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1 GI > Laxatives > Flashcards

Laxatives Flashcards

1
Q

Laxative license in IBS

A

Linaclotide

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2
Q

Laxative first line in preg if dietary and lifestyle aren’t sufficient

A

Bulk forming - eg ispagula husk

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3
Q

Useful definition of constipation

A

Passage of hard stools less frequently that the patient’s own normal pattern

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4
Q

What electrolyte imbalance can result from laxative abuse

A

Hypokalaemia

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5
Q

The 4 main classes of laxatives

A

Bulk forming
Softening
Stimulant
Osmotic

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6
Q

Counselling for bulk forming laxatives

A

Adequate fluid intake must be maintained to avoid intestinal obstruction

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7
Q

What is an effective bulk forming preparation that I can’t find in the BNF?

A

Unprocessed wheat bran taken with food or fruit juice

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8
Q

What type of laxative is ispagula

A

Bulk forming

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9
Q

What type of laxative is methycellulose

A

Bulk forming and faecal softener

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10
Q

Name some bulk forming laxatives

A

Ispagula
Methycellulose
Stercula

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11
Q

Powerful laxatives like cascara and castor oil are obsolete but what sort of laxatives are they

A

Stimulant

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12
Q

What sort of laxative is docusate

A

Stimulant and softener

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13
Q

What sort of laxative is Senna

A

Stimulant

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14
Q

What sort of laxative is bisocodyl

A

Stimulant

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15
Q

What type of laxative is picosulfate

A

Stimulant

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16
Q

What sort of laxatives are co-danthramer and co-danthrusate

When can we use them

A

Stimulant

Palliative care - carcinogenic and genotoxic

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17
Q

What is the actin of glycerol suppositories

A

Lubricant and mild irritant ( in the stimulant section )

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18
Q

Disadvantage of stimulant laxatives

When to avoid

A

Often cause abdocramp

Avoid in obstruction

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19
Q

What can excessive use of stimulant laxatives lead to (2)

A

Diarrhoea and hypokalaemia

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20
Q

Why should we avoid unstandardised preparations of cascara, frangula, rhubarb and Senna?

A

Action is unpredictable

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21
Q

Why should we avoid aloes, jalap, colocyth

A

DRASTIC PURGATIVE ACTION

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22
Q

Parasympathomemeitcs are rarely used for their GI action as stimulants… Some examples of these include

A

Bethanechol
Neostigmine
Pyridostigmine

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23
Q

Softener are useful in what conditions according to the BNF

A

Haemorrhoids

Anal fissure

24
Q

Liquid paraffin is what sort of laxative and what is the disadvantage

A

Softening

Leakageeeeeeeee

25
Q

how do osmotic laxatives work?

A

increase the amount of water in the large bowel by drawing in fluid or retaining the fluid they were administered with

26
Q

lactulose is what sort of laxative

what is it also used for? how does this work

A

osmotic - synthetic disacharide that is not absorbed from the GI - producing osmotic diarrhoea of low faecal pH thus discouraging ammonia producing organisms (treat hepatic encephalopathy)

27
Q

macrogols are what sort of laxative

A

osmotic

28
Q

what is the disadvantage of osmotic laxatives

A

dehydration - giving with fluid my reduce this

29
Q

why should sodium salts be avoided as a laxative?

what is the mode of action here anyway?

A

sodium and water retention (osmotic laxative)

30
Q

what type of laxative is magnesium salts

when is this used?

A

osmotic - often abused but ok for occasional use

31
Q

phosphate enemas are what sort of laxative?

when are they used?

A

osmotic

surgery

32
Q

what is licaclotide mode of action

what do we treat with it?

A

guanylate cyclase C receptor agonist that is used for IBS associated with constipation

it increases intestinal fluid secretion and transit and decreases viceral pain
(it’s metabolised in the GI and therefore virtually undetectable in the plasma)

33
Q

what is lubipristone for?

mode of action?

A

chloride channel activator

idiopathic constipation that doesn’t respond adequately to lifestlye chages

34
Q

what is prucalopride for?

mode of action?

A

treatment of chronic constipation in woment where other laxatives have failed
selective seritonin 5HT4 receptor agnonist with prokinetic properties

35
Q

steps for constipation treatment in preg

A

-dietary and lifestyle
1st - bulk forming e.g. ispagula
2nd - osmotic e.g. lactulose
3rd - stimulant e.g. bisocodyl/ senna

36
Q

how many days without passing stools should be a concern in children

A

3

37
Q

should you sell laxatives for children

A

no - should be managed by a specilist

38
Q

in infants what home type remedy could you use for constipation?

A

increased intake of fluids - particularly juice containing sorbitol (prune, pear or apple) may be sufficient

39
Q

what laxatives are suitable for infants under 1 year

A

lactulose

oral prep containing macrogols or glycerol supositories can be used for faecal impaction

40
Q

what is the treatment of constipation for children over 1 year

A 
review of diet
then
macrogol
then
lactulose
then
stimulant
41
Q

treatment of faecal impaction may initially …

A

increase symptoms of soiling and abdo pain

use macrogols and if this doesnt work in two weeks use a stumulant

42
Q

when in the day should ispagula husk be had

A

not before bed

with plenty of fluid

43
Q

how should methycellulose be taken when being used for ostomy control

A

avoid fluid intake for 30 mins before admin

44
Q

what is a selective opioid antagonist used for opiod induced constipation

A

methylnaltrexone bromide (subcutaneous)

45
Q

how long does lactulose take to act

A

about 48 hours

46
Q

`codanthomer cautions

A

avoid prolonged exposure to skin

only for palliative care

47
Q

what colour can codanthromer change your urine

A

red

48
Q

senna is licensed from what age

A

2 years

49
Q

what time of day is senna usually taken

A

at night

50
Q

when in the day should sterculia be taken

A

NOT before going to bed - preparations that swell in contact with water shouldnt be then then

51
Q

how does loperamide work?

who is it suitable for

A

opioid receptors in the gut but doesnt cross the BBB
antimotility

suitable for adults ONLY

52
Q

why dont we use antibiotics for diahorreah in the UK

A

usually a viral cuase

53
Q

what antibiotic might be given for prophylaxis of travelers diarrhoea - but prophylaxis is not usually recommended

A

cipro

54
Q

when can bulk forming laxative be used for diarrhoea?

A

ispagula etc are used for diarrhoea associated with diverticuar disease

55
Q

how does racecadotril work?

A

used for dihorreah, inhibits the breakdown of endogenous opioids thus increasing opioid stimulation in the GI

56
Q

age at which you can sell loperamide OTC

A

18

1 GI (4 decks)

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