Managing Diarrhoea, Constipation and IBS Flashcards
name some opioids used for diarrhoea
codeine phosphate,
diphenoxylate,
loperamide (in immodium)
how do opioids work in teh gut to treat diarrhoea?
agonist of the mu-opioid receptors in the gut. inhibit propulsive movements of the bowel and prolong transit time which also provides an opportuinty for enhanced fluid absorption whcih may harden stool
why are opioids used for diarrhoea not addictive?
they do not cross the blood-brain barrier
name some bulk-forming laxatives
bran,
isphaghula husk,
methylcellulose,
sterculia
why would bulk forming laxatives not be good for someone with acute diarrhoea?
full effect takes a few days so you may need something that acts quicker.
what type of laxative are macrogols?
osmotic laxative
what type of laxative is lactulose?
osmotic
how do osmotic laxatives work?
draw water back into stool - need to keep patients hydrated for it to work
why are osmotic laxatives given to patients with liver failure?
they increase gut transit time whcih reduces ammonia absorption and acidifies the stool which inhibits proliferation of ammonia-producing bacteria and this can prevent hepatic encephalopathy
when are osmotic laxatives contraindicated and why?
intestinal obstruction due to increased risk of perforation
give some examples of stimulant laxatives (3)
bisacodyl
docusate sodium
senna
how do stimulant laxatives work
increase bowel movements and secretion of water and electrolytes from colonic mucosa
which stimulant laxative would you use if you wanted rapid action in 15-30 minutes?
bisacodyl
which stimulant laxative is a powerful irritant often given orally to prepare the bowel for surgery or colonoscopy because it acts in <6hrs?
sodium picosulphate
what type of laxative is docusate sodium?
faecal softener
what diet would you suggest to someone with constipation?
high fibre diet
what laxative could you give to someone with constipation at night to give mornign bowel action?
senna or bisacodyl
for longer-term constipation therapy, what tends to be well tolerated and effective?
regular macrogol or lactulose
which laxatives are safe to use in pregnancy?
senna, magnesium salts and docusate
which laxatives would you use for the elderly or terminally ill who have opioid-induced constipation?
bisacodyl or co-danthrusate
what type of laxatives should you use for constipation where neurological disease is the cause?
faecal softener with regular enemas or rectal washouts
how should you manage diarrhoea in an uncomplicated case?
increase oral fluid and electrolyte intake
what pharmacological therapy could you use for mild to moderate diarrhoea?
opioids
in what cases of diarrhoea should you not give something to treat diarrhoea?
in gastroenteritis when prolonging contact of the organism with the gut mucosa can be detrimental
name 2 antimuscarinic drugs used to treat gut spasms
hyoscine butylbromide (buscopan) propantheline
name 2 other antispasmodica agents that are not anti-muscarinics
mebeverine
peppermint oil
what advice should be given to someone to manage their IBS?
- treatments involve a combination of drugs, CBT, relaxation and hypnotherapy
- reduce intake of tea and coffee
- smoking cessation
- avoid trigger foods