Managing Diarrhoea, Constipation and IBS

Question 1

name some opioids used for diarrhoea

Answer 1

codeine phosphate,
diphenoxylate,
loperamide (in immodium)

Question 2

how do opioids work in teh gut to treat diarrhoea?

Answer 2

agonist of the mu-opioid receptors in the gut. inhibit propulsive movements of the bowel and prolong transit time which also provides an opportuinty for enhanced fluid absorption whcih may harden stool

Question 3

why are opioids used for diarrhoea not addictive?

Answer 3

they do not cross the blood-brain barrier

Question 4

name some bulk-forming laxatives

Answer 4

bran,
isphaghula husk,
methylcellulose,
sterculia

Question 5

why would bulk forming laxatives not be good for someone with acute diarrhoea?

Answer 5

full effect takes a few days so you may need something that acts quicker.

Question 6

what type of laxative are macrogols?

Answer 6

osmotic laxative

Question 7

what type of laxative is lactulose?

Answer 7

osmotic

Question 8

how do osmotic laxatives work?

Answer 8

draw water back into stool - need to keep patients hydrated for it to work

Question 9

why are osmotic laxatives given to patients with liver failure?

Answer 9

they increase gut transit time whcih reduces ammonia absorption and acidifies the stool which inhibits proliferation of ammonia-producing bacteria and this can prevent hepatic encephalopathy

Question 10

when are osmotic laxatives contraindicated and why?

Answer 10

intestinal obstruction due to increased risk of perforation

Question 11

give some examples of stimulant laxatives (3)

Answer 11

bisacodyl
docusate sodium
senna

Question 12

how do stimulant laxatives work

Answer 12

increase bowel movements and secretion of water and electrolytes from colonic mucosa

Question 13

which stimulant laxative would you use if you wanted rapid action in 15-30 minutes?

Answer 13

bisacodyl

Question 14

which stimulant laxative is a powerful irritant often given orally to prepare the bowel for surgery or colonoscopy because it acts in <6hrs?

Answer 14

sodium picosulphate

Question 15

what type of laxative is docusate sodium?

Answer 15

faecal softener

Question 16

what diet would you suggest to someone with constipation?

Answer 16

high fibre diet

Question 17

what laxative could you give to someone with constipation at night to give mornign bowel action?

Answer 17

senna or bisacodyl

Question 18

for longer-term constipation therapy, what tends to be well tolerated and effective?

Answer 18

regular macrogol or lactulose

Question 19

which laxatives are safe to use in pregnancy?

Answer 19

senna, magnesium salts and docusate

Question 20

which laxatives would you use for the elderly or terminally ill who have opioid-induced constipation?

Answer 20

bisacodyl or co-danthrusate

Question 21

what type of laxatives should you use for constipation where neurological disease is the cause?

Answer 21

faecal softener with regular enemas or rectal washouts

Question 22

how should you manage diarrhoea in an uncomplicated case?

Answer 22

increase oral fluid and electrolyte intake

Question 23

what pharmacological therapy could you use for mild to moderate diarrhoea?

Answer 23

opioids

Question 24

in what cases of diarrhoea should you not give something to treat diarrhoea?

Answer 24

in gastroenteritis when prolonging contact of the organism with the gut mucosa can be detrimental

Question 25

name 2 antimuscarinic drugs used to treat gut spasms

Answer 25

hyoscine butylbromide (buscopan)
propantheline

Question 26

name 2 other antispasmodica agents that are not anti-muscarinics

Answer 26

mebeverine

peppermint oil

Question 27

what advice should be given to someone to manage their IBS?

Answer 27

• treatments involve a combination of drugs, CBT, relaxation and hypnotherapy
• reduce intake of tea and coffee
• smoking cessation
• avoid trigger foods