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NURP 424 Adv Pharm > Week 6: Antidiarrheals and Laxatives > Flashcards

Week 6: Antidiarrheals and Laxatives Flashcards

1
Q

Diphenoxylate/Atropine (Lomotil) MOA

A
  • antimotility agent that inhibits excessive GI motility and GI propulsion
  • atropine is added to this and has anticholinergic effects that decrease secretion in the bowel and slow peristalsis
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2
Q

Loperamide (Imodium) MOA

A
  • antimotility agent that acts through opiod receptors to inhibit peristalsis and prolong gastric time
  • reduces fecal volume and diminishes loss of fluid and electrolytes
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3
Q

Bismuth Subsalicylate (Pepto Bismol) MOA

A

both antisecretory and antimicrobial actions

  • prevent secretions from entering the GI tract
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4
Q

Kaolin and Pectin (Kaopectate) MOA

A

a clay-like powder that attracts and hold bacteria, and pectin thickens the stool by absorbing mosture

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5
Q

Polycarbophil (FiberCon) MOA

A

can provide bulk to your stools by absorbing water in the GI tract

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6
Q

diphenoxylate/atropine (Lomotil) ADRs

A

anticholinergic effects!

Dry mouth, dry eyes, urinary retention, blurred visions, drowsiness, dizziness, confusion/sedation

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7
Q

Lomotil cautions/contraindications

A
  • Schedule V - risk of dependence!
  • caution in liver dz, fever, bloody stool, fecal leukocytes
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8
Q

loperamide (Imodium) ADRs

A

abdominal discomfort, constipation, drowsiness, dry mouth

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9
Q

Bismuth (Pepto Bismol) ADRs

A
  • black stools, darkening of tongue, tinnitus
  • avoid in pts w/ ASA allergy or those taking salicylates
  • avoid in pregnancy, lactation, and in pediatrics (has aspirin = reyes syndrome)
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10
Q

Antidiarrheal patient education

A
  • risk of rebound constipation
  • need to increase fluid intake and electrolyte drink if PO intake is poor
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11
Q

Laxitives

A

1st line for maintenance:

  • Bulk Laxatives: Methylcellulose (Citrucel) and Psyllium (Metamucil)
  • Stool Softeners: (Colace)

2nd line

  • Lubricant Laxatives: Glycerin suppositories and Mineral oil

3rd line (or 1st line for acute constipation)

-Irritants and Stimulants: Bisacodyl (Correctol, Dulcolax), Caster oil, Senna (Ex-lax, Senokot)

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12
Q

Senna (Senokot), bisacodyl (Dulcolax), caster oil MOA

A

Stimulant 3rd line treatment in chronic constipation (or 1st line in acute constipation)

  • directly stimulates the myenteric plexus, which results in prostaglandin release and increase in cAMP concentration
  • dramatically increases peristaltic activity
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13
Q

Senna/Stimulant ADRs

A

Abdominal cramping, electrolyte imbalance, diarrhea, nausea, vomiting

  • loose stools with prolonged use
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14
Q

Stimulants (Senna/Bisacodyl) cautions/ contraindications

A
  • caution in CV disease
  • not to be used if bowel obstruction is suspected or active
  • safe in pregnancy and lactation (except caster oil)
  • bisacodyl ok in pediatrics > 6 y/o
  • senna and caster oil ok in pediatrics > 2 y/o
  • no caster oil in preg/lac
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15
Q

Psyllium (Metamucil) MOA

A

Bulk Laxative that is the safest 1st line drug for constipation

  • absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time
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16
Q

Psyllium (Metamucil) Cautions/ contraindications

A
  • use caution with narrowed esophageal or intestinal lumen
  • undx abd pain/bowel obstruction
  • OK with pregnancy/lactations
  • OK in pediatrics > 6 y/o
17
Q

Psyllium (Metamucil) ADRs

A
  • abdominal cramping, bloating, esophageal or intestinal obstruction (rare), gas
18
Q

Magnesium Hydroxide (Milk of Mag) and Polyethylene glycol (Miralax) and Lactulose MOA

A

Osmotic 2nd line treatment of constipation

  • draws water into the intestinal lumen to increase intraluminal pressure, which distends the colon and increases peristalsis
19
Q

Osmotics ADRs

A

abdominal cramping, nausea, diarrhea, bloating

20
Q

Osmotics Cautions/contraindications

A
  • lactulose with caution in diabetics
  • use magnesium-based with caution in renal impairment
21
Q

Docusate sodium (Colace) MOA

A

stool softener

  • reduces the surface tension of the oil/water interface on the stool and facilitates a mixture of fat and water into the stool
  • emollient action
22
Q

Mineral oil/glycerin MOA

A

Lubricant 2nd line treatment of constipation

  • eases passage of stool by decreasing water absorption and lubricating the intestine
23
Q

Lubricants cautions/contraindications

A
  • avoid in pregnancy/lactation
  • avoid in the elderly / BEERS
  • ok for pediatrics > 6 y/o
24
Q

Lubricants/Mineral oil ADRs

A
  • abdominal cramping, diarrhea, nausea, oily rectal leakage, vomiting
25
Q

Chloride Channel Activators: Lubiprosone (Amitiza) Indications

A

Injection used for opioid induced constipation, IBS in women >18 y/o

  • chronic idiopathic constipation
26
Q

Lubiprosone (Amitiza) MOA

A

Chloride channel activator/hyperosmotic

  • activate chloride channels in the GI epithelial lining, producing chloride-rich secretions that soften the stool and increase motility
27
Q

Lubiprosone (Amitiza) cautions/ contraindicaitons

A
  • NO if known or suspected bowel obstruction
  • NO in pregnancy or pediatrics
28
Q

Lubiprosone (amitiza) ADRs

A
  • headache, nausea, diarrhea, abdominal pain and bloating
29
Q

Opiod-Receptor Antagonist - Methylnaltrexone (Relistor) MOA

A

Think Methylanaltrexone / Naloxone

opioid receptor antagonist at the mu receptors in the GI tract -

30
Q

Methylnaltrexone (Relistor) indications

A

opiod-induced constipation (OIC)

  • better option to Amitiza
31
Q

Opiod-receptor antagonists (Relistor) cautions/ contraindications

A
  • known or suspected bowel obstruction
  • use caution in pregnancy
  • not recommended in pediatrics
  • monitor for opiod withdrawal symptoms
32
Q

Relistor ADRs

A
  • flatulence, nausea, diarrhea, abdominal pain and bloating
  • opioid withdrawal

NURP 424 Adv Pharm (63 decks)

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