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PHAR 154 > IBS / Diarrhea / Constipation / NV > Flashcards

IBS / Diarrhea / Constipation / NV Flashcards

1
Q

What is the Gastrocolic Reflex?

A

-Inherent urge to have a bowel movement 30mins after ingesting a meal.

-Colon has increased motility in response to stomach stretching with meal ingestion.

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2
Q

Role of PNS in gastric motility? Role of SNS in gastric motility?

A

PNS: Stimulate it.
SNS: Inhibit it.

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3
Q

How long can it take food to be completely processed by the digestive tract?

A

1-2d

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4
Q

What important hormone (95% of it) is produced in the Small Intestine?

A

Serotonin

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5
Q

In terms of a multiplying factor, how many more women suffer from digestive health issues on a weekly basis (relative to men)?

A

2x

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6
Q

On average, how many liters of fluid enter the Duodenum each day?

A

9L

-2L from Diet & 7L from Intestinal Secretions.

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7
Q

Approximately how many liters of fluid are absorbed by the Small Intestine each day? Large Intestine?

A

SI: 8L
Colon: 0.85L (850mL)

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8
Q

About how many mL’s of fluid are excreted in stool each day?

A

150mL

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9
Q

What could be some underlying causes as to why someone might have increasing constipation as they age?

A

-Disease States
-Drug Causes
-Immobile
-Fluid Intake (maybe)

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10
Q

Medically speaking, how is constipation defined?

A

< 3 bowel movements / week

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11
Q

What is the most common pattern of bowel movements (how many per day)?

A

1 per day (but pattern is seen in less than 50% of people)

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12
Q

Do most people have a bowel movement each day?

A

Nope (most people are irregular)

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13
Q

What are some major complications that can arise from constipation?

A

-Anal Fissures / Tears
-Rectal Bleeding
-Hemorrhoids
-Abdominal Swelling
-Bloating

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14
Q

Is constipation simply infrequent stool passages?

A

Nope… Can mean hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after bowel movements.

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15
Q

Is pain a characteristic sign of constipation?

A

Nope… Consistent pain means start thinking of other conditions (ie. IBS).

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16
Q

How do anal fissures in kids bring upon constipation?

A

Induces withdrawal from performing normal bowel movements.

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17
Q

What is the most commonly encountered bowel type condition that we as Pharmacists encounter?

A

IBS (even more so than constipation).

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18
Q

After how many days should we expect to refer constipated patients to a Doctor (if OTC things don’t work)?

A

-7d (for lack of bowel movement)

-21d (for lingering constipation)

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19
Q

What are some red flags that can come about from being constipated?

A

-Change to Stool Texture
-Change to BM Routine
-Blood
-Hemorrhoids
-Weight Loss
-Reduced Appetite
-NV
-Frequent Pain
-Narrowing Stools
-Unresponsive to OTC Treatments

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20
Q

If left untreated, constipation can lead to what?

A

-Hemorrhoids
-Rectal Prolapse (part of Intestine pushes through Anus)

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21
Q

What are some causes of Large Bowel Obstruction?

A

-Growth / Tumor (most common cause)

-Volvulus

-Bowel Strictures caused by scar tissue formation

-Intussusception

-Impacted Stool

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22
Q

Symptoms of Large Bowel Obstruction?

A

-Belly Cramping
-Belly Swelling / Bloating
-Unable to Pass Gas
-Unable to Pass Stool
-Vomiting

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23
Q

Are Large Bowel Obstructions slow or quick in symptomatic progression?

A

Quick (& usually very dramatic, as those with LBO’s can’t pass Stools at all).

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24
Q

Is excessive fluid intake a good treatment option for someone with constipation?

A

Nope… Don’t need 2L of fluid intake per day (ingestion of 2L even through diet is fine). Just want to aim for normal hydration levels.

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25
Q

If I’m a chronic coffee drinker & have acute constipation, would I be in a fluid deficit (& thus require more fluid intake)?

A

Nope… Those who have coffee chronically are in no fluid deficits. Only those who don’t drink it & have one may be in slight fluid deficits.

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26
Q

Is upping fiber intake a good idea for treating constipation?

A

Not a bad move.

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27
Q

Some examples of foods that increase dietary fiber intake?

A

-Granola Bar (1g)
-1/4 cup Cashews (1g)
-Apple (3g)
-3/4 cup Bran Flakes (5g)
-3 tsp Metamucil (3.5g)
-Bran Muffin (4g)

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28
Q

Nursing Care plays a big role in ______ ________.

A

bowel retraining

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29
Q

What fruit is particularly effective as a natural laxative & contains both insoluble / soluble fiber (as well as antioxidants)?

A

Prunes

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30
Q

What agent contained within Prunes allows it to act as a natural laxative?

A

Sorbitol

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31
Q

For an adult wanting to use Prunes as a fiber enhancer, how much should they start by adding?

A

Approximately 4 Prunes (or 1/2 cup Prune Juice)

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32
Q

What are 1st line agents for constipative prevention?

A

Bulk Forming Agents… Forms of Soluble Fiber.

-Psyllium (Metamucil)
-Inulin
-Bran

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33
Q

Which one has a more gritty palatability to it: Inulin or Psyllium?

A

Psyllium

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34
Q

How many Oat Bran tablets per day are needed to be ingested in order to reach Bran Muffin levels of Fiber?

A

5-6tabs / day

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35
Q

How many days does it take for Bulk Forming Agents to work?

A

2-3d

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36
Q

How fast does Senna work? Enemas?

A

Senna: 6hrs
Enema: 15mins

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37
Q

How do Bulk Forming Agents work?

A

-Swell in Intestinal Fluid & create a gel-like substance (which facilitates passage).

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38
Q

Why should Psyllium be taken immediately with water?

A

-As it thickens upon standing (disgusting palatability & obstructive potential increases).

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39
Q

T or F: Psyllium administration requires a lot of additional water intake.

A

False… Isn’t a “jelly plug”. Regular water intake fine.

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40
Q

How should we start dosing Psyllium?

A

1 rounded tsp BID (then scale back every 3d until constipation is under management).

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41
Q

What does the body sometimes do to clear out Psyllium-Induced Obstructions (although very rare)?

A

Diarrhea (body attempts to generate more fluid to clear obstruction).

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42
Q

What was the original culprit of Psyllium-Induced Obstructions?

A

Formulation itself (used to come in granular form).

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43
Q

The Prodiem product with blue packaging contains what? Green packing contains what?

A

Blue: Sennosides (for acute relief of constipation).

Green: Polycarbophil (for prevention of constipation).

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44
Q

Prodiem Overnight Relief Therapy provides constipative relief in how many hours? Bulk Fiber Therapy provides relief in how many hours?

A

ORT: 6-12hrs
BFT: 12-72hrs

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45
Q

Product comparison: Psyllium vs. Inulin…

A

Psyllium: Thickens, OD-TID use, mix with water, lowers Cholesterol (5%).

Inulin: Non-Thickening, OD-TID use, add to fluid or food, lesser Cholesterol effects than Psyllium.

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46
Q

How do Metamucil Capsules differ from Metamucil Gummies (ie. Active ingredient used)?

A

Caps: Psyllium
Gummy: Inulin

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47
Q

How many Metamucil Capsules need to be taken each day to have the same effects as the powder?

A

6-8 Capsules

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48
Q

Why is Senna not favorable to use for chronic constipation flare-ups?

A

Alters normal gut etiology

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49
Q

Docusate is classified as a _____ ________.

A

stool softener

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50
Q

How does Docusate work?

A

Detergent (Micelle formation that allows better mixing of aqueous & fatty compounds)

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51
Q

What complaint does Jeff have about Docusate usage?

A

Vast majority of people underdosed (1-2 caps standard; should jump to using 4-8 caps instead).

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52
Q

For most people taking Docusate, when should we expect to see maximal effects (after how many days)?

A

1-2d (for some, up to 3-5d)

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53
Q

For Nursing Home patients, how many capsules of Docusate should they get each day? Palliative Care patients?

A

NH: 4 Caps / Day
PC: Up to 8 Caps / Day

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54
Q

Why is Mineral Oil contraindicated for concurrent use with Docusate?

A

Docusate greatly increases Serum Mineral Oil levels.

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55
Q

T or F: The brand name Docusate product Surfak (with 240mg Docusate Ca2+) is stronger / more effective than Colace (with 100mg Docusate Na+).

A

False… Are equipotent.

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56
Q

Are the Docusate concentrations in Senokot S effective?

A

Nope… 50mg (vs. 100mg in Colace) is sub-therapeutic.

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57
Q

What are the main problems with using Mineral Oil as a constipation lubricating agent?

A

-Anal Seepage
-Lipid Pneumonia (especially laying down)

No issues with fat-soluble vitamin absorption!

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58
Q

Why do we avoid bedtime dosing with Mineral Oil in order to treat constipation?

A

Risk of Lipid Pneumonia (that worsens when one lies down)

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59
Q

How long does orally administered Mineral Oil take to work?

A

6-8hrs

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60
Q

How do Osmotic agents such as Citro Mag work in the gut?

A

Formulation incorporates non-absorbable ions (ie. Mg2+ Citrate, MgOH), which remain in the gut & draws water towards them.

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61
Q

What are the primary indications for Osmotic / Saline agents?

A

-Bowel Evacuations (for Colonoscopies or acute constipative relief)

-Overnight Relief (Phillips)

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62
Q

How is Phillips MOM traditionally dosed for laxation? As an antacid agent?

A

Laxative: 30-60mL HS
Antacid: 5-15mL QID

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63
Q

What people should take caution using Osmotic Laxatives chronically?

A

-CHF & Chronic Renal Insufficiency (due to effects on electrolyte imbalances, fluid & salt overload).

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64
Q

Fleet Enemas provide constipative relief in how many mins?

A

2-5mins (extremely fast)

65
Q

Non-Saline Osmotic agents include what sorts of products?

A

-Glycerin Suppositories
-Lactulose Syrup
-PEG 3350 (RestoraLAX)

66
Q

What is the agent of choice for infants & children who have acute constipation and require quick relief?

A

Glycerin Suppositories (within 30mins)

67
Q

How does Lactulose Syrup work within the Colon?

A

Lactic Acid metabolism in the Colon (via bacteria) draws water into the stool, thereby increasing osmotic pressure & stool volume.

68
Q

How long does Lactulose Syrup take to work? What’s the OD dose given?

A

15-60mL; Works in 1-2d.

69
Q

Can Lactulose Syrup be safely used in Diabetics?

A

Yep (sugars present in it are unabsorbed in the gut).

70
Q

How much product is present in a capful of RestoraLAX?

A

17g

71
Q

How long does PEG 3350 take to work?

A

Couple days

72
Q

Jimmy is a 16yr old coming in for some acute constipative relief. He hasn’t seen a doctor yet, but is wanting to try RestoraLAX. What do you tell him?

A

Label states it shouldn’t be used < 18yrs (unless MD involved).

-Probably a safe agent to use, but on test don’t recommend under 18 (as the label says that) unless MD is involved.

73
Q

How often should PEG 3350 doses be titrated up?

A

Every 2-3d (until dose that works alleviates the constipation).

74
Q

Oral Stimulant agents such as Senna & Bisacodyl take around how many hours to relieve constipation?

A

6-12hrs

75
Q

The old ExLax product contained what ingredient?

A

Phenolphthalein

76
Q

What are some side effects of Stimulant agents used to treat constipation?

A

Diarrhea / Cramping

77
Q

Where did Stimulant agents for constipation get a bad rap for overuse risk?

A

Anorexia world

78
Q

How do we dose Senokot for constipation use?

A

2-4 tabs OD or BID

1-2 tabs OD or BID (if extra strength)

79
Q

If somebody is taking T3s for pain relief & is put on Senakot for constipative relief, how might their dose on the first night differ if:

-T3 given late in 1st day?
-T3 given early in 1st day?

A

Late: 8mg 1st night
Early: 16mg 1st night

80
Q

What really odd indication did Jeff discuss in class that a pregnant woman tried using Castor Oil for?

A

As a labor inducer

81
Q

Colyte & PicoSalex are used for what?

A

Colonoscopy Flushing Agents

82
Q

Probiotics: Good for acute constipation?

A

Nope (more used preventatively)

83
Q

Constipative relief needed now… What’s better: Senna or PEG 3350?

A

Senna

84
Q

Constipative prevention is desired… Senna or PEG 3350?

A

PEG 3350

85
Q

When should we get concerned about elderly constipation?

A

-Unexplained New Onset (ie. Due to meds)
-Blood
-Weight Loss
-Fever
-NV
-History of Colorectal Cancer

86
Q

In terms of bowel movement frequency, do breast fed or formula fed infants (on average) have more bowel movements?

A

Breast Fed > Formula Fed (3 vs. 2 / day)

87
Q

Is there a reason to be concerned with an infant only having one bowel movement per week?

A

Nope (so long as no straining & stools aren’t dry & no sudden changes to the patterns of bowel movements).

88
Q

When does infant type constipation usually rear its head?

A

Upon starting solid foods

89
Q

What benefits would using a stool to prop the feet on have for kids undergoing a bowel movement?

A

Provides something to dig the feet into (provides straining power)

90
Q

What’s a good rule of thumb to follow for upping a child’s fiber intake (as a preventative constipation measure)?

A

Age + 5 = Grams amount

91
Q

Safe to use Senna & PEG 3350 in kids?

A

Absolutely

92
Q

What is the lowest age that Pharmacists can recommend an Enema?

A

2yrs

93
Q

For kids initiating PEG 3350, what should dosing be started at?

A

1/2 capful

94
Q

Senna, MOM, Miralax or RestoraLAX… Are they safe to use in pregnancy?

A

100% (extremely minimal systemic absorption taking place)

-However, some concern with Senna & Bisacodyl (uterine contraction).

95
Q

Are Bulk Forming Agents such as Psyllium & Inulin good for treating Opiate-Induced Constipation?

A

Nope… Slow OOA, Bloating, Gas as adverse side effects (& risk of obstruction rises).

96
Q

Recommended 1st line prevention agent for Opiate-Induced Constipation?

A

PEG 3350

97
Q

Common drug agents that can cause constipation?

A

-Opioid Pain Relievers
-Antihistamines
-TCAs

98
Q

Which ABs are the main culprits of Drug-Induced Diarrhea?

A

-Fluoroquinolones
-Penicillins
-Cephalosporins

99
Q

AB-Induced Diarrhea cases typically occur after how many days of therapy initiation?

A

2-3d (resolves when agent d/c)

100
Q

Other commonly used drug agents that induce diarrhea?

A

-Antihypertensives
-H2 Receptor Antagonists
-NSAIDs
-PPIs
-SSRIs

101
Q

Does Pepto Bismol have an indication for use in drug-induced diarrhea cases?

A

Nope

102
Q

Probiotics good for prevention of drug-induced diarrhea?

A

Meh (evidence is still inconclusive but worth a shot if it’s a case of AB-induced diarrhea)

103
Q

T or F: Actual incidence of food-related allergies is lower than the perceived incidence.

A

True (10% actual vs. 19% of Americans in a study believing to have them).

104
Q

When do signs & symptoms of food poisoning rear their head?

A

Hrs - Even Weeks Later

105
Q

MOA of Imodium?

A

Targets Meu Receptors in the gut & slows gastric motility.

106
Q

Which products are better than Pepto Bismol as Antacids (although they take longer to work)?

A

Pepcid or Zantac

107
Q

How does Kaopectate work to treat upset stomach from a disagreeable food?

A

Adsorbing agent… Attapulgite in it acts as a binding site to leach toxins out of the gut.

108
Q

Culturelle Probiotics… Good for Food Intolerances?

A

Nope (might help with bacterial food poisoning but no help for food intolerances).

109
Q

At what age do we not recommend using Imodium under? At what age is it C/I?

A

Not Recommend: 12yrs & Under

C/I: 2yrs & Under

110
Q

VGE is most common in kids aged what?

A

3-24mths

111
Q

Up to 50% of VGE cases are caused by what?

A

Rotavirus (sometimes Norovirus)

112
Q

Typical length of time for a VGE infection?

A

1-3d (but gut needs 1wk to normalize)

113
Q

How is the preventable Rotavirus Vaccine administered? When do kids get it?

A

-Orally (not via needle).

-Given at 2mths (1st dose) & 4mths (2nd dose).

114
Q

In terms of % body weight loss, what is classified as mild pediatric diarrhea? Moderate? Severe?

A

Mild: Up to 5%
Mod: 6-9%
Severe: >/= 10%

115
Q

In young infants (less than 18mths of age), what can be a telltale sign of cerebral dehydration?

A

Fontanelle Depression

116
Q

What’s the rule for pediatric diarrhea referrals?

A

< 6mths: Refer!
1yr & less: 1d
1-3yrs: 2d
> 3yrs: 3d

117
Q

When are Pedialyte solutions or Gastrolyte powders suitable add-ons?

A

Mild Diarrhea & dehydration is more of a concern (not needed if there are no signs of dehydration).

118
Q

T or F: Anti-Emetics such as Gravol are recommended add-ons to mild diarrhea cases with concurrent vomiting.

A

False… Not recommended.

119
Q

T or F: Kids should never drink juices during a VGE flu.

A

False… Osmotic force effects are blown way out of proportion.

120
Q

T or F: Those on Infant Formulas must halt Lactose containing formulas for Lactose-Free ones during a case of VGE.

A

False… Old thinking was to go to Lactose-Free for a few weeks (but not necessary anymore).

121
Q

Most common bug responsible for Traveler’s Diarrhea?

A

E. coli

122
Q

T or F: The incidence of Traveler’s Diarrhea is higher in backpackers (vs. those staying at resorts), as well as with those on PPIs or H2 Blockers.

A

True!

123
Q

What are some commonly prescribed ABs for Prevention of Traveler’s Diarrhea?

A

Azithromycin
Septra (TMP / SMX)

124
Q

Preventative TD Pepto Bismol doses for people:

> 14yrs:
10-14yrs:
5-9yrs:
2-4yrs:

A

> 14yrs: 524mg QID
10-14yrs: 262mg QID
5-9yrs: 131mg QID
2-4yrs: 88mg QID

125
Q

What does the Dukoral vaccine prevent?

A

Cholera Infection… Given to anyone over 2yrs (orally) & offers protection for 2yrs.

126
Q

Treatment options once you get TD?

A

1) 1-3d AB + Loperamide

2) Loperamide alone

3) Pepto Tabs (2 x 262mg tabs q 0.5hrs up to 8 doses)

127
Q

Once blood shows up in stool of a TD case, is Imodium a treatment option?

A

NOOOOOOOOO

128
Q

In America, how low in age does Imodium packaging indicate use for?

A

6yrs & up (not allowed in Canada below 12yrs)

129
Q

AB Prevention of TD didn’t work… Now what?

A

1) Switch to Pepto q 0.5hr dosing.

2) Switch to Loperamide.

130
Q

Pepto Prevention for TD didn’t work… Now what?

A

1) 1-3d AB switch + Loperamide

131
Q

Preventative treatment of Hep A & Hep B?

A

Vaccination! Twinrix is a dual vaccine that covers both (good idea to do).

132
Q

What is the max amount of Imodium one can take / day?

A

16mg

133
Q

North American _____ & Asian _____ more commonly have IBS.

A

women ; men

134
Q

IBS symptoms?

A

-Over 6mths long
-Abdominal Pain / Spasm
-Bloating / Fullness
-Urgency
-Constipation / Diarrhea (spectrum of range)
-Mucous in stool (no bleeding)

135
Q

T or F: IBS patients can have mixed stool patterning that changes over time.

A

True! Can be IBS-D & change to IBS-C (and vice versa).

136
Q

What IBS symptom is much more prevalent in female cases (up to 75-90%)?

A

Bloating / Distention

137
Q

What does “FODMAP” refer to?

A

Foods to avoid in IBS…
F - Fermentable
O - Oligosaccharides
D - Disaccharides
M - Monosacharides
P - Polyols

138
Q

What type of IBS (C or D) is Psyllium recommended for?

A

IBS-C (some degree of helping with IBS-D but better for C).

139
Q

How does Pinaverium work in IBS-D?

A

Ca2+ Channel Antagonist that induces muscle relaxation.

140
Q

How does Trimebutine work in IBS-D?

A

Is an Opiate Receptor Agonist / 5HT-3 Receptor Antagonist.

141
Q

Loperamide: Good for IBS-C or IBS-D?

A

IBS-D (2-4mg up to QID)

142
Q

Inulin / Psyllium / PEG 3350 good for acute IBS-C flare-ups?

A

Nope… Too long to work. Use Senna instead!

143
Q

Peppermint Oil: Good for IBS-C & IBS-D?

A

Meh (worth trying but taper expectations as evidence is inconclusive at best).

144
Q

TCAs: Good for IBS-C or IBS-D?

A

IBS-D (as they have anti-cholinergic side effects & slow gut motility down).

145
Q

SSRIs: Good for IBS-C or IBS-D?

A

IBS-C (as they have anti-constipative effects), but currently are of minimal value.

146
Q

When would be the best time to put somebody with IBS-C on an SSRI?

A

If they also have depression (treats two conditions).

147
Q

Alosetron: What’s its indication?

A

IBS-D women only (reduced diarrhea & pain by binding 5-HT3 receptors).

148
Q

Tegaserod: What’s its indication?

A

IBS-C women only (prokinetic agent that agonizes 5-HT4 receptors).

149
Q

Linaclotide treats mod-severe IBS-C… How does it work?

A

Guanylate Cyclase C Agonist… Stimulates GIT fluid secretions, increases colonic transit & reduces abdominal symptoms.

150
Q

Viberzi (Eluxadoline)… How does it work to treat IBS-D?

A

Mu Opioid Agonist.

151
Q

Solution for preventing nausea prior to taking Emergency Plan B?

A

1/2 - 1 tab Gravol

152
Q

What’s the Benadryl salt derivative that has some value in Motion Sickness?

A

Dimenhydrinate

153
Q

Can I give Gravol to kids < 6yrs (even if it has cough & cold ingredients in it)?

A

Absolutely safe to do so!

154
Q

Can kids use Scopolamine patches?

A

Adult use only

155
Q

Can 2nd gen AH agents such as Aerius or Claritin be used for Motion Sickness?

A

Nope… Only have AH component but we also require Anti-Cholinergic component.

156
Q

T or F: Ginger has more proof for morning sickness use than motion sickness use.

A

True

157
Q

Most cases of nausea / vomiting in pregnancy cease by how many weeks?

A

12wks

158
Q

Major treatment of NV in pregnancy?

A

Diclectin (Doxylamine + Pyridoxine combo)

159
Q

Gravol dosing for NV in pregnancy?

A

50-100mg q4-6hrs

PHAR 154 (11 decks)

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