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Pharm 584 > MCP Lower GI > Flashcards

MCP Lower GI Flashcards

1
Q

Constipation: Definition and Symptoms

A
  • Decrease in the frequency of fecal elimination
  • Symptoms:
    • Difficult passage of hard, dry stools
    • Straining to have a stool
    • Not feeling completely evacuated
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2
Q

Diarrhea: Definition and Symptoms

A
  • Abnormal increase in stool frequency or liquidity
  • More than 3 bowel movements per day is considered abnormal
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3
Q

When to refer:

A
  • Blood or mucous in stool
  • Acute abdominal pain/cramps
  • N/V with Constipation
  • Persistent comiting with Diarrhea
  • Dehydration
  • Diarrhea:
    • Temperature >101​
    • Children, elderly, pregnant
    • Immunocompramised
    • DM, severe renal dz, multiple unstable med. conditions
    • ​Does not improve or worsens after 48 hours
  • Constipation
    • Sudden change in BM lasting for >2weeks
    • Laxative use with no BM
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4
Q

Non-pharmalogical Recommedations: Constipation

A
  • Add fiber, whole grains to diet and limit foods without fiber
    • Soluble fiber: absorb water, help manage diabetes and cholesterol
    • Insoluable fiber: not absorb water, good for constipation
    • See effect in 3-5 days
  • Drink more liquids
  • Exercise more regularly
  • Avoid stress
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5
Q

Non-pharmalogical Recommendations: Diarrhea

A
  • Drink caffeine free, clear liquids
  • Replace electrolytes
  • BRAT diet
    • Bananas
    • Rice
    • Applesauce
    • Toast
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6
Q

Stool Softners: Drugs, MOA, Indications, Onset, Duration

A
  • Docusate sodium (Colace, DOSS-Relief)
  • MOA:
    • Draws water into the stool to mix with and soften stool
  • Indications:
    • Constipation prevention
    • To prevent straining in pts. with anorect. conditins
  • Onset: 1-3 days
  • Duration: 3 days
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7
Q

Stool Softners: Administration

A
  • Take 1 to 4 times daily as needed
  • Take with full glass of water
  • Use for up to 1 week unless otherwise advised by PCP
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8
Q

Stool Softners: Side Effects

A
  • Diarrhea
  • Cramps
  • Bitter taste in mouth
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9
Q

Stool Softners: Cautions/Contraindications

A
  • GI obstruction, nausea or vomiting
  • Concomitant use with mineral oil
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10
Q

Bulk Forming Laxatives: Drugs, MOA, Indication, Onset

A
  • Methylcellulose (Citrucel)
  • Psyllium (Metamucil)
  • MOA:
    • Dissolve or swell in fluid of intestines, stimulate peristalsis and evacuation
  • Indications
    • Treatment of occasional constipation
    • May be indicated for patients on low fiber diets, older patients, patients with IBS
    • Prophylaxis for patients that should refrain from: straining
  • Onset:
    • 12-24 hours
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11
Q

Bulk Forming Laxatives: Administration

A
  • Powder: 1 rounded tablespoon, up to 3 times per day
    • Mix with 8 oz of water or juice
  • Metamucil: also available in capsules, waffers, and fiber singles
  • Citrucel: also available in fiber caplets
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12
Q

Bulk-Forming Laxatives: Side Effects, Cautions/Contraindications

A
  • Side Effects
    • Abdominal cramping
    • Flatulence
  • Cautions/Contraindications
    • GI obstruction, nausea or vomiting
    • Patients with difficulty swallowing
    • Patients with fluid restriction
    • Separate doses of bulk-forming laxatives from other medication by 2 hours
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13
Q

Hyperosmotic Laxatives: Drugs

A
  • PEG (Miralax, GoLytely)
  • Glycerin (Pedia-lax)
  • Lactulose (Enulose)
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14
Q

Hyperosmotic Laxatives: MOA, indications

A
  • MOA
    • Draws water into stool via electolyte and osmotic effects, causing perstalsis and bowel movement
  • Indications
    • Treatment of occasional constipation​
    • Bowel prep/cleansing before intestinal procedures (ex: colonoscopy)
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15
Q

Administration, Onset, SE: PEG

A
  • Miralax
    • Dissolve 1 capful in 4-8 ox of liquid and drink once daily, use up to 2 weeks
    • Onset 12-72 hours
  • GoLytely
    • Fill jug with water, drink every 10 min until 4L consumed or rectal effluent is clear.​
    • Chilling helps with taste
    • Onset: 0.5-2 hours
  • SE
    • Bloating, cramping, abdominal discomfort
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16
Q

Administration, Onset, SE: Glycerin

A
  • Unwrap and insert one suppository rectally daily or as directed
  • Onset:
    • 15-30 min
  • SE: Rectal irritation
17
Q

Administration, SE, Onset: Lactulose

A
  • Lactulose (Enulose)
    • 15-30 mL daily
      • max 60mL/day
    • also for hepatic encephalitis
  • Onset
    • 24-48 hours
  • SE
    • Bloating, cramping, abdominal discomfort
  • Caution in pts with DM
18
Q

Stimulant Laxatives: Drugs, MOA, Indications

A
  • Senna (Senokot, Exlax)
  • Bisacodyl (Dulcolax)
  • MOA
    • ​Stimulates peristaltic activity by direct action on intestinal mucosa or nerve plexus
  • Indications
    • Treatment of occasional constipation
    • Treatment of chronic constipation induced by opiates
19
Q

Stimulant Laxative: Onset

A
  • Senna
    • 6-10 hours
  • Bisacodyl
    • 6-10 hours
    • Suppository: 15-60 min
20
Q

Stimulant Laxatives: SE

A
  • Cramping
  • Diarrhea
  • Fluid and electrolyte loss
    • potassium and dehydration
21
Q

Stimulant Laxatives: Cautions/Contradindications

A
  • Bisacodyl-Don’t crush or chew tablet or take them within as hour of taking antacids or milk
  • GI obstruction, nausea or vomiting
  • Inflammatory bowel disorders
  • Caution in preggos, oldsters
  • Overuse may result in laxative dependence
22
Q

Antidiarrheal: Drugs

A
  • Diphenoxylate/atropine (Lomotil C-V)
  • Loperamide (Immodium)
23
Q

Antidiarrheal: MOA, Indications

A
  • MOA:
    • Directly binds instestinal opioid receptors to inhibit perstalsis
  • Indications:
    • Diarrhea (acute and chronic)
24
Q

What is the purpose of atropine in Lomotil

A
  • If take greater than needed dose, causes dry mouth/thirst and not pleasant SE
25
Q

Antidiarrheal: Precautions

A
  • Should not be used for
    • Diarrhea that occurs along with high fever or blood in stool
    • Bacteral enteritis
    • pseudomembranous colitis associated with broad spectrum antibiotic use
26
Q

Loperamide: Administration, SE, Cautions/Contra

A
  • Admin
    • max 16mg daily
  • SE
    • Dizziness, constipation
  • Cautions
    • Do not exceed 48 hours
    • D/C is worsen, abdominal swelling/bulging
    • AAP does not recommend for CHILDREN
    • Caution with pregnancy
    • Use for acute flares of ulcerative colitis
27
Q

Lomotil: Administration, Side Effect, Caution, Onset, Duration

A
  • Drink lots of: caffiene free clear liquids during 1st 24 hours
  • Onset: 45-60 min
  • Duration: 3-4 hours
  • Side Effects
    • Abdominal discomfort, N/V, constipation, dizziness, drowiness
  • Cautions
    • use for >10 days at max dose
    • Not for children <2 b/c more susceptible to atropine
    • Caution with preggos, children
    • Severe liver disease

Pharm 584 (13 decks)

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