PHARM II lecture 2 Flashcards
Constipation are more common in
elderly, women, patient of lower socioeconomic class
What is the Rome Criteria
Two ore more of the following symptoms for at least 3 months
-hard stools at least 25% of the time
-2 or fewer bm per week
-difficulty passing at least 25% of the time
-incomplete evacuation at a minimum 25% of the time
why is urinary incontinence associated with constipation?
bowel presses on the bladder when it is impacted
Alarm symptoms of constipation
-change in bowel habits >2 week
-worsening of constipation despite treatment
-blood in stool
Which medications commonly cause constipation?
opioids, anticholinergics, calcium containing antacids
Which medications commonly cause constipation?
opioids, anticholinergics, calcium-containing antacids
What is the goal bm for constipation?
2 or 3 normal bm per week
non-harm treatment for constipation
-fluids
-activity
-fiber in diet (25-30g/day)
Can laxative abuse cause constipation?
Yes
Bulk forming aggent
psyllium
onset of psyllium
12-72 hours
SE of bulk forming agents
-bloating
-cramping
-flatulence
which constipation med is 1st line?
psyllium
MOA of psyllium
absorb water and increase fecal mass
- require adequate hydration (8oz)
-caution in debilitated patients
what is an osmotic
miralax
onset of miralax
2.24-96 hours
what line is miralax?
2nd
SE of osmotic meds
nausea, cramping, flatulence, electrolyte disturbance
stimulants
senna
onset of senna
6-12 hours
SE of stimulants
cramping, nausea, electrolyte disturbance
which line is senna considered
2nd or 3rd
MOA for stimulants
-increase contractions of intestinal walls by stimulating nerves
-possible dependence of long term use
surfactant
docusate sodium
onset of surfactants
12-72 hours
SE of surfactants
cramping, fecal soiling
MOA of surfactants
-increases mixing of fatty materials in stool
-2nd or 3rd line
-requires adequate hydration
What can you use in patients who failed other options with chronic constipation
chloride channel activator and guaylate cyclase c agonist
stimulant suppositories
Bisacodyl
onset of stimulant suppositories
15-60 minutes
Suppositories
glycerin
Onset for suppositories
15-60 minutes
Fleet enema
sodium phosphate
Onset of fleet enema
5-15 minutes
Saline enema
Warm saline
Onset of saline enema
5-15 mintues
concern with fleet enema
phosphate buildup in renal insufficiency pts
Digital health vibrant
non drug vibrating capsule to stimulate bowel movements
Acute diarrhea
<2 weeks
Chronic diarrhea
> 4 weeks
definition of diarrhea
3 > unformed stool per 24 hour
Supportive care of diarrhea
hydration and electrolytes
adults and kids with diarrhea
adults:no solids/dairy for 1 day
kids:BRAT diet
Loperamide
drug of choice for diarrhea
-inhibit peristalsis, prolong transit time, reduce fecal volume and increase anal sphincter tone
Dosage for loperamide
4 mg orally initially
- 2mg after each loose stool, max is 16 mg
When is imodium use CI
c.diff is suspected
opioid treatment for diarrhea
Diphenoxylate with atropine
-does not cause too much respiratory depression
-reduce abuse potential
lactobacillus
-restore normal intestinal function
-may help with constipation
lactase enzymes
-lactose intolerance
which infectious diarrhea is the most common
viral
how long does it take to resolve traveler’s diarrhea
48 hours
antibiotics used for traveler’s diarrhea
cirpo if they are at high risk
treatment for traveler’s diarrhea
- oral hydration
- imodium
- floroquinolone
What kind of bacteria is c.diff
gram + spore forming anaerobic bacillus
which antibiotics cause c.diff
ampicillin, clindamycin, cephalosporins, fluroquinolones
fidaxomicin
1st line treatment but not used due to cost
alternative for c.diff treatment
vancomycin, metronidazole for non severe
