Constipation And Laxatives/antidiarrheal Agents

Question 1

Diarrhea acute vs chronic

Answer 1

Acute:

• lasts less than 4 days
• predominantly caused by infectious agents

Chronic:

• symptoms persist for 3 weeks in children/adults to 4 weeks in infants
• caused by infectious organisms/food intolerance/drugs/IBD

Question 2

Why does bile-salt-binding resins work for diarrhea?

Answer 2

It is believed that malabsorption of bile salts may cause diarrhea
- draws water into colonic lumen

is believed to be tied to Crohn’s disease, gallbladder surgery and surgical resection of colon

Question 3

What are the two opiod agonists that have highest potential for abuse?

Answer 3

Diphenoxylate and difenoxin
- both can cross blood brain barrier at high doses

• both should be used with atropine combo therapy to reduce abuse potential*
• this does cause dry mouth though

Question 4

Constipation most common causes

Answer 4

Failure to respond to defecating urges chronically

Inadequate fiber in diet

Inadequate fluid intake

Weakness of abdominal muscles

Inactivity and bed rest

Pregnancy

Hemorrhoids

Narcotics/anticholinergic agents/CCBs/diuretics/calcium/iron supplements/aluminum antacids

Question 5

Laxatives that result in soft or semi fluid stool within 6-12 hrs

Answer 5

Oral bisacodyl

Magnesium sulfate

Question 6

Laxatives that cause watery evacuation in 1-6 hrs

Answer 6

Magnesium citrate

Magnesium hydroxide

Magnesium sulfate

Senna

Rectal bisacodyl