Laxatives and Anti-diarrheals Flashcards
what percentage of the population carries clostridium difficile as part of their normal flora?
5%
what kind of antibiotic is vancomycin?
systemic
when are anti-diarrheal meds contraindicated?
C. difficile or E. coli is suspected
acute diarrhea is __________?
how long does it last?
self-limiting, lasts 3 days to 2 weeks
what is diarrhea caused by? (5)
drugs, bacteria, viruses, dietary intolerances and chronic conditions
chronic diarrhea lasts how long?
3-4 weeks
Define diarrhea
an increase in frequency and fluidity of BMs
diarrhea is a __________ of something else
symptom
what type of diarrhea are adsorbent anti-diarrheals used with?
mild to moderate
what is an example of an adsorbant anti-diarrheal?
bismuth subsalicylate (pepto bismol)
why is atropine added to diphenoxylate?
to discourage the recreational use of the opiate diphenoxylate by causing ↑ HR, dry mouth
what are the nursing implications (NIs) of adsorbent anti-diarrheals?
-may cause tongue and stools to darken
-D-D interaction with aspirin, warfarin or NSAIDs
(subsalicylate is a kind of aspirin)
what are two kinds of opiate anti-diarrheas?
Loperamide
diphenoxylate/atropine
what schedule is diphenoxylate? and what are the Adverse effects?
schedule 5
drowsiness and dizziness
what does the combination drug Diphenoxylate/atropine do?
reduce bowel motility time
reduce rectal spasm pain
↓ stool frequency and volume
what is an over the counter (OTC) opiate?
loperamide (Immodium)
What are the effects of Loperamide?
-inhibits peristalsis and prolongs transit times
-direct effect on the nerves in the intestinal muscle wall
-↓ fecal volume and frequency
why would you take probiotics?
-may be helpful for diarrhea d/t antibiotics
-promote “good” bacteria and suppress “bad” bacteria
-affect the gut microbiome
what is the name of a probiotic?
lactobacillus acidophilus
where are probiotics found?
-in food: fiber, fermented foods (kefir, kombucha), yogurt
-powders, capsules
constipation is not a disease, it is a _________
symptom
what is constipation defined as?
-infrequent passage of abnormally hard and dry stools
-2 or less per week
-feeling of incomplete evacuation
when are laxatives contraindicated?
with GI obstruction and bowel perforation
what effect do laxatives have on constipation?
↑fecal movement, facilitates defecation
what are common AE for laxatives?
bloating, gas, abdominal discomfort and cramping
how long must you wait before or after taking other meds to take a PO laxative?
2 hours
what is an example of a bulk forming laxative?
psyllium (Metamucil)
how does psyllium help with constipation?
it is bulk forming fiber
it increases fecal mass
what is the NI for metamucil?
must drink it with water within a certain time period or it congeals and can cause obstruction
what laxatives are used to prevent and are used for long term management of constipation?
psyllium and docusate sodium
what is the safest laxative?
psyllium
how does mineral oil help with constipation?
lubricates fecal material and eases passage of stool
how does docusate sodium help with constipation?
-it is an emollient
-promotes H2O absorption
-eases passage of stool
what is a NI for docusate sodium?
administer with a full glass of water
what is a kind of hyperosmotic laxative?
polyethylene 3350 (Golytely, Miralax)
what does a hyperosmotic laxative do?
it is an osmotic agent (it pulls water into intestines)
when is a hyperosmotic laxative given?
to induce bowel cleansing
as bowel prep for colon procedures (given day before)`
how do you know your bowels are prepped for a procedure?
you are “pooping” clear water with no stool pieces
what is a NI for a hyperosmotic laxative for bowel prep?
drink 8 oz every 10-15 minutes
how often and how long can miralax be used?
it can be used daily for up to 7 days
how does saline act as a laxative?
it increases osmotic pressure and draws water into the colon
what are some examples of saline laxatives?
-saline enema (fleet enema)
-milk of magnesia
-magnesium citrate
when is milk of magnesia contraindicated?
in renal disease (b/c kidneys are supposed to excrete 80-85% of magnesium ingested)
what are NI for milk of magnesia?
shake solution
monitor F&E imbalance
milk of magnesia act as a laxative and ___________?
a antacid
where are milk of magnesia and magnesium citrate active?
they are osmotically active in the GI
what are the NI for magnesium citrate?
refrigerate
monitor for F&E imbalance
which of the saline laxative are used to treat constipation and which are used for bowel prep?
magnesium citrate is used for bowel prep
saline enemas and milk of magnesia are used to treat constipation
what are two kinds of stimulant laxatives?
bisdodyl (dulcolax) and senna
how does a stimulant laxative work?
stimulates intestinal nerves →peristalsis and ↑ H2O in colon
what are senna and dulcolax (bisacodyl) used for?
treatment for constipation
what are the risks associated with stimulant laxatives?
-may be habit forming (laxative dependence)
-F&E depletion
what are the NI for bisacodyl (dulcolax) and senna?
-monitor electrolyte imbalance
what are the risks associated with the abuse of stimulant laxatives?
-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
what aging changes are associated with constipation?
↓ water intake
↓ fiber intake
↓ activity
chronic illness may delay evacuation
↑ use of laxatives
what lifestyle changes are associated with improving problems with constipation?
↑ fluid intake
↑ fiber
↑ physical activity
