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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
Q

Sorbitol/ Lactulose

A

nonabsrobable sugars
used in hepatic encephalopathy= lactulose
sweetner

26
Q

Magnesium Citrate & Sodium Phosphate

A

VERY POWERFUL
dehydrate and cause electrolyte problems.
DRINK LOTS OF WATER

27
Q

Propylethen Glycol

A

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
Q

Stimulant Laxatives

A

stimulate nerve plexus
cause peristalsis
Long term use may cause dependence & dilatation of bowel

29
Q

RX stimulant laxatives

A

Senna (Senokot & Ex-Lax)
Bisacodyl (Dulcolax)
Castor oil

30
Q

Senna

A

from a plant
browns walls of colon
6-12 hrs oral
1-2 hrs rectaly

31
Q

Bisacodyl

A

ONLY USE EVERY FEW WEEKS

oral: 6-10 hrs
suppository: 30-60 min

32
Q

ADR of Bisacodyl

A

severe abdominal cramping

33
Q

Castor Oil

A

Plant derivative
stron
not used much

34
Q

Dont give laxatives…

A

in setting of acute abdominal pain until have ruled out other causes of abdominal pain.

35
Q

RXs that cause constipation

A

Opiates (narcotics)- very common and a large problem in use of narcotics
Anticholinergics
Antacids with aluminum or calcium
Ccb- verapamil, delitazem

36
Q

What are the two types of constipation?

A

Chronic

Actute (fecal impaction)

37
Q

Constipation treatment: 3

A

Lifestyle changes
Fiber and bulk formers
Other drugs in chronic constipation

38
Q

What role do stimulant laxatives play in constipation managment?

A

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
Q

Lubiprostone MOA

A

used in chronic constipation
CL channel stimulator, increases fluid secretion
Improves spontaneous bowel movements
Safe for elderly

40
Q

Linalotide MOA

A

increasing chloride and bicarbonate secretion
fluid increases the GI transit time is decreased.
patients > 18 years

41
Q

Naloxegol RX clinical uses

A

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
Q

Acute Constipation Treatment w/ impaction

A

eneams

disimpact with saline, mineral oil, h2o enema

43
Q

Acute Constipation Treatment w/o impaction

A

choose laxative
tap water enema or glycerin suppository
subjective treatment

44
Q

Laxative Abuse

A

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
Q

Antidiarrheals

A

Does not work for severe diahrea
pallatives
DO NOT USE IF DIAHREAH IS BLOODY OR PT HAS HIGH FEVER

46
Q

3 anti diarrheal agnts

A

Opioid agonists

Colloidal bismuth compounds (Pepto-Bismol)

Polycarbophil (Fiber Con or Fiber-Lax)

47
Q

MOA of opioid Agonists

A

bind to receptors on the bowel= prolong passing

48
Q

Opiod Agonists LISt

A

Loperamide (Imodium)
Diphenoxylate /atropine (Lomotil)
Codeine

49
Q

Loperamide

A

does not cross blood brain barrier

2 mg after 1st loose stool
max 16 mg day (8 capsules)

50
Q

Diphenoxylate 2.5 mg/Atropine 0.025 mg(Lomotil)

A

narcotic, low doses don’t cross blood brain barrier; higher doses do.

51
Q

Why is an anticholinergic drug added to diphenoxylate

A

anticholinergic increases antidiarrheal action

If take in overdosage to get narcotic effect of Diphenoxylate the anticholinergic causes unpleasant side effects

52
Q

MOA for Colloidal Bismuth and Polycarbophil

A

-decrease stool frequency and liquidity by absorbing water

53
Q

What drug is indicated for traveler’s diahreah?

A

Bismuth

54
Q

Should you feed children with the squirts?

A

yes.
children with diarrhea do worse if don’t feed them, so should feed them for sure, rest is controversial
BRAT diet

55
Q

What is the BRAT diet?

A

bannanas, rice, applesauce, toast

56
Q

What should you avoid if you have the squirts?

A

milk

57
Q

How to keep someone well hydrated?

A

1 tsp liquid 10-15 mintues

PHARM EXAM 2 (3 decks)

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