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Pharm > Palliation of Constipation, Nausea, and Vomiting > Flashcards

Palliation of Constipation, Nausea, and Vomiting Flashcards

1
Q

Bulking agent (laxatives)

A

Dietary Fiber/ Psyllium (Metamucil)

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2
Q

Bulking agent (Fiber/Psyllium-Metamucil) MOA

A

Increase stool weight, cause retention of fluid in stool, stimulate peristalsis

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3
Q

Bulking agent (Fiber/Psyllium-Metamucil) SE/Contra

A

SE: flatulence
CI: do not use in debilitated patients who cannot drink adequate fluid
*MUST increase fluid intake, otherwise hard massive stool

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4
Q

Osmotic laxatives- Nonabsorbable sugars

A

Lactulose/Sorbitol

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5
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) MOA

A

Draw water into the bowel lumen and into the stool; (nonabsorbable sugars)
Lactulose: bacteria degrade in colon, increases osmotic pressure and acidification of stool, increase stool water content
Sorbitol: does not need to be degraded, works more quickly

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6
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) SE

A

Sickly sweet, bloating, cramps, flatulence

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7
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) Indication

A

Treat Constipation (NOT used to prevent constipation)

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8
Q

Osmotic laxatives

A 
Nonabsorbable sugars (Lactulose/Sorbitol)
Saline and magnesium salts (Magnesium citrate/Magnesium hydroxide-MOM/Sodium phosphate)
Polyethylene Glycol (Miralax, Glycolax/Colyte, Golytely)
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9
Q

Osmotic laxatives- Saline and magnesium salts

A

Magnesium citrate
Magnesium hydroxide=Milk of Magnesia
Sodium phosphate=Fleets Phospho-Soda

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10
Q

Osmotic laxatives- Saline and magnesium salts MOA

A

Osmotically active particles (Mg, Phos, Na)
*Mg also stimulates CCK (stimulates peristalsis)
Increased intraluminal volume
Stimulates intestinal activity
High dose: rapid bowel evacutation

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11
Q

Osmotic laxatives- Saline and magnesium salts SE/CI

A

CI: Bowel obstruction, Dehydration, Electrolyte abnormalities, renal failure (caution with CHF and LF)
SE: ischemic colitis, acute phosphate nephropathy (sodium phosphate)–intratubular deposition of calcium-phosphate

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12
Q

Osmotic laxatives- Saline and magnesium salts Indication

A

Magnesium citrate/Sodium phosphate: Bowel preps

Magnesium hydroxide-MOM: constipation

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13
Q

Osmotic laxatives-Polyethylene Glycol

A

Miralax, Glycolax (constipation)

Colyte, Golytely (bowel prep)

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14
Q

Osmotic laxatives-Polyethylene Glycol MOA

A

Osmotically active > retains water in stool > softer stool = more frequent bowel movements
Contents NOT absorbed systemically, SAFE in anyone

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15
Q

Osmotic laxatives-Polyethylene Glycol Indications

A

Miralax, Glycolax: constipation (small daily doses)

Colyte, Golytely: bowel prep (large volumes)

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16
Q

Stimulant Laxatives

A

Senna, Bisacodyl

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17
Q

Stimulant Laxatives MOA

A

Stimulate bowel motility

Senna: Converts to active metabolites by bacteria in colon>
Stimulates myenteric plexus > peristalsis

Bisacodyl: parasympathetic stimulation > peristalsis

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18
Q

Stimulant Laxatives SE

A

Cramping, Melanosis Coli (colonic lumen-macs filled with lipofusion)

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19
Q

Stimulant Laxatives Indications

A

Constipation (for opioids)

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20
Q

Detergent Laxatives (stool softeners)

A

Docusate (Colase)

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21
Q

Detergent Laxatives MOA

A

Lube up the bowels, makes them more slippery
Increases penetration of fluid into the stool
Emulsifies feces, water, fat

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22
Q

Lubricants

A

Glycerin suppository/enema

Mineral oil enema

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23
Q

Lubricant MOA

A 
Glycerin suppository/enema:
Osmotic- softeners, lubricates stool
Irritant- stimulates rectal contractions
Mineral oil enema:
Coats fecal material
Softens stool, lubricates
24
Q

Lubricant SE

A

Mineral oil should NEVER be administered oral to debilitated patients > aspiration > lipoid pneumonitis

25
Q

Lubricant Indication

A

Fecal Impaction

26
Q

Large volume enemas MOA

A

Soften stool by increasing water content
Distend distal colon
Induce peristalsis

27
Q

Large volume enemas indication

A

Fecal impaction

28
Q

Palliation of Constipation (steps)

A

Stool softener (Docusate)
Stimulant (Senna, Bisacodyl)
Osmotic agent (Lactulose, sorbitol, MOM, polyethylene glycol-low dose)
Enemas (Tap water, sodium phosphate)
Magnesium citrate/sodium phosphate (last choice)

29
Q

Chemoreceptor Trigger Zone (stimulants, receptors)

A

Can be stimulated by drugs (opiates, chemo), renal failure (metabolic products), bacterial toxins
Receptors: dopamine, 5-HT3

30
Q

Vestibular center (stimulants, receptors)

A

Motion sickness, inner ear infection

Receptors: acetylcholine, histamine

31
Q

Gut (stimulants, receptors)

A

Gastroenteritis, radiation, GERD, metastasis, obstruction, local toxins, drugs
Receptors: 5-HT3, vagus, dopamine

32
Q

Vomiting Center Receptors

A

Acetylcholine
H1
5-HT2

33
Q

Dopamine Receptor Antagonists

A

Prochlorperazine

Metaclopramide

34
Q

Prochlorperazine (Dopamine Antagonist) MOA

A

Central dopamine receptor antagonist in CTZ

Peripherally blocks vagus nerve (GI)

35
Q

Prochlorperazine (Dopamine Antagonist) Indications

A

Opioid related nausea and vomiting

GI disorders, inflammation, infection

36
Q

Prochlorperazine (Dopamine Antagonist) SE

A 
Extrapyramidal effects (movement disorders)
Dystonic reactions
37
Q

Metoclopramide (Dopamine Antagonist) indications

A

Chemotherapy induced nausea and vomiting

Treatment of upper GI tract dysmotility (diabetic gastroparesis, gastric stasis)

38
Q

Metoclopramide (Dopamine Antagonist) MOA

A

Blocks the chemoreceptor trigger zone

Promotes motility of upper GI tract > increases gastric emptying

39
Q

Metoclopramide (Dopamine Antagonist) SE

A

Extrapyramidal effects (dystonia, akathisia, parkinsonism)
Acute dystonic reactions (trismus, torticollis-jaw, neck spasm)
CAUTION: parkinson’s disease

40
Q

Ondansetron MOA

A

Serotonin (5-HT3) receptor antagonist

41
Q

Ondansetron Indication

A

Chemotherapy induced nausea/vomiting and prophylaxis
Radiation induced nausea/vomiting and prophylaxis
Post operative N/V

42
Q

Ondansetron SE

A

QT prolongation

Headache

43
Q

Promethazine MOA

A

Histamine (H1) receptor antagonist

44
Q

Promethazine Indications

A

Motion sickness Rx/prevention

Inner ear vestibular disorder

45
Q

Promethazine SE

A

Sedation

46
Q

Scopolamine MOA

A

Anticholinergic

47
Q

Scopolamine Indication

A

Treatment of motion sickness

Vestibular apparatus mediated N/V

48
Q

Scopolamine SE

A

Confusion
Urinary retention
Acute narrow angle glaucoma
Dry mouth

49
Q

Corticosteroids

A

Prednisone

Dexamethasone

50
Q

Corticosteroid (Prednisone, Dexamethasone) Indication

A

Nausea due to increased intracranial pressure

51
Q

Benzodiazepines

A

Lorazepam

Diazepam

52
Q

Benzodiazepines (Lorazepam, Diazepam) Indication

A

Anxiety associated nausea and vomiting (anticipatory)

53
Q

Palliation of N/V: Vestibular (Receptors/Drugs)

A

Receptors: Cholinergic, Histaminic
Drugs: Scopolamine (anti-Ach); Promethazine (anti-H)

54
Q

Palliation of N/V: Obstruction of Bowel caused by constipation (Receptors/Drugs)

A

Receptors: 5-HT3, Dopamine, Vagus
Drugs: Appropriate laxatives!

55
Q

Palliation of N/V: dysMotility of upper GI tract (Receptors/Drugs)

A

Receptors: Dopamine
Drugs: Metoclopramide

56
Q

Palliation of N/V: Infection, Inflammation (receptors/drugs)

A

Receptors: 5HT3, vagal, dopamine?
Drugs: Prochlorperazine (blocks vagal stimulation)

57
Q

Palliation of N/V: Toxins stimulating CTZ (receptors/drugs)

A

Receptors: Dopamine, 5-HT3
Drug: Ondansetron (emetogenic chemo); prochlorperazine (opiates)

Pharm (20 decks)

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