Lower GI Drugs Flashcards
Constipation Treatment
LIFESTYLE!
Bulk-Forming Laxatives
Natural: PSYLLIUM (Metamucil), Bran, Apples, Broccoli, Prunes
Synthetic: Cellulose
Take with water or they can cause obstruction
SE: Bloating, Abdominal Pain, Blockage, etc
Stool Softener
DOCUSATE (Colace)
Dehydrocholic Acid
Poloxamer 188
Wetting agent
Recommended for after childbirth or surgery. For people who need to avoid straining
SE: Stomach pain, Diarrhea, Cramping
Contraindications: APPENDICITIS, Stomach or intestine blockage, Should not be combined with oil
- Tolerance and Electrolyte imbalances
Lubricants
MINERAL OIL - short term treatment of constipation. Don’t use long term or daily.
Blocks absorption of fat soluble vitamins and drugs
Aspiration causes LIPID PNEUMONIA
Contraindications: Within 2 hours of meal, Missed BM for only 1-2 days, Trouble swallowing, With stool softener
Stimulants
SENNA, Cascara, Aloe Vera, Castor Oil, Microlax, BISACODYL (Dulcolax)
Most severe laxative - rapid onset
Can cause dehydration and loss of electrolytes
Chronic use can lead to Melanosis Coli - lazy bowel (worse constipation)
Contraindications: Pregnancy, Breast-Feeding, Children, Long term use
Osmotic
Saline: MAGNESIUM
Hyperosmotics: Lactulose, Sorbitol, PEG
Use for: Before colonoscopy, or surgery. Elimination of drugs or foods from OD/Poison.
Trying to really clear you out.
SE: Mg can impair renal function and CHF
Rarely recommended
Chloride Channel Activator
LUBIPROSTONE - prescription, can be used safely for 6-12 months
Linaclotide - cGMP agonist. Same mechanism as E.Coli stable toxin
Relieve stomach pain, IBS with constipation
SE: Moderate nausea
When to Treat Diarrhea
Usually, don’t. There’s an underlying issue.
Profuse watery diarrhea with signs of dehydration (NOT FOR CHOLERA) Bloody or black diarrhea Fever > 101.3 or 38.5 Passage of >6 stools in 24 hours VIPomas or Carcinoid Tumors
Opiods
LOPERAMIDE - first line. Non-sedating, non-addictive, can be used during breast feeding. Pushes stool back and forth, NO propulsion.
DIPHENOXYLATE - Combined with atropine to reduce addictive side effects.
- Can cause nausea, changes in mood, many other serious side effects
Adsorbents
ATTAPULGITE - clay like substance that reduces movements and improves consistency
BISMUTH SUBSALICYLATE - Pepto
SE: May bind medications. Take several hours apart
Oral Rehydration Therapy
Pedialyte, Rehydralyte
BRAT Diet
