Laxative and Stimulant Classes Flashcards
Chemical stimulant MEDS and prototype
MEDS: bisacodyl (Dulcolax), castor oil, senna (Senokot)
(Metamucil adds bulk to the stool. Take lots of water with these for them to work well)
PROTOTYPE: castor oil
- Induces premature labor
CI chemical stimulants
- Acute abdominal disorders (Where increased motility could lead to rupture or further exacerbation of the inflammation)
- CAD/CVD (d/t fluid loss and electrolyte imbalance when taking this med)
What should be alerted when it comes to castor oil
irritant effect has been associated with premature labor
AE Chem stimulants
- Most of these are d/t (rapid change in fluid and e-)
- GI effects : Diarrhea, abdominal cramping, and nausea
- CNS effects :Dizziness, headache, and weakness (use a bedside commode)
- CV effects :Sweating, palpitations, flushing, and fainting
- Cathartic dependency (body gets used to it and needs it to function)
DDI Chem stimulants
- Some interfere with the timing or process of absorption
- Don’t give a drug and then a stimulant, bc it doesn’t give time for the med to be absorbed (therapeutic effect)
Bulk laxatives MEDS and prototype
polycarbophil (FiberCon) , psyllium (Metamucil), methylcellulose (Citrucel)
Prototype: psyllium (Metamucil)
MOA bulk laxatives
- Cause fecal matter to increase in bulk
- Increase motility of GI tract by increasing size of fecal matter and pulling fluid into intestines
CI and DDI of bulk lax
CI:
- Acute abdominal disorders (Where increased motility could lead to rupture or further exacerbation of the inflammation)
DDI:
- Some interfere with the timing or process of absorption
- Should not take with other medications, should separate by 2 hours
AE Bulk lax
- GI effects - Diarrhea, abdominal cramping, and nausea
- CNS effects – Dizziness, headache, and weakness
- CV effects – Sweating, palpitations, flushing, and fainting
- Cathartic dependency
(Must take with at least 8 ounces of water to improve effectiveness and decrease risk of fluid and electrolyte imbalance, if not, will worsen constipation)
Osmotic lax MEDS
Lactulose (Constilac)
Magnesium citrate (Citrate of Magnesia)
Magnesium hydroxide (MOM)
Magnesium sulfate (Epsom salts)
Polyethylene glycol (MiraLax)
Polyethylene glycol electrolyte (GoLYTELY)
MOA and CI osmotic lax
MOA:
Draw water into the GI tract and stimulate GI motility
CI:
- Acute abdominal disorders (increased motility could lead to rupture or further exacerbation of the inflammation)
- DM (e- imbalances, sugar)
- Renal insufficiency (Mg containing substances)
- Sz : Polyethylene glycol electrolyte – sz = electrolyte wasting cause neuronal instability and precipitates sz
AE and DDI of osmotic lax
AE:
- GI effects - Diarrhea, abdominal cramping, bloating (d/t pulling water to intestines), and nausea
- CNS effects – Dizziness, headache, and weakness
- CV effects – Sweating, palpitations, flushing, and fainting
DDI:
- Should not take with other medications, should separate by 2 hours
- MOM (only an osmotic) : antacid properties, may interfere with meds that require an acidic environment
Lubricating laxatives MEDs and Prototype
- Docusate (Colace) : Has a detergent (gliding) action on the surface of the intestinal bolus, making a softer stool
- glycerin (Sani-Supp): Hyperosmolar laxative used to gently evacuate the rectum without systemic effects higher in the GI tract
- mineral Oil (Agoral Plain): Forms a slippery coat on the contents of the intestinal tract
- Essentially decrease strain
PROTOTYPE: mineral oil
MOA and CI of lubricating lax
MOA:
Do NOT stimulate intestinal motility
CI:
Acute abdominal disorders
Pregnancy / lactation
AE lubricating lax
- GI effects : Diarrhea, abdominal cramping, nausea, leakage and staining of stool
- CNS effects : Dizziness, headache, and weakness
- CV effects : Sweating, palpitations, flushing, and fainting
DDI lubricating lax
- Should not take with other medications, should separate by 2 hours
- Mineral oil can interfere with absorption of fat soluble vitamins
ADEK vitamins
Opioid antagonist MEDS
MEDS:
alvimopan (Entereg)
methylnatrexone bromide (Relistor)
naloxegol (Movantik)
naldemedine (Symproic)
MOA and Indications opioid antagonist
MOA:
- Block effects of opioids on GI tract by binding to peripheral opioid receptors
- Helps maintain normal motility and secretions (movantik)
Indications:
- Opioid induced constipation
- GI recovery after surgery
CI, AE, DDI
CI:
- Bowel obstruction : Risk of GI perforation
- Pregnancy / lactation: Opioid w/d symptoms in fetus/neonate
AE:
- GI effects – n/v/d, abd pain, dizziness, flatulence
- CNS effects –headache
- Misc – opioid w/d (chills, anxiety, irritability, yawning)
DDI: other opioid antagonists
Gastrointestinal stimulants MEDS and prototype
- Dexpanthenol (Ilopan): Increases acetylcholine levels and stimulates the parasympathetic system
- Metoclopramide (Reglan): Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine
- Leads to increased GI activity and rapid movement of food through the upper GI tract
PROTOTYPE: Metoclopramide
- Typically used in DM (for gastroparesis) to move food thru intestines
- EPS effects, Parkinson like rxns
MOA and indications of GI stimulants
MOA:
Stimulate parasympathetic activity within the GI tract
Increase GI secretions and motility
Indications:
When rapid movement of GI contents is desirable
CI and AE of GI stimulants
CI:
- GI obstruction
- Pregnancy / lactation
- Tardive dyskinesia, sz, depression (slowing of mood d/t parasympathetic effect): Reglan can cause or exacerbate these symptoms. Risk of sedation/sz if reglan combined with CNS sedatives and risk of tardive dyskinesia. if used with antipsychotics
AE:
- GI : n/v/d, intestinal spasm, cramping
- Cardiac :hypotension, bradycardia, weakness, fatigue
- Misc :tardive dyskinesia*
DDI to GI stimulants
- EtOH and CNS depressants (combined effect)
- Antipsychotics (EPS)
- MAOIs (serotonin syndrome)
Antidiarrheal drugs MEDS and prototype
- Bismuth subsalicylates (black discoloration of tongue and oral mucosa, if bought outside of US, type of aspirin: bleeding): Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea
- Loperamide (lmodium): Has a direct effect on the muscle layers of the GI tract; slows peristalsis and allows increased time for absorption of fluid and electrolytes
- Opium derivatives (paregoric): through the CNS cause spasm within the GI tract, stops peristalsis and diarrhea C-III controlled substance
PROTOTYPE: Loperamide (11hr half life)
Could be given up to 3 times a day
MOA and indications of antidiarrheals
MOA:
- Slow the motility of the GI tract through direct action on the lining of the GI tract
Indications:
- Relief of symptoms of acute or chronic diarrhea
- Reduction of volume of discharge from ileostomies
- Prevention and treatment of traveler’s diarrhea (drinking different water from other countries, not an infx)
CI, AE, and DDI to antidiarrheals
CI:
- Pregnancy / lactation
- GI obstruction
- Acute abdominal conditions
- Diarrhea due to poisonings
AE:
GI – n/v/c, distension (d/t peristalsis), abd pain, dry mouth, toxic megacolon (rare)
CNS – fatigue, weakness, dizziness
DDI: vary
NI for antidiarrheals
Assess bowel pattern, shouldn’t be taken if they suspect food poisoning or other causes of diarrhea
