Managing Diarrhoea, Constipation and IBS Flashcards

1
Q

name some opioids used for diarrhoea

A

codeine phosphate,
diphenoxylate,
loperamide (in immodium)

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2
Q

how do opioids work in teh gut to treat diarrhoea?

A

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

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3
Q

why are opioids used for diarrhoea not addictive?

A

they do not cross the blood-brain barrier

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4
Q

name some bulk-forming laxatives

A

bran,
isphaghula husk,
methylcellulose,
sterculia

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5
Q

why would bulk forming laxatives not be good for someone with acute diarrhoea?

A

full effect takes a few days so you may need something that acts quicker.

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6
Q

what type of laxative are macrogols?

A

osmotic laxative

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7
Q

what type of laxative is lactulose?

A

osmotic

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8
Q

how do osmotic laxatives work?

A

draw water back into stool - need to keep patients hydrated for it to work

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9
Q

why are osmotic laxatives given to patients with liver failure?

A

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

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10
Q

when are osmotic laxatives contraindicated and why?

A

intestinal obstruction due to increased risk of perforation

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11
Q

give some examples of stimulant laxatives (3)

A

bisacodyl
docusate sodium
senna

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12
Q

how do stimulant laxatives work

A

increase bowel movements and secretion of water and electrolytes from colonic mucosa

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13
Q

which stimulant laxative would you use if you wanted rapid action in 15-30 minutes?

A

bisacodyl

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14
Q

which stimulant laxative is a powerful irritant often given orally to prepare the bowel for surgery or colonoscopy because it acts in <6hrs?

A

sodium picosulphate

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15
Q

what type of laxative is docusate sodium?

A

faecal softener

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16
Q

what diet would you suggest to someone with constipation?

A

high fibre diet

17
Q

what laxative could you give to someone with constipation at night to give mornign bowel action?

A

senna or bisacodyl

18
Q

for longer-term constipation therapy, what tends to be well tolerated and effective?

A

regular macrogol or lactulose

19
Q

which laxatives are safe to use in pregnancy?

A

senna, magnesium salts and docusate

20
Q

which laxatives would you use for the elderly or terminally ill who have opioid-induced constipation?

A

bisacodyl or co-danthrusate

21
Q

what type of laxatives should you use for constipation where neurological disease is the cause?

A

faecal softener with regular enemas or rectal washouts

22
Q

how should you manage diarrhoea in an uncomplicated case?

A

increase oral fluid and electrolyte intake

23
Q

what pharmacological therapy could you use for mild to moderate diarrhoea?

A

opioids

24
Q

in what cases of diarrhoea should you not give something to treat diarrhoea?

A

in gastroenteritis when prolonging contact of the organism with the gut mucosa can be detrimental

25
Q

name 2 antimuscarinic drugs used to treat gut spasms

A
hyoscine butylbromide (buscopan)
propantheline
26
Q

name 2 other antispasmodica agents that are not anti-muscarinics

A

mebeverine

peppermint oil

27
Q

what advice should be given to someone to manage their IBS?

A
  • treatments involve a combination of drugs, CBT, relaxation and hypnotherapy
  • reduce intake of tea and coffee
  • smoking cessation
  • avoid trigger foods