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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
Q

Stimulant Laxatives
how long do they take to work?
how do they work?

A

6-8 hrs

not fully understood

26
Q

example of stimulant laxative:
Bisacodyl (Dulcolax)
when to take it
how long does it take to work

A

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
Q

ex of Stimulant Laxative
Senna (senokot, Ex-Lax)

how do they work?
safe?
convienent?
covered by: 
long term use?
A

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
Q

This drug treats

  • chronic idiopathic constipation
  • constipation predominant IBS (IBS-C)
  • opioid-induced constipation in patients with non-cancer pain
A

Lubiprostone (Amitiza)

29
Q

How does Lubiprostone work?

A

Stimulate type 2 chloride channels (CIC-2) in small intestine increasing chloride-rich fluid secretion into small intesntine

-increased motility

30
Q

What are a couple downfalls with Lubiprostone (amitiza)

A

Very poor bioavailability; rapidly metabolized in stomach and jejunum

methadone decreases activity of CIC-2
Not effective when given with methadone

31
Q

What cytochrome system does lubiprostone use?

A

none

32
Q

Lubiprostone (Amitiza) side effects?
dose adjustment?
contraindicated in?

A

Nausea
Diarrhea
Dyspnea

No dose adjustment in renal impairment; dose adjustment needed in moderate to severe hepatic failure

Contraindicated in obstruction

33
Q

Opioid Receptor Antagonists are a type of

A

laxative

34
Q

Opioid Receptor Antagonists (examples of these drugs)

A

Methylnaltrexone (Relestor) and alvimopan (Entereg)

35
Q

Opioid receptor antagonists work well for people who are on opioids…how?

A

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
Q

Important characteristic of Opioid Receptor Antagonists

A

do not cross BBB

37
Q

Relestor– type of ?

fxn:

A

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
Q

Entereg type of ?

fxn?

A

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
Q

In treating diarrhea, what is our biggest concern?

A

rehydration!!!!

oral rehydration with electrolyte solution =#1 priority

40
Q

Anti-diarrheal agents main fxn

A

increase transit time in the gut

the longer you are in the gut, it slows down the poop

41
Q

in anti diarrheal agents, you should reserve tx for

A

patients with significant or persistent symptoms

Everyone is stressed gets diarrhea sometimes—don’t need tx all the time

42
Q

Do not treat patients with anti-diarrheal meds if they present with

A

high fever
bloody stools
microorganisms in stool

43
Q

Commonly used antidiarrheal OTCs

A

Bulk Forming Agents
Bismuth
Loperamide (Imodium) ** most effective

44
Q

Bulk-Forming Agents
used to tx?
fxn?
does it totally get rid of diarrhea?

A

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
Q

Bismuth–used to tx?

fxn?

A

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
Q

Loperamide (Imodium)
what type of drug specifically
potent?

A

anti diarrheal–opIoid AGONIST

~50 times more potent than morphine

47
Q

Loperamide –how do you use it and not get high?

A

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
Q

Bile Acid Sequesterants are used to tx?

OTC or Rx?

A

Anti Diarrhea

Rx

49
Q

Bile Acid sequestrants are good for

A

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
Q

Side effects of Bile Acid Sequestrants

A

Bloating
Gas
Fecal impaction

51
Q

Examples of Bile Acid Sequestrants

they all have the word ___ in them

A

Cholestyramine, colestipol (Colestid), colesevalam (Welchol

chole

52
Q

Diphenoxylate (Lomotil)
Difenoxin (Motofen)
= meds to tx?

A

Diarrhea

53
Q

Diphenoxylate (Lomotil)
Difenoxin (Motofen) structurally similar to ______ so it has potential for ______

how to deal with this problem?

A

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
Q

Constipation and toxic megacolon may result from excessive use of

A

Diphenoxylate & Difenoxin

55
Q

Other options to tx diarrhea

A 
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
Q

Clonidine is used in

side effects

A

Used in diabetic patients with autonomic neuropathy leading to chronic diarrhea
Side effects: hypotension, fatigue, depression

57
Q

IBD is a ______, ________ chronic, inflammatory condition occurring in the GI tract

A

idiopathic, immune mediated

58
Q

two types of IBD

A

ulcerative colitis, Crohn’s disease

59
Q

what plays a role in developing IBD?

A

Genetics, environmental factors, and immune system all play a role

Inflammatory mediators are key

60
Q

Women are more likely to develop ______

while men are more likely to develop _______

A

Crohns

ulcerative colitis

61
Q

Onset of IBD

A

Onset: 15-30 years old; peaks again from 60-80

Pharmacology (3 decks)

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