatus (3)

A
  1. eructation (belching): aerophagia, eating quickly, excessive salivation, gum chewing, mal-fitted dental app., nausea, resp disorders, smoking, carbonated bev
  2. bloating, cramping, pain: aerophag, cancer, eating disorders, GI disorders
  3. flatus: celiac diseas, eating beans/complex carbs/dairy/veg, disaccharidase deficiency, pancreatic insuff
24
Q

Assessment for belching/flatulence

what to do with consumption of nonabsorbable carbs or lactose?

air wallowing, overeating?

none of the above?

A

consider appropriate enzyme supplementation (lactase)

educate pt

consider trial of simethicone or probitoics - if no relief, consider a trial of bismuth subsalicylate

25
Q

Gas Red Flags (9)

A 
Unintentional weight loss
 Blood in stool or vomit
 Moderate to severe abdominal pain/swelling
 Sudden changes in bowel habits
 Nausea or vomiting
 Dysphagia
 Dyspepsia
 Fever or chills
 Presence of long-standing diabetes, celiac disease, history of GI pathology
26
Q

Gas Goals of Therapy

A

Educate patients about the normal aspects of GI gas
 Relieve symptoms (belching, pain, bloating, flatulence)
 Educate patients regarding preventive measures

27
Q

Non pharm management of eructation?

A

 Avoid gulping air, eat meals slowly
 Adjust poorly fitting dental apparatus
 Reduce consumption of gas-producing/releasing substances

28
Q

Non pharm management of bloating?

A

 Avoid large meals, overeating
 Eat less and earlier in the day
 Avoid dietary and pharmaceutical triggers

29
Q

Non pharm management of flatulence?

A

 Smaller, more frequent meals
 Exercise
 Eat foods low in FODMAPs (Fructans, fructose, galacto oligosaccharides lactose, mannitol, sorbitol)

30
Q

Gas pharm treatment

Alpha-D-galactosidase (Beano)

  • dose?
  • used for?
  • do not consume with __________
A

150–450 GaIU PO with the first bite of food
(300–1200 GaIU/day)

Effective in reducing flatus and abdominal discomfort associated with ingestion of non-absorbable carbs
 Do not consume with hot foods
 inactivates enzymes
 Adverse effects: rare allergic reactions

31
Q

Gas pharm treatment

Bismuth subsalicylate (Pepto-Bismol)

  • dose
  • used for?
  • AE
A

524 mg QID PO (maximum 8 doses/day)
 Binds sulfide gas, effective for short term relief of intestinal gas
 Do not recommend at high doses or as long term therapy to avoid salicylate toxicity
 Adverse effects: constipation, diarrhea, nausea, tongue discoloration, grey/black stool, vomiting
- Don’t recommend bismuth for over 3-4 weeks

32
Q

Gas pharm treatment

Lactase (Lactaid)

  • dose
  • used for?
  • AE
A

 Can prevent flatulence in patients with lactase deficiency if taken with or prior to ingestion of lactose
 Dose varies based on amount of lactose ingested

33
Q

Gas pharm treatment

Laxatives

use?

A

 Reduce symptoms of intestinal gas associated with constipation

34
Q

Gas pharm treatment

probiotics

use?

A

 Some data has shown a reduction in both short-term and long-term symptoms of abdominal distension, bloating, gas
 Many available options on the market, not always consistent in quantity and type of bacterial species combined

35
Q

Simethicone (Ovol, Gas X)

  • dose
  • use
A

80–160 mg per meal PO
 Prevents bubbling of liquids in stomach, not absorbed in GI tract
 No clear benefit in reduction of symptoms of intestinal gas but used for
treatment of flatulence and abdominal bloating

36
Q

Gas - others

name the ones described here:

  1. no evidence, do not recommend
  2. not treating gas but bac overgrowth
  3. muscle relaxant studied in eructation, need more evidence
  4. Insufficient evidence for peppermint, garlic or ginger
A
  1. activated charcoal?
  2. antibiotics
  3. baclofen
  4. natural pdts
37
Q

Monitoring

when to refer?

A

 Refer if symptoms persist longer than 1-2 weeks despite self-care
 Monitor for improvement after exclusion diets, if no change consider
other triggers
 Educate and reassure patients that gastrointestinal gas is a normal
bodily process

Pharmacotherapy (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions