Pharm #2 - Constipation /Vomiting Flashcards
state class & MOA
Dietary Fiber
Psyllium
SE?
bulking agent
MOA:
Increases stool weight
Fluid retention in stool
***Must have adequate fluid intake
SE: Flatulence
Contraindications for
dietary fiber
psyllium
-Debilitated
-End of life
[Inability to intake appropriate amount liquid (1.5-2 liters/day)]
Lactulose
Sorbitol
- class
- moa
- se
Osmotic Laxatives: Nonabsorbable sugars
osmotic load into the colonic lumen stimulates movement
SE:Bloating Cramps Flatulence
** very sweet and require prescription
Magnesium hydroxide (Milk of Magnesia)
- class
- moa
Contra?
Osmotic Laxatives: Saline and Magnesium Salts
MOA: osmotic load into the colonic lumen stimulates movement
Contra: renal failure (can cause hypermagnesemia)
** ions can be partially absorbed**
Magnesium citrate
- class
- moa
- se
COntra (4)
Osmotic Laxatives: Saline and Magnesium Salts
MOA: osmotic load into the colonic lumen stimulates movement
- HIGH DOSES = RAPID BOWEL EVACUATION
USE AS BOWEL PREP FOR ENDOSCOPY
SE: dehydration, electrolyte abnormalities
- ischemic colitis (rare)
Contra: bowel obstruction fecal impaction renal failure cautious in CHF
Sodium phosphate
- class
- moa
- se
Osmotic Laxatives: Saline and Magnesium Salts
MOA: osmotic load into the colonic lumen stimulates movement
- HIGH DOSES = RAPID BOWEL EVACUATION
USE AS BOWEL PREP FOR ENDOSCOPY
SE: dehydration, electrolyte abnormalities
COntra:
bowel obstruction
fecal impaction
renal failure
cautious in CHF
(same as magnesium citrate)
Which osmotic laxative can cause acute phosphate nephropathy, and intrabular deposition in calcium phosphate?
Sodium Phosphate
- can be used for enema
Miralax, Glycolax
- class
- moa
Low dose polyethylene glycol
MOA: osmotic load into the colonic lumen stimulates movement
- no absorption of ions
Colyte
Golytely
- class
- moa
- se
HIGH dose polyethylene glycol
MOA: osmotic load into the colonic lumen stimulates movement
**BOwel prep for colonoscopy or colon surgery
(1-4 liters of prep, no absorption of ions, requires prescription)
Senna
Bisacodyl
- class
- moa
- se
Stimulant laxatives - prevention of constipation with opiate therapy
Stimulate intestinal motility via myenteric plexus
- for constipation or prevention of constipation with opiate therapy
SE: cramping
- *melanosis coli with long term use
- bisacodyl can be given rectally in suppository form
Docusate
- class
- moa
Detergent laxative STOOL SOFTENER
MOA: surfactant
- increases penetration of fluid into stool
GLycrin
- class
- moa
Lubricant
Administered rectally:
- osmotic
- irritant
- stimulates rectal contractions
- for fecal impaction
mineral oil
- class
- moa
CONTRA?
Lubricant
Moa: Administered rectall
- coats feces softens and lubricates feces
- for fecal impaction
NEVER USE IN PATIENTS AT RISK OF ASPIRATION
- lipoid pneumonitis
tap water enemy
sodium phosphate
- class
- moa
Large volume enemas
MOA:
- increase water content of stool
- distend distal colon
- induce peristalsis
use for fecal impaction
Prochlorperazine
Class
MOA (2)
Dopamine receptor antagonist
MOA:
1. central - blcoks dopamine receptors in the CTZ
- Peripheral - blocks GI vagus nerve projections to the vomiting center
Prochlorperazine
- indications
SE (2)
- Opiod induced nausea/vomiting
- Primary GI disorders (gastroenteritis)
SE:
- Extrapyramidal effects
- acute dystonic reactions
Metoclopramide
CLass
MOA (2)
USE
DOpamine antagonist
MOA:
central and peripheral dopamine inhibition
- prokinetic on upper GI (by inhibiting cholinergic stimulation)
USE:
Moderalty emetogenic chemo induced nausea/vomiting
(for severe use odansetron)
- post op
-dysmotility of upper GI (gastroparesis and gastric stasis)
Metoclopramide
SE (3)
Contraindication
SE:
- Tardive dyskinesia (avoid use >12 weeks)
- Extrapyramidal side effects
- Acute dystonic reaction
Contraindication: caution in Parkinson’s patients
(met the park)
Ondansetron
Class
MOA
USE
5HT-3 Antagonist
MOA:
-central inhibition of dopamine receptors in CTZ
peripheral block of 5HT3 induced transmission of vagal
Ondansetron
SE (2)
SE:
- QT prolongation
- Headache
Promethazine
Class
MOA
USE
H1 receptor antagonist
blocks H1 receptors in vestibular apparatus
Used for motion sickness
Promethazine
SE
sedation
which 2 drugs for motion sickness
promethazine
and scopolamine
Scopolamine
Class
MOA
anti-cholinergic
- blocks cholingeric receptors of the vestibular apparatus
Use for motion sickness
