Laxatives

Question 1

Senna drug class and clin ind?

Answer 1

Stimulant laxative

Constipation
As a suppository for faecal impaction

Question 2

Senna MOA?

Elimination?

Answer 2

Increases water and electrolyte secretion from colonic mucosa
This increases volumes
Triggers mass peristaltic wave
Poopsies

Through urine and faeces

Question 3

Senna Contraindications?

Answer 3

Pts with BO- could cause a perf

Pt with haemorrhoids or anal fissure

Question 4

Senna interactions?

Clue DDW

Answer 4

Digoxin: Stimulant laxatives can cause hypokalaemia
Diuretics: Senna depletes sodium
Warfarin: Diarrhoea decreases absorption of vitamin K+ and therefore increases bleeding risk

Question 5

Senna SEs?

Answer 5

Abdo pain with diarrhoea

Melanosis coli: reversible pigmentation of the intestinal wall

Question 6

Senna dose, route and TTW (time to work)

Answer 6

Constipation: PO 15-30mg QD
Faecal impaction: Rectal stimulant laxative should usually be prescribed once only or PRN with a max dose frequency of once in a 24 hour period

Ttw= 8-12 hours

Question 7

Lactulose, macrogol, phosphate enema drug class and clin ind

Answer 7

Osmotic laxative: it is also a stool softener

Constipation and faecal impaction

Question 8

Lactulose MOA

Elimination

Answer 8

Holds water in the stool, maintains volume and stimulates peristalsis

Also reduces ammonia absorption

Largely excreted through stool

Question 9

Lactulose contraindications

Answer 9

Intestinal obstruction- risk of perf

Use with caution in pts with HF, ascites and electrolyte disturbance- can cause massive fluid shift

Question 10

Lactulose interactions

Answer 10

Generally well tolerated

Effect of warfarin may be slightly increased

Question 11

Lactulose SEs

Answer 11

Flatulence
Abdominal cramping
Nausea
Diarrhoea

Question 12

Lactulose dose, route, TTW

Answer 12

15ml TWICE A DAY- adjust according to response

Might take a few days to see response

Can be taken with or without food

Question 13

Movicol dose?

Answer 13

2–6 sachets daily in divided doses usually for up to 2 weeks
Maintenance 2–4 sachets daily

Note it is a combination laxative- both a softener and stimulant

Question 14

Co-danthramer drug class and clin ind

Answer 14

Combo laxative- stimulant and softener

For constipation in palliative care

Question 15

Co-danthramer MOA

(Dantron+ poloxamer)

Elimination

Answer 15

Dantron is an anthraquinone stimulant laxative, which acts on nerve endings in the colonic mucosa.

Poloxamer 188 is a wetting agent, which acts as a stool softener.

In the stool

Question 16

Co-danthramer contraindications/ cautions

Answer 16

Acute IBD
BO
Severe dehydration

Prolonged used causes hypokalaemia

Question 17

Co-danthramer SEs

Answer 17

Abdo cramps
Nausea
Possible skin reaction
Red urine

Question 18

Co Danthramer route, dose and ttw

Answer 18

Standard oral capsules: 1-2 capsules, QD at night
Suspension: 5-10mls QD at night

TTW: 6-12 hours