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PHARM EXAM 2 > Laxatives and Anti-diarrheals > Flashcards

Laxatives and Anti-diarrheals Flashcards

1
Q

what do laxatives do?

A

increase number of BMs or make the BM easier to pass

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2
Q

what 3 things can prevent constipation?

A

high fiber diet, adequate fluid intake and regular exercise

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3
Q

What are the 4 mechanisms of laxatives?

A

Bulk forming
Stool softeners
Osmotic
Stimulant

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4
Q

MOA of Bulk forming Laxatives

A 
Indigestible, hydrophilic 
absorbs water that is already in the colon making a bulky gel
Distends + peristalsis moves it out
only few are safe for regular use
GAS AND DISTENTION
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5
Q

How much water do u take with bulk forming?

A

8 oz

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6
Q

how long does it take to see an effect with bulk forming?

A

weeks, start with low dose

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7
Q

Two types of Bulk forming…

A

1) natural plant products

2) synthetic fibers

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8
Q

Natural Plant Product Bulk Laxatives problems

A

bloating and flatus, bacteria eat the natural fiber

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9
Q

RXs - natural bulk forming laxatives

A

Psyllium

Methylcellulose

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10
Q

Advantages of Synthetic bulk forming laxatives…

A
  • not flatus, bacteria cant diget it

absorbs toxin and water

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11
Q

RX synthetic laxative

A

Polycarbophil

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12
Q

MOA Stool softeners

A

-are surfactants
soften BM, lets water and lipids penetrate
makes it easier to pass

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13
Q

OTC Stool Softeners

A

Docusate (Colace)- most commonly used
Glycerin
Mineral oil

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14
Q

Clinical use of Docusate

A

avoid straining after surgery

to prevent constipation

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15
Q

how long does it take docusate to work?

A

1-3 days, safe to use every day

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16
Q

Glycerin MOA

A

often given as a supository to childre, works in 30 min.,

Is a local irritant

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17
Q

MINERAL OIL

A

-aspirate= pnumonia
long term use= decrease absorption of ADEK
ANAL LEAKAGE

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18
Q

MOA Osmotic Laxatives

A

they are non absorbable liquids

sit in colon, increasing the concentration gradient, the body secretes more H2O into colon to dilute the osmotic laxative

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19
Q

What are the most powerful laxatives?

A

Osmotic ones
they purge the bowel
work 1-6 hours, faster as enema

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20
Q

clinical use of osmotic laxative

A

used for acute evacuation of the bowel before a procedure

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21
Q

ADRs of osmotic laxatives

A

alter fluid and electrolyte balance

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22
Q

what is the most common osmotic laxative?

A

sulfate

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23
Q

RXs osmotic laxatives

A 
Magnesium oxide (milk of magnesia, MOM)
Sorbitol 
Lactulose (Chronulac)
Magnesium citrate/sulfate
Sodium phosphate
Polyethylene glycol (PEG) (Colyte, GoLYTELY, Miralax)
24
Q

Magnesium oxide Use

A

acute constipation and prevention

25
Sorbitol/ Lactulose
nonabsrobable sugars used in hepatic encephalopathy= lactulose sweetner
26
Magnesium Citrate & Sodium Phosphate
VERY POWERFUL dehydrate and cause electrolyte problems. DRINK LOTS OF WATER
27
Propylethen Glycol
laxative made with larger amount of liquid electrolytes added cleans bowel but does it more gently Safer than mag citrate & NaPO4 but have to take a lot (4 liters over several hours) NO gas or cramps USED BEFORE SURGERY
28
Stimulant Laxatives
stimulate nerve plexus cause peristalsis Long term use may cause dependence & dilatation of bowel
29
RX stimulant laxatives
Senna (Senokot & Ex-Lax) Bisacodyl (Dulcolax) Castor oil
30
Senna
from a plant browns walls of colon 6-12 hrs oral 1-2 hrs rectaly
31
Bisacodyl
ONLY USE EVERY FEW WEEKS oral: 6-10 hrs suppository: 30-60 min
32
ADR of Bisacodyl
severe abdominal cramping
33
Castor Oil
Plant derivative stron not used much
34
Dont give laxatives...
in setting of acute abdominal pain until have ruled out other causes of abdominal pain.
35
RXs that cause constipation
Opiates (narcotics)- very common and a large problem in use of narcotics Anticholinergics Antacids with aluminum or calcium Ccb- verapamil, delitazem
36
What are the two types of constipation?
Chronic | Actute (fecal impaction)
37
Constipation treatment: 3
Lifestyle changes Fiber and bulk formers Other drugs in chronic constipation
38
What role do stimulant laxatives play in constipation managment?
THEY SHOULD BE AVOIDED Special cases bed-ridden, geriatric or chronic constipation often end up using bulk-forming agents daily & more powerful laxatives every few weeks (at most)
39
Lubiprostone MOA
used in chronic constipation CL channel stimulator, increases fluid secretion Improves spontaneous bowel movements Safe for elderly
40
Linalotide MOA
increasing chloride and bicarbonate secretion fluid increases the GI transit time is decreased. patients > 18 years
41
Naloxegol RX clinical uses
used in opiod induced constipation mu-opioid receptor antagonist. It is composed of naloxone conjugated with a polyethylene glycol polymer, which limits its ability to cross the blood-brain barrier. It inhibits the opiod from binding to receptors in GI tract
42
Acute Constipation Treatment w/ impaction
eneams | disimpact with saline, mineral oil, h2o enema
43
Acute Constipation Treatment w/o impaction
choose laxative tap water enema or glycerin suppository subjective treatment
44
Laxative Abuse
Bowel is purged & then it takes a couple of days for another BM. Patient thinks the period after purge is more constipation & takes more laxatives You have to gradualy tapper them off, don’t use a stimulant one, also use a anti contipationd drug
45
Antidiarrheals
Does not work for severe diahrea pallatives DO NOT USE IF DIAHREAH IS BLOODY OR PT HAS HIGH FEVER
46
3 anti diarrheal agnts
Opioid agonists Colloidal bismuth compounds (Pepto-Bismol) Polycarbophil (Fiber Con or Fiber-Lax)
47
MOA of opioid Agonists
bind to receptors on the bowel= prolong passing
48
Opiod Agonists LISt
Loperamide (Imodium) Diphenoxylate /atropine (Lomotil) Codeine
49
Loperamide
does not cross blood brain barrier 2 mg after 1st loose stool max 16 mg day (8 capsules)
50
Diphenoxylate 2.5 mg/Atropine 0.025 mg(Lomotil)
narcotic, low doses don’t cross blood brain barrier; higher doses do.
51
Why is an anticholinergic drug added to diphenoxylate
anticholinergic increases antidiarrheal action If take in overdosage to get narcotic effect of Diphenoxylate the anticholinergic causes unpleasant side effects
52
MOA for Colloidal Bismuth and Polycarbophil
-decrease stool frequency and liquidity by absorbing water
53
What drug is indicated for traveler's diahreah?
Bismuth
54
Should you feed children with the squirts?
yes. children with diarrhea do worse if don’t feed them, so should feed them for sure, rest is controversial BRAT diet
55
What is the BRAT diet?
bannanas, rice, applesauce, toast
56
What should you avoid if you have the squirts?
milk
57
How to keep someone well hydrated?
1 tsp liquid 10-15 mintues

PHARM EXAM 2 (3 decks)

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