Laxative and Anti-Diarrhea

Question 1

What does constipation mean?

Answer 1

A change in bowel habits but has a varied meaning

Question 2

What are bulk laxatives?

Answer 2

Oral non-digestible hydrophilic colloids that absorb water

Question 3

What do bulk laxatives cause?

Answer 3

Intestinal distension that promotes peristalsis

Question 4

What are examples of bulk laxatives?

Answer 4

Psyllium seed

Methylcellulose

Question 5

How do stool softeners work?

Answer 5

Surfactants that promote water absorption in stool

Question 6

Examples or stool softeners?

Answer 6

Mineral oil

Docusate

Question 7

Three general categories for osmotic laxatives:

Answer 7

Magnesium or phosphate salts
Non-absorbable sugars
Polyethylene glycols

Question 8

What are non-absorbable sugars?

Answer 8

Lactulose

Sorbitol

Question 9

Polyethylene glycol molecular weight?

Answer 9

3350

Question 10

What are stimulant laxatives?

Answer 10

Aloe
Senna
Cascara sagrada
Bisacodyl

Question 11

What is a common chloride channel activator?

Answer 11

Lubiprostone

Question 12

How do guanylate cyclase C agonists work?

Answer 12

Stimulate guanylate cyclase 2C increasing bicarbonate and Cl- secretion by CFTR

Question 13

What effect do guanylate cyclase c agonists have of neurons?

Answer 13

Decrease activation of colonic sensory neurons (decreases pain) and activates colonic motor neurons (increasing smooth muscle contraction)

Question 14

Who do you give narcotic receptor antagonists to?

Answer 14

Patients on narcotic therapy

Question 15

What are three narcotic receptor therapies and which are chronic and acute therapy?

Answer 15

Chronic: Methylnaltrexone, naloxegol
Acute: Alvimopan

Question 16

What are bile acid binders used for?

Answer 16

Regional ileitis - Crohn’s disease

Question 17

How do bile acid binders work?

Answer 17

They bind and prevent reabsorption of bile acids in the lumen

Question 18

Example of bile acid binder:

Answer 18

Cholestyramine

Question 19

What does bismuth subsalicylate do?

Answer 19

Binds and inactivates bacterial enterotoxins

Question 20

What is octreotide?

Answer 20

An analog of somatostatin (works as somatostatin inhibiting everything)

Question 21

What are two drugs that are antidiarrheal opioids?

Answer 21

Diphernoxylate

Loperamide

Question 22

Why is loperamide OTC?

Answer 22

Because it fails to reach significant CNS levels

Question 23

What is used to reverse opiate induced constipation?

Answer 23

Alvimopan (short term)
Methylnaltrexone (caution with intestinal malignancy)
Naloxegol (cancer)

Question 24

What are the three classifications of primary constipation?

Answer 24

Normal transit: hard stool or difficult defecation with normal frequency
Slow transit: abnormal innervation of bowels with slow infrequent defecation
Defecation disorders: cannot relax muscles for defecation or stretch response diminished (older ppl)

Question 25

What causes secondary constipation?

Answer 25

Medication, chronic disease, psychosocial

Question 26

What is biofeedback used for?

Answer 26

To retrain the defecation muscles

Question 27

What are enemas and suppositories good for?

Answer 27

Fecal impactions or patients that cannot tolerate oral preparations

Question 28

Why are phosphate enemas avoided in older patients?

Answer 28

It can mess with electrolyte balance and become fatal