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Pharmacology > Laxatives and Anti Diarrheal > Flashcards

Laxatives and Anti Diarrheal Flashcards

1
Q

Constipation affects _____ people worldwide

A

2.5million

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2
Q

____&_____ more likely to complain of constipation but that doesn’t mean

A

women and elderly

doesn’t mean that they are more likely to suffer from it

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3
Q

Symptoms of constipation

A

Less than 3 stools a week
Straining
Hard, dry stools
Feeling as though there is incomplete emptying of bowel

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4
Q

Most people who complain of constipation do not actually

A

suffer from it

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5
Q

Bulk-Forming Laxatives
are used to tx?
how long do they take to work?

A

constipation
1-3 DAYS

ex: Metamucil, fiber advance

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6
Q

examples of bulk forming laxatives

A

Psyllium, methylcellulose, polycarbophil

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7
Q

how do bulk forming laxatives work?

A

Composed of indigestible hydrophilic colloids that absorb water
Forms bulky, emollient GEL
Mechanism: distension of colon triggering peristalsis

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8
Q

side effects of bulk forming laxatives

A

bloating and gas (because its this bulk gelatenous mass sitting in your gut)– can create more of a problem for constipation

-May prevent absorption of other drugs—don’t want to take them with meds because meds can get stuck in this gelatenous mass and not get absorbed (so 2-3hr separation from other drugs)

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9
Q

Who are bulk forming laxatives good for/not good for?:

A

Not good for people on opiods– because we stopped a receptor in gut

Good for people with diarrhea or people with “melty poop” soft/loose stools ??

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10
Q

if someone comes in and says “I’m constipated” are bulk forming laxatives the drug of choice?

A

NO….because it can lead to further constipation and it takes 1-3 days to work.

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11
Q 
Stool Softeners 
known as \_\_\_\_\_\_\_\_\_\_
takes how long to work
what is their function?
is it a laxative?
A

surfactants
1-3 DAYS (like bulk forming laxatives)
literally just soften the stool
NOT a laxative

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12
Q

Examples of stool softeners

A

Docusate (Colace), glycerin, fleet enema

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13
Q

are stool softeners good for people on opioids?

A

Not good for people on opioids (constipated) because
stool softeners do not increase peristalsis

Good for people with pellet stools

Not a laxative—just a stool softener—can be given with laxative to help someone pass the stool

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14
Q

Do stool softeners cure you of constipation?

Mechanism

A

Mechanism: soften stool to allow for water and lipid incorporation
Doesn’t really cure you of constipation

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15
Q

Mineral oil is a type of:

what is the deal with it?

A

stool softener
lubricates fecal material
can tx impaction in kids/adults
not good to take orally anymore because you can aspirate and cause lipid pneumonitis
long term use may impair fat soluble vitamin absorption

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16
Q

Osmotically active agents work to tx

A

constipation

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17
Q

What are some examples of Osmotically active agents

A

1) Saline Laxatives (magnesium sulfate, citrate, hydroxide)
2) Nondigestible sugars and alcohols (lactulose)
3) Polyethylene glycol-electrolyte solutions

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18
Q

Osmotically active agents take how long to work ?and how do they fxn?

A

1-3HOURS

brings water into colon leading to distension and peristalsis

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19
Q

Osmotically active agents–watch out for patients with

A

Use with caution in patients with renal insufficiency, electrolyte imbalances, cardiac disease, and those on diuretics

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20
Q

Magnesium citrate works like a charm and very quickly if someone is ________-whereas bulk forming laxative would not be the choice.

A

very constipated (severely constipated)

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21
Q

Nondigestible sugars and alcohols
Lactulose
can be used to tx

A

chronic constipation from opioids, safe in the elderly, and pts with idiopathic chronic constipation

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22
Q

Nondigestible sugars and alcohols
Lactulose

how to dose?

weird dosing

A

Given as 15-30ml hs (bedtime)
pt may have some Abdominal discomfort and distension initially but subsides with continued use

  • **weird dosing. if you see someone taking lactulose 20-30g 3-4x a day, they are being treated for hepatic encephalopathy
  • -it removes ammonia from the gut
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23
Q

Polyethylene glycol-electrolyte solutions
examples of these drugs
**mostly used for

A

Golytely, Moviprep, Trilyte

colon preps

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24
Q

Polyethylene glycol-electrolyte solutions

OTC version=

A

Miralax – constipation treatment (OTC version)

**mix with water before using

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25
Stimulant Laxatives how long do they take to work? how do they work?
6-8 hrs | not fully understood
26
example of stimulant laxative: Bisacodyl (Dulcolax) when to take it how long does it take to work
Bisacodyl (Dulcolax) (overnight relief) Available as a tablet or suppository (suppository works in 30-60 minutes) Do not use more than 10 days due to risk of developing atonic colon Often seen in combination with PEG for colonoscopy prep
27
ex of Stimulant Laxative Senna (senokot, Ex-Lax) ``` how do they work? safe? convienent? covered by: long term use? ```
Gut bacteria converts drug into active form of drug Safe and covered by medicaid Poorly absorbed According to the literature, long-term use does not appear to harm the functioning of the gut nor is it carcinogenic
28
This drug treats - chronic idiopathic constipation - constipation predominant IBS (IBS-C) - opioid-induced constipation in patients with non-cancer pain
Lubiprostone (Amitiza)
29
How does Lubiprostone work?
Stimulate type 2 chloride channels (CIC-2) in small intestine increasing chloride-rich fluid secretion into small intesntine -increased motility
30
What are a couple downfalls with Lubiprostone (amitiza)
Very poor bioavailability; rapidly metabolized in stomach and jejunum methadone decreases activity of CIC-2 Not effective when given with methadone
31
What cytochrome system does lubiprostone use?
none
32
Lubiprostone (Amitiza) side effects? dose adjustment? contraindicated in?
Nausea Diarrhea Dyspnea No dose adjustment in renal impairment; dose adjustment needed in moderate to severe hepatic failure Contraindicated in obstruction
33
Opioid Receptor Antagonists are a type of
laxative
34
Opioid Receptor Antagonists (examples of these drugs)
Methylnaltrexone (Relestor) and alvimopan (Entereg)
35
Opioid receptor antagonists work well for people who are on opioids...how?
This seems counter intuitive because you are blocking the effects of the opioid, right? No because these opioid receptor antagonists do not cross BBB (so effects of opioid still work to relieve pain)
36
Important characteristic of Opioid Receptor Antagonists
do not cross BBB
37
Relestor-- type of ? | fxn:
Opioid Receptor Antagonist sub-q injection for patients with advanced illness receiving palliative care, as well as opioid-induced constipation in patients with chronic non-cancer pain
38
Entereg type of ? | fxn?
opioid receptor antagonist capsule approved for acceleration of gut transit time following surgery with partial bowel resection Restricted to hospital use only and only for 15 doses Increased risk of MI
39
In treating diarrhea, what is our biggest concern?
rehydration!!!! | oral rehydration with electrolyte solution =#1 priority
40
Anti-diarrheal agents main fxn
increase transit time in the gut | the longer you are in the gut, it slows down the poop
41
in anti diarrheal agents, you should reserve tx for
patients with significant or persistent symptoms | Everyone is stressed gets diarrhea sometimes—don’t need tx all the time
42
Do not treat patients with anti-diarrheal meds if they present with
high fever bloody stools microorganisms in stool
43
Commonly used antidiarrheal OTCs
Bulk Forming Agents Bismuth Loperamide (Imodium) ** most effective
44
Bulk-Forming Agents used to tx? fxn? does it totally get rid of diarrhea?
antidiarrheal Modify stool texture and viscosity; patient perception of diarrhea improved “bulk up” the stool but doesn’t totally get rid of diarrhea May be useful in occasional mild diarrhea
45
Bismuth--used to tx? | fxn?
Bismuth- like peptobismal--anti diarrheal Anti-secretory, anti-inflammatory, antimicrobial effects (can help if theres microbes ex: travelers diarrhea) Works on abdominal cramping Useful in traveler’s diarrhea
46
Loperamide (Imodium) what type of drug specifically potent?
anti diarrheal--opIoid AGONIST | ~50 times more potent than morphine
47
Loperamide --how do you use it and not get high?
Does not cross BBB (that’s why you can’t get high off of it –like taking morphine just for your gut If no improvement in 48 hours, loperamide should be discontinued Useful in traveler’s diarrhea Can be used in long term chronic diarrheal disease
48
Bile Acid Sequesterants are used to tx? | OTC or Rx?
Anti Diarrhea | Rx
49
Bile Acid sequestrants are good for
Good for patients with malabsorption of bile salts such as those with Crohn’s, or surgical resection of gut Also bind drugs so require at least 2 hour separation (exception: colesevalam)
50
Side effects of Bile Acid Sequestrants
Bloating Gas Fecal impaction
51
Examples of Bile Acid Sequestrants | they all have the word ___ in them
Cholestyramine, colestipol (Colestid), colesevalam (Welchol chole
52
Diphenoxylate (Lomotil) Difenoxin (Motofen) = meds to tx?
Diarrhea
53
Diphenoxylate (Lomotil) Difenoxin (Motofen) structurally similar to ______ so it has potential for ______ how to deal with this problem?
Structurally similar to meperidine/demerol, potential for abuse (controlled substance) -Opioid structure that DOES cross the BBB So you formulate it with atropine so if someone takes large doses of it, they end up with severe side effects that they won’t like
54
Constipation and toxic megacolon may result from excessive use of
Diphenoxylate & Difenoxin
55
Other options to tx diarrhea
``` Codeine Paregoric (opium tincture) Clonidine Marijuana Colo syrup- brand name emetrol= for people that just become nauseous and we don’t know why they become nauseous ``` benzos--don't stop N/V but they relieve the anxiety of someone who is nervous about vomitting/ancitpitory phase.
56
Clonidine is used in | side effects
Used in diabetic patients with autonomic neuropathy leading to chronic diarrhea Side effects: hypotension, fatigue, depression
57
IBD is a ______, ________ chronic, inflammatory condition occurring in the GI tract
idiopathic, immune mediated
58
two types of IBD
ulcerative colitis, Crohn’s disease
59
what plays a role in developing IBD?
Genetics, environmental factors, and immune system all play a role Inflammatory mediators are key
60
Women are more likely to develop ______ | while men are more likely to develop _______
Crohns ulcerative colitis
61
Onset of IBD
Onset: 15-30 years old; peaks again from 60-80

Pharmacology (3 decks)

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