Laxatives and Anti-diarrheals

Question 1

what percentage of the population carries clostridium difficile as part of their normal flora?

Answer 1

5%

Question 2

what kind of antibiotic is vancomycin?

Answer 2

systemic

Question 3

when are anti-diarrheal meds contraindicated?

Answer 3

C. difficile or E. coli is suspected

Question 4

acute diarrhea is __________?
how long does it last?

Answer 4

self-limiting, lasts 3 days to 2 weeks

Question 5

what is diarrhea caused by? (5)

Answer 5

drugs, bacteria, viruses, dietary intolerances and chronic conditions

Question 5

chronic diarrhea lasts how long?

Answer 5

3-4 weeks

Question 6

Define diarrhea

Answer 6

an increase in frequency and fluidity of BMs

Question 7

diarrhea is a __________ of something else

Answer 7

symptom

Question 8

what type of diarrhea are adsorbent anti-diarrheals used with?

Answer 8

mild to moderate

Question 9

what is an example of an adsorbant anti-diarrheal?

Answer 9

bismuth subsalicylate (pepto bismol)

Question 10

why is atropine added to diphenoxylate?

Answer 10

to discourage the recreational use of the opiate diphenoxylate by causing ↑ HR, dry mouth

Question 10

what are the nursing implications (NIs) of adsorbent anti-diarrheals?

Answer 10

-may cause tongue and stools to darken
-D-D interaction with aspirin, warfarin or NSAIDs
(subsalicylate is a kind of aspirin)

Question 10

what are two kinds of opiate anti-diarrheas?

Answer 10

Loperamide
diphenoxylate/atropine

Question 11

what schedule is diphenoxylate? and what are the Adverse effects?

Answer 11

schedule 5
drowsiness and dizziness

Question 12

what does the combination drug Diphenoxylate/atropine do?

Answer 12

reduce bowel motility time
reduce rectal spasm pain
↓ stool frequency and volume

Question 13

what is an over the counter (OTC) opiate?

Answer 13

loperamide (Immodium)

Question 14

What are the effects of Loperamide?

Answer 14

-inhibits peristalsis and prolongs transit times

-direct effect on the nerves in the intestinal muscle wall

-↓ fecal volume and frequency

Question 15

why would you take probiotics?

Answer 15

-may be helpful for diarrhea d/t antibiotics
-promote “good” bacteria and suppress “bad” bacteria
-affect the gut microbiome

Question 16

what is the name of a probiotic?

Answer 16

lactobacillus acidophilus

Question 17

where are probiotics found?

Answer 17

-in food: fiber, fermented foods (kefir, kombucha), yogurt

-powders, capsules

Question 18

constipation is not a disease, it is a _________

Answer 18

symptom

Question 19

what is constipation defined as?

Answer 19

-infrequent passage of abnormally hard and dry stools
-2 or less per week
-feeling of incomplete evacuation

Question 20

when are laxatives contraindicated?

Answer 20

with GI obstruction and bowel perforation

Question 21

what effect do laxatives have on constipation?

Answer 21

↑fecal movement, facilitates defecation

Question 22

what are common AE for laxatives?

Answer 22

bloating, gas, abdominal discomfort and cramping

Question 23

how long must you wait before or after taking other meds to take a PO laxative?

Answer 23

2 hours

Question 24

what is an example of a bulk forming laxative?

Answer 24

psyllium (Metamucil)

Question 25

how does psyllium help with constipation?

Answer 25

it is bulk forming fiber it increases fecal mass

Question 26

what is the NI for metamucil?

Answer 26

must drink it with water within a certain time period or it congeals and can cause obstruction

Question 27

what laxatives are used to prevent and are used for long term management of constipation?

Answer 27

psyllium and docusate sodium

Question 28

what is the safest laxative?

Answer 28

psyllium

Question 29

how does mineral oil help with constipation?

Answer 29

lubricates fecal material and eases passage of stool

Question 30

how does docusate sodium help with constipation?

Answer 30

-it is an emollient -promotes H2O absorption -eases passage of stool

Question 31

what is a NI for docusate sodium?

Answer 31

administer with a full glass of water

Question 32

what is a kind of hyperosmotic laxative?

Answer 32

polyethylene 3350 (Golytely, Miralax)

Question 33

what does a hyperosmotic laxative do?

Answer 33

it is an osmotic agent (it pulls water into intestines)

Question 34

when is a hyperosmotic laxative given?

Answer 34

to induce bowel cleansing as bowel prep for colon procedures (given day before)`

Question 35

how do you know your bowels are prepped for a procedure?

Answer 35

you are "pooping" clear water with no stool pieces

Question 36

what is a NI for a hyperosmotic laxative for bowel prep?

Answer 36

drink 8 oz every 10-15 minutes

Question 37

how often and how long can miralax be used?

Answer 37

it can be used daily for up to 7 days

Question 38

how does saline act as a laxative?

Answer 38

it increases osmotic pressure and draws water into the colon

Question 39

what are some examples of saline laxatives?

Answer 39

-saline enema (fleet enema) -milk of magnesia -magnesium citrate

Question 40

when is milk of magnesia contraindicated?

Answer 40

in renal disease (b/c kidneys are supposed to excrete 80-85% of magnesium ingested)

Question 41

what are NI for milk of magnesia?

Answer 41

shake solution monitor F&E imbalance

Question 42

milk of magnesia act as a laxative and ___________?

Answer 42

a antacid

Question 43

where are milk of magnesia and magnesium citrate active?

Answer 43

they are osmotically active in the GI

Question 44

what are the NI for magnesium citrate?

Answer 44

refrigerate monitor for F&E imbalance

Question 45

which of the saline laxative are used to treat constipation and which are used for bowel prep?

Answer 45

magnesium citrate is used for bowel prep saline enemas and milk of magnesia are used to treat constipation

Question 46

what are two kinds of stimulant laxatives?

Answer 46

bisdodyl (dulcolax) and senna

Question 47

how does a stimulant laxative work?

Answer 47

stimulates intestinal nerves →peristalsis and ↑ H2O in colon

Question 47

what are senna and dulcolax (bisacodyl) used for?

Answer 47

treatment for constipation

Question 48

what are the risks associated with stimulant laxatives?

Answer 48

-may be habit forming (laxative dependence) -F&E depletion

Question 49

what are the NI for bisacodyl (dulcolax) and senna?

Answer 49

-monitor electrolyte imbalance

Question 50

what are the risks associated with the abuse of stimulant laxatives?

Answer 50

-loss of muscle and nerve response -risk of dependence -laxatives draw water into the lumen which can ↑ the risk of dehydration in older adults and ↑ risk of F&E imbalances

Question 50

what aging changes are associated with constipation?

Answer 50

↓ water intake ↓ fiber intake ↓ activity chronic illness may delay evacuation ↑ use of laxatives

Question 51

what lifestyle changes are associated with improving problems with constipation?

Answer 51

↑ fluid intake ↑ fiber ↑ physical activity