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OTC > constipation and diarrhea > Flashcards

constipation and diarrhea Flashcards

1
Q

signs and symptoms of constipation

A

anorexia, dull headache, low back pain, abdominal discomfort, bloating, and flatulence

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2
Q

primary cause of constipation

A

inadequate dietary fiber, fluid intake, and/or exercise

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3
Q

structural conditions causing constipation

A

anal fissure and pregnancy

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4
Q

systemic conditions that cause constipation

A
  • endocrine: thyroid disorders, diabetes
  • IBS
  • MS, neuropathy
  • parkinsonism
  • dementia
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5
Q

psychological conditions that cause constipation

A

depression, eating disorders, stress, changes in routine

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6
Q

medications that can cause constipation

A

anticholinergics, TCA, benzodiazepines, cholestyramine, calcium, and iron supplements

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7
Q

exclusions for constipation

A
  1. significant abdominal pain or cramping or distention
  2. unexplained flatulence
  3. fever or NV
  4. unexplained changes in bowel habits
  5. marked change in the character of stool
  6. rectal bleeding
  7. < 2 years of age
  8. anorexia
  9. inflammatory bowel disease, colostomy
  10. 14 days of symptoms or recurrences over 3 months
  11. 7 days of OTC treatment
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8
Q

non pharm therapy

A

gradually increase high-fiber food, increase fluid intake, exercise regularly

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9
Q

increase these foods for a high-fiber diet

A

fruits, vegetables, whole grains

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10
Q

decrease these foods for a high-fiber diet

A

meat, chest, processed foods

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11
Q

fiber intake for women

A

25 grams

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12
Q

fiber intake for males

A

38 grams

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13
Q

examples of bulk forming agents (fiber supplements)

A

methylcellulose, polycarbophil, and psyllium

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14
Q

onset of fiber supplements

A

12-72 hours

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15
Q

ADE of fiber supplements

A

abdominal discomfort and flatulence

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16
Q

fiber supplement precautions

A

swallowing difficulties, GI ulcer, high calcium content in polycarbophil, sugar content in some formulations

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17
Q

first choice for pregnant women

A

fiber supplements

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18
Q

MOA fiber supplements

A

dissolves and swells in intestines and adds bulk and water to stool

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19
Q

examples of emollient agents (stool softeners)

A

docusate

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20
Q

MOA of stool softeners

A
  • surfactant
  • facilitates mixture of aqueous and fatty substances to soften stool
  • lower surface tension of stool, allowing more water to enter stool
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21
Q

onset of stool softeners

A

12-72 hours

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22
Q

ade for stool softeners

A

minimal

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23
Q

precautions of stool softeners

A

larger than recommended doses can lead to sweating, muscle cramps, and irregular heartbeat.

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24
Q

contraindications with stool softeners

A

mineral oil`

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25
Q

examples of hyperosmotic agents

A

PEG 3350 and glycerin

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26
Q

MOA of hyperosmotic agents

A

contain large, poorly absorbed ions or molecules that draw water into the colon or rectum through osmosis

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27
Q

peg3350 onset

A

12-72 hours

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28
Q

glycerin onset

A

15-30 min

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29
Q

ade of peg3350

A

bloating, abdominal discomfort, cramping, flatulence

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30
Q

glycerin ade

A

rectal irritation

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31
Q

peg3350 precaution

A

fda approved labeling indicates patients with renal disease or OBS should consult PCP prior to use

32
Q

glycerin precaution

A

avoid if preexisting rectal irritation

33
Q

peg3350 age requirements

A

must be at least 17 yoa

34
Q

examples of stimulants

A

senna and bisacodyl

35
Q

MOA of stimulants

A

increase motility by stimulation of intestinal SM (causing intestines to contract and push out stool), increase secretion of water and electrolytes in the intestines

36
Q

onset of po stimulants

A

6-10 hours

37
Q

Bisacodyl suppository onset

A

15-60 min

38
Q

ade of stimulants

A

cramping and local irritation of the mucosa

39
Q

stimulant precautions

A

electrolyte or fluid deficiencies, malabsorption due to hypermotility

40
Q

DDI with stimulants

A

avoid with antacids

41
Q

opioid induced constipation

A

docusate and stimulant combo typically

42
Q

examples of lubricant agents

A

mineral oil

43
Q

moa of mineral oil

A

coats stool and prevents absorption of water into the colon

44
Q

po onset of mineral oil

A

6-8 hours

45
Q

rectal onset of mineral oil

A

5-15 min

46
Q

when using mineral oil avoid..

A
  1. < 6 years of age
  2. pregnancy
  3. bedridden/elderly
  4. difficulty swallowing
  5. aspiration risk
47
Q

contraindication of mineral oil

A

docusate

48
Q

eating and mineral oil

A

impairment of absorption of fat-soluble vitamins (do not take within 2 hours of eating)

49
Q

mineral oil use

A

avoid if possible, better and safer treatment alternatives are available

50
Q

examples of saline laxative agents

A

magnesium citrate, magnesium hydroxide, magnesium sulfate, sodium phosphates

51
Q

MOA of saline laxatives

A

ions draw water into the intestines by osmosis, increasing intraluminal pressure and promoting GI motility

52
Q

po onset of saline laxatives

A

30 min - 6 hours

53
Q

rectal onset of saline laxatives

A

up to 15 min

54
Q

ade of saline laxatives

A

abdominal cramping, NV, dehydration, hypermagnesemia

55
Q

precautions for saline laxatives

A

elderly, electrolyte changes, renal failure, restricted diet (na, phos, mg), CHF, use with diuretics

56
Q

saline laxative use

A

used prior to colonoscopy to evacuate bowel and take with water to prevent dehydration

57
Q

acute diarrhea

A

symptoms lasting less than 14 days

58
Q

persistent diarrhea

A

symptoms lasting 14 days to 4 weeks

59
Q

chronic diarrhea

A

symptoms lasting > 4 weeks

60
Q

minimal to no dehydration

A 
self treatable
good, alert mental status
drinks normally
normal HR
mouth is moist
skin has instant recoil
capillary refill is normal\
extremities are warm
urine output is normal/decreased
< 3 stools/day
61
Q

mild-moderate dehydration

A 
self treatable
normal, fatigue mental status
eager to drink
normal or increased HR
mouth is dry
skin recoils < 2 seconds
capillary refill is prolonged
extremities are cool
urine output is decreased
3-5 stools/day
62
Q

severe dehydration

A 
not self treatable
apathetic or lethargic mental status
unable to drink
tachy or bradycardia
mouth is parched
skin recoils in > 2 seconds
capillary refill is prolonged and minimal
cold extremities
urine output is minimal
6-9 stools/day
63
Q

exclusions for diarrhea

A
  1. infants < 6 months of age
  2. moderate diarrhea < 2 yo
  3. children with high fluid output, fever, or mental status changes
  4. severe diarrhea
  5. stool containing blood/mucus
  6. DM, cardiac/renal disease, URTI
  7. severe abdominal pain, cramping, tenderness, distention
  8. pregnancy
  9. immunocompromised
64
Q

nonpharm treatment

A

ORS, preventative measires

65
Q

loperamide MOA

A

synthetic opioid agonist

produces antidiarrheal effects by slowing intestinal motility, lacks CNS effects bc it is a substrate for p-glycoprotein

66
Q

loperamide indication

A

symptomatic relief of acute, nonspecific diarrhea

67
Q

ade of loperamide

A

dizziness and constipation

68
Q

precautions for loperamide

A

should not be used in invasive bacterial diarrhea, children < 6 or in patients taking saquinavir

69
Q

length of use for loperamide

A

no more than 2 days

70
Q

loperamide warnings

A

serious heart problems with misuse and abuse

71
Q

BSS MOA

A

reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid, exerts antibacterial effects and antisecretory effects

72
Q

BSS indication

A

acute diarrhea, travelers diarrhea prophylaxis, or indigestion

73
Q

ade of BSS

A

tinnitus (dose related), gout, reyes syndrome, black staining of stool and darkening of tongue

74
Q

precautions of BSS

A

children < 12

75
Q

patients with lactate deficiency

A

lactase enzymes

76
Q

probiotics

A

lactobacillus, Bifidobacterium lactis, saccharomyces boulardii

77
Q

zinc supplementation

A

reduces duration, severity, and persistence of acute diarrhea in children < 5

OTC (22 decks)

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