Chapter 51 Bowel disorder drugs Flashcards
(116 cards)
1
Q
The key symptoms of gastrointestinal (GI) disease are?
A
abdominal pain, nausea and/or vomiting, and diarrhea.
2
Q
Diarrhea is a leading cause of morbidity and mortality in?
A
underdeveloped countries
3
Q
Diarrhea is defined as the passage of?
A
stools with abnormally increased frequency, fluidity, and weight, or increased stool water excretion.
4
Q
Acute diarrhea refers to diarrhea of sudden onset in a previously healthy individual. It lasts from 3 days to 2 weeks and is self-limiting, resolving without sequelae. Causes of acute diarrhea include?
A
drugs, bacteria, viruses, nutritional factors, and protozoa.
5
Q
Chronic diarrhea lasts for longer than 3 to 4 weeks and is associated with recurrent passage of diarrheal stools, possible fever, nausea, vomiting, weight reduction, and chronic weakness. Causes of chronic diarrhea include?
A
tumors, acquired immunodeficiency syndrome, diabetes mellitus, hyperthyroidism, Addison’s disease, and irritable bowel syndrome (IBS).
6
Q
Drugs used to treat diarrhea include?
A
adsorbents, anticholinergics, opiates, and probiotics.
7
Q
Treatment is aimed at stopping?
A
stool frequency, alleviating abdominal cramps, replenishing fluids and electrolytes, and ending weight loss and nutritional deficits from malabsorption.
8
Q
Fluid and electrolyte replacement is vital while a patient is experiencing diarrhea.
A
.
9
Q
Patients with diarrhea associated with a bacterial or parasitic infection must NOT use?
A
Antidiarrheal drugs, because this will cause the organism to stay in the body longer and will prolong recover
10
Q
Drugs used to treat diarrhea are called antidiarrheal drugs. Based on the specific mechanism of action, they are divided into different groups:
A
adsorbents, antimotility drugs, and probiotics (also known as intestinal flora modifiers and bacterial replacement drugs).
11
Q
Adsorbents mechanism of action
A
- Coat the walls of the gastrointestinal (GI) tract
- Bind to the causative bacteria or toxin, which is then eliminated through the stool
- Examples: bismuth subsalicylate (Pepto-Bismol), activated charcoal, and antilipemic drugs colestipol and cholestyramine
12
Q
Antimotility drugs: anticholinergics Mechanism of action
A
- Decrease intestinal muscle tone and peristalsis of GI tract
- Result: slows the movement of fecal matter through the GI tract
- Example: belladonna alkaloids
13
Q
Antimotility drugs: opiates mechanism of action
A
- Decrease bowel motility and reduce pain by relief of rectal spasms
- Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed
- Examples: paregoric, opium tincture, codeine, over-the-counter (OTC) loperamide, diphenoxylate
14
Q
Antimotility drugs: anticholinergics mechanism of action
A
- Slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract
- Drying effect
- Reduce gastric secretions
- Used in combination with adsorbents and opiates
15
Q
Activated charcoal is not only helpful in coating the walls of the GI tract and absorbing bacteria but also is useful in cases of?
A
Overdose because of its drug-binding properties
16
Q
Probiotics mechanism of action
A
- Also known as intestinal flora modifiers and bacterial replacement drugs
- Bacterial cultures of Lactobacillus organisms work by:
- Supplying missing bacteria to the GI tract
- Suppressing the growth of diarrhea-causing bacteria
- Example: Lactobacillus acidophilus (Bacid)
17
Q
The primary action of opiates in diarrhea tx is to?
A
Reduce bowel motility. A secondary effect that makes opiates beneficial in the Tx of diarrhea is reduction of pain associated with diarrhea by relief of rectal spasms
-Because they decrease the transit time of food through the GI tract, they permit longer contact of the intestinal contents with the absorptive surface of the bowel, which increases absorption of water, electrolytes, and other nutrients from the bowel and reduces stool frequency and net volume
18
Q
Antidiarrheal indications
A
1) Adsorbents: milder cases
2) Anticholinergics and opiates: more severe cases
3) Probiotics: antibiotic-induced diarrhea
19
Q
Antidiarrheal contraindications
A
- known drug allergy
- any major acute GI condition (intestinal obstruction, colitis)
20
Q
Antidiarrheal adverse effects for absorbents
A
- Increased bleeding time
- Constipation, dark stools
- Confusion
- Tinnitus
- Metallic taste
- Blue gums
21
Q
Antidiarrheal adverse effects for anticholinergics
A
- Urinary retention, impotence
- Headache, dizziness, confusion, anxiety, drowsiness,
- Dry skin, flushing
- Blurred vision
- Hypotension, bradycardia
22
Q
Antidiarrheal adverse effects for Opiates
A
- Drowsiness, dizziness, lethargy
- Nausea, vomiting, constipation
- Respiratory depression
- Hypotension
- Urinary retention
- Flushing
23
Q
Adsorbents interactions
A
- Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs.
- Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin).
- Toxic effects of methotrexate are more likely when given with adsorbents.
24
Q
The primary action of opiates in diarrhea treatment is to?
A
reduce bowel motility and thus permit longer contact of intestinal contents with the absorptive surface of the bowel. A secondary effect that makes opiates beneficial in the treatment of diarrhea is reduction of the pain associated with diarrhea by relief of rectal spasms.
25
Many drugs are absorbed from the intestines into the bloodstream, where they are delivered to their respective sites of action. A number of the antidiarrheals have the potential to alter this normal process by either?
increasing or decreasing the absorption of these other drugs.
26
The therapeutic effects of the anticholinergic antidiarrheals can be decreased by?
co-administration with antacids.
-Amantadine, tricyclic antidepressants, monoamine oxidase inhibitors, opiates, and antihistamines, when given with anticholinergics, can result in increased anticholinergic effects.
27
Anticholinergics work by decreasing?
GI peristalsis through their parasympathetic blocking effects. Adverse effects include urinary retention, headache, confusion, dry skin, rash, and blurred vision.
28
The opiate antidiarrheal have what interaction
Central nervous system (CNS) depressant effects if they are given with CNS depressants, alcohol, opioids, sedative-hypnotics, antipsychotics, or skeletal muscle relaxants
29
The only opiate-related antidiarrheal that is available as an OTC medication is?
Loperamide (Imodium); all others are prescription only drugs because of the risk for respiratory depression and dependency associated with opiate use
30
Antidiarrheal Opiate: Drug Loperamide (Imodium A-D)
- synthetic antidiarrheal similar to diphenoxylate
- inhibits both peristalsis in the intestinal wall and intestinal secretion, thereby decreasing the number of stools and their water content
- OTC
- Contraindicated: severe ulcerative colitis, pseudomembranous colitis, and acute diarrhea associated with Escherichia coli
31
Do NOT give bismuth subsalicylate to?
children or teenagers with chickenpox or influenza because of the risk of Reye’s syndrome.
32
Use adsorbents carefully in?
older patients and those with decreased bleeding time, clotting disorders, recent bowel surgery, or confusion.
33
Do not administer anticholinergics to patients with a?
history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, or toxic megacolon.
34
Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes.
Assess fluid volume status, input and output, and?
mucous membranes before, during, and after initiation of treatment.
- Teach patients to notify their prescribers immediately if symptoms persist.
- Monitor for therapeutic effect.
35
Before giving antidiarrheal preparations, obtain a thorough history and perform an assessment of?
Bowel patterns, general state of health, any recent illness, GI complaints, and any dietary changes
-always assess for possible causes of diarrhea such as food intolerance, lactose/wheat/gluten intolerance, fever/infection, and any medications that may be precipitating the changes in bowel patterns
36
In the abdominal assessment, include?
auscultation of bowel sounds in all four quadrants after inspection of the entire `abdomen but before percussion and palpation.
37
When the frequency of bowel sounds ranges from 6 to 32 per minute, it is important to describe exactly what is heard and the amount of activity in each of the four quadrants. Terms such as high-pitched, low-pitched, gurgling, or tinkling may be used to describe the character of the sounds, whereas activity may be described as?
hypoactive (fewer than 6 sounds per minute), normoactive (between 6 and 32 sounds per minute), or hyperactive (more than the normal range).
38
Stool assessment
Assess frequency, consistency, amount, color, and odor of stools
-need to rule out C. difficile infection
39
Report complaints of?
Abdominal pain/distention, bloody stools, confirmation of hypoactive to no bowel sounds, and/or fever
40
When administering diphenoxylate with atrophine, be wary of overuse because large amounts may result in?
Dry mouth, abdominal pain, tachycardia, and blurred vision
41
Elderly patients are more susceptible to?
fluid and electrolyte depletion associated with diarrhea; therefore, closely assess hydration status and age.
42
With antidiarrheals, educate the patient that the drugs must be taken?
Exactly as directions indicate, with strict adherence to the recommended dose, frequency, and duration of tx
43
Antidiarrheals: Encourage the pt to be aware of fluid?
Intake and any dietary changes that would impact health status or possibly exacerbate present symptoms
44
Antidiarrheals: Document any changes in?
Bowel patterns, weight, fluid volume, intake and output, as well as in the mucous membranes during and after treatment-whether for constipation or diarrhea
45
Inform the patient with bismuth subsalicylate must be taken as directed and that this medication will?
Turn the stool black or grey
46
Bismuth subsalicylate is a salicylate-based product and is NOT to be taken with?
Other salicylates to avoid toxicity
47
Check with childrens provider before giving bismuth subsalicylate to child or teenager with a ?
Viral infection, such as chickenpox or influenza, because of risk for Reye's syndrome
48
Antidiarrheals: Diphenoxylate hydrochloride and loperamide may be given?
Without regard to food intake but must be given with adequate fluid
- advise to follow specific directions
- maximum amounts are NOT to be exceeded, and if diarrhea continues or other symptoms occur (fever, abdominal pain, bloody stools) instruct to contact prescriber
49
Most probiotics derived from Lactobacillus or Bifidobacterium bacteria
- take exactly as directed
| - foods with probiotics: yogurt, fermented milk, miso, tempeh, juices and soy beverages
50
Counsel the patient to take antidiarrheal drugs with caution when performing tasks that require?
Mental alertness or motor skills until it is clear how the drug actually affects them
-advise them to report: abdominal distention or firm/hard abdomen, abdominal pain, worsening (or no improvement) of symptoms, rectal bleeding, unrelieved constipation or diarrhea, fever, N/V or other GI-related s/s, dizziness, muscle weakness, and muscle cramping
51
How to help with the adverse effect of dry mouth?
Frequent mouth care, fluid intake, or use of sugarless gum or candy
52
Bismuth subsalicylate may turn the stool?
Tarry black, so warn them this may happen
| -avoid other slicylates while taking this drug
53
What may help minimize constipation?
Increasing the intake of fluids (water), foods high in fiber and whole grains, green leafy vegies, fruits, exercise
54
For patients taking powder forms of methylcellulose, emphasize the need to have the powder?
Thoroughly mixed with at least 6 oz of liquid, which is stirred and drunk immediately to avoid esophageal or throat obstruction
55
Inform the patient taking senna to avoid?
Other medications within 1 hour of taking it and that it often takes 6-12 hours for the laxative effect to occur
56
With alosetron, emphasize the importance of reporting to the prescriber immediately any severe?
Constipation, bloody diarrhea, rectal bleeding, or worsening of abdominal pain
- DON'T double dosages if dose is omitted
- improvement in condition will take 4 weeks
57
Treatment of constipation is individualized, with consideration of the patient’s?
age, concerns, and expectations; duration and severity of constipation; and potential contributing factors.
58
The time span between ingestion and defecation is 24-36 hours. The last segment of the GI tract,the large intestine (colon) is responsible for?
1) forming the stool by removing excess water from the fecal material
2) temporarily storing stool until defecation
3) extracting essential vitamins from the intestinal bacteria (especially vitamin K)
59
Treatment of constipation
1) Surgical (extreme cases)
2) Nonsurgical treatments
- Dietary (e.g., fiber supplementation)
- Behavioral (e.g., increased physical activity)
- Pharmacologic
60
Laxatives are among the most misused over-the-counter
| (OTC) medications. Long-term and often inappropriate use of laxatives may result in?
Laxative dependence, produce damage to the bowel, or lead to previously nonexistent intestinal problems. With the exception of the bulk-forming type, laxatives are not to be used for long periods
61
Laxatives may act by:
(1) affecting fecal consistency
(2) increasing fecal movement through the colon
(3) facilitating defecation through the rectum
62
Bulk forming
- High fiber
- Absorb water to increase bulk
- Distend bowel to initiate reflex bowel activity
- Examples
1) psyllium (Metamucil)
2) methylcellulose (Citrucel)
63
Bulk-forming laxatives are composed of water-retaining
(hydrophilic) natural and synthetic cellulose derivatives.
They act in a manner similar to that of the fiber naturally
contained in the diet. They?
absorb water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement.
64
Emollient Laxatives
- Stool softeners and lubricants
- Promote more water and fat in the stools
- Lubricate the fecal material and intestinal walls
- Examples
* Stool softeners: docusate salts (Colace, Surfak)
* Lubricants: mineral oil
65
Hyperosmotic
- Increase fecal water content
- Results in bowel distention, increased peristalsis, and evacuation
- Examples
1) Polyethylene glycol (PEG)
2) Sorbitol, glycerin
3) Lactulose (also used to reduce elevated serum ammonia levels)
66
Emollient laxatives either directly?
lubricate the stool and the intestines, as with mineral oil, or act as fecal softeners. By lubricating the fecal material and the intestinal walls, lubricant emollient laxatives prevent water from moving out of the intestines, which softens and expands the stool
67
Stool softeners and bulk-forming drugs are often preferred to other drugs in the treatment of constipation because they are?
not as problematic with regard to fluid and electrolyte loss.
68
```
Hyperosmotic laxatives (e.g., glycerin, lactulose, sorbitol,
and polyethylene glycol) work by?
```
increasing fecal water content, which results in distention, increased peristalsis, and evacuation. Their site of action is limited to the large intestine.
69
Saline laxatives
- Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines
- Results in bowel distention (promotes peristalsis and evacuation), increased peristalsis, and evacuation
- Examples
1) Magnesium hydroxide (Milk of Magnesia)
2) Magnesium citrate (Citroma)
70
Saline laxatives consist of various magnesium or sodium
| salts that?
increase osmotic pressure and draw water into the
| colon, producing a watery stool, usually within 3 to 6 hours after ingestion.
71
Rectal enemas of sodium phosphate, a saline laxative, produce?
Defecation 2-5 minutes after administration
72
Stimulant laxatives
Stimulate the nerves that innervate the intestines, which results in increased peristalsis via intestinal nerve stimulation
-also increase fluid in colon, which increases bulk and softens the stool
Examples
senna (Senokot)
bisacodyl (Dulcolax)
73
Some of the common uses of laxatives include?
1) facilitation of bowel movements in patients with inactive colon or anorectal disorders
2) reduction of ammonia absorption in hepatic encephalopathy (lactulose only)
3) treatment of drug induced constipation
4) treatment of constipation associated with pregnancy and/or the postobstetric period
5) treatment of constipation caused by reduced physical activity or poor dietary habits
6) removal of toxic substances from the body
7) facilitation of defecation in megacolon
8) preparation for colonic diagnostic procedures or surgery
74
Bulk-forming laxative drugs
1) Psyllium
| 2) Methylcellulose
75
Emollient laxative drugs
1) Docusate salts
| 2) Mineral oil
76
Hyperosmotic laxative drugs
1) Polythylene glycol 3350 (GoLYELY)
| 2) Lactulose
77
Saline laxative drugs
1) Magnesium salts
78
Stimulant laxative drugs
1) Senna
| 2) Bisacodyl
79
Laxatives contraindictions
Use caution with laxatives in the presence of the following:
acute surgical abdomen; appendicitis symptoms such as
abdominal pain, nausea, and vomiting; fecal impaction
(mineral oil enemas excepted); intestinal obstruction; and
undiagnosed abdominal pain.
80
Bulk-forming adverse effects
```
Impaction
Fluid overload/disturbances
Electrolyte imbalances
Esophageal blockage
Gas formation
```
81
Emollient (laxative) adverse effects
Skin rashes
Decreased absorption of vitamins
Electrolyte imbalances
Lipid pneumonia
82
Hyperosmotic (laxative) adverse effects
Abdominal bloating
Electrolyte imbalances
Rectal irritation
83
Saline (laxative) adverse effects
```
Magnesium toxicity (with renal insufficiency)
Cramping
Electrolyte imbalances
Diarrhea
Increased thirst
```
84
Stimulant (laxative) adverse effects
```
Nutrient malabsorption
Skin rashes
Gastric irritation
Electrolyte imbalances
Discolored urine
Rectal irritation
All laxatives can cause electrolyte imbalances!
```
85
Laxatives alter intestinal function; therefore, they can interact with?
other drugs because many drugs are absorbed in the
| intestines.
86
Bulk-forming laxative interactions?
Can decrease the absorption of antibiotics, digoxin, salicylates, tetracyclines, and warfarin
87
Emollient laxative: Mineral oil interactions
Can decrease the absorption of fat-soluble vitamins (A,D,E, and K)
88
Fat soluble vitamins
A,D,E, & K
89
Hyperosmotic laxatives: Polyethylene glycol and Lactulose interactions
Can cause increased CNS depression if given with barbiturates, general anesthetics, opioids, or antipsychotics
90
Oral antibiotics can decrease the effects of?
Lactulose
91
Stimulant laxatives (Bisacodyl, Senna) interactions
Decrease the absorpton of antibiotics, digoxin, nitrofurantoin, salicylates, tetracyclines, and oral anticoagulants
92
Bulk forming laxatives need to be taken with?
liberal amounts of water to prevent esophageal obstruction and/or fecal impaction
93
Bulk forming laxative: Methylcellulose (Citrucel)
- Synthetic
- attracts water into the intestine and absorbs excess water into the stool, stimulating the intestines and increasing peristalsis
- contraindications: GI obstruction and hepatitis
- oral drug available in powdered form that provides 2 g of fiber per heaping TBS
94
Bulk forming laxative: Psyllium (Metamucil)
- natural obtained from dried seed of the plantago psyllium plant
- many characteristics of methylcellulose
- contraindicated: intestinal obstruction or fecal impaction, abdominal pain and/or nausea and vomiting
- oral use in wafer and powder form
95
Emollient Laxatives: Docusate salts (calcium and sodium) (Colace)
- stool softening that facilitate the passage of water & lipids (fats) into the fecal mass, which softens the stool
- Tx constipation, to soften fecal impactions, prevent opioid-induced constipation
- docusate does not cause pt's to defecate; it simply softens the stool to ease passage
- contraindicated: intestinal obstruction, fecal impaction, nausea and vomiting
96
Emollient laxative: Mineral oil
- Ease passage of stool by lubricating the intestines and preventing water from escaping the stool
- Only lubricant laxative
- mixture of liquid hydrocarbons derived from petroleum and is used to treat constipation associated with hard stools or fecal impaction
- contraindicated: intestinal obstruction, abdominal pain, N/V
- available as enemas and in products for oral use
- combination products: Haley's M-O, includes mineral oil and milk of magnesia (magnesium hydroxide)
97
Hyperosmotic laxative: Polyethylene glycol 3350 (GoLYELY)
- Given before diagnostic or surgical bowel procedures, very potent that induces total cleansing of the bowel
- 3350 designation refers to the osmolality of drug
- powdered dosage that contains mixtures of electrolytes that also help stimulate bowel evacuation
- powser reconstituted in a large volume of fluid (1 gal) that is then gradually drunk by patient on the afternoon of the dya before the procedure
- contraindicated: GI obstruction, gastric retention, bowel perforation, toxic colitis, toxic megacolon, or ileus
- oral solution of PEG-3350 and electrolyes available for GI lavage
- diarrhea usually occurs within 30-60 minutes after ingestion; complete evacuation and cleansing of the bowel is accomplished within 4 hours
98
Hyperosmotic laxative: Lactulose
- synthetic derivative of natural sugar lactose, which is not digested in the stomach or absorbed in the small bowel. Instead it passes unchanged into large intestine, where it is metabolized
- colonic bacteria digest lactulose to produce lactic acid, formic acid, and acetic acid, which creates a hyperosmotic environment that draws water into colon and produces a laxative effect
- this drug induced acid environment also reduces blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation
- this effect helpful in reducing serum ammonia levels in pt's with hepatic encephalopathy
- contraindicated: low-lactose diet
- solution for either oral or rectal use
99
Saline laxative: Magnesium salts
- unpleasant tasting OTC laxative preparations
- use with caution w/renal insufficiency, because they can be absorbed enough to cause hypermagnesemia
- used to evacuate the bowel rapidly in prepartion for endoscopic examination and to help remove unabsorbed poisons from GI tract
- contraindicated: renal disease, abdominal pain, N/V, obstruction, acute surgical abdomen, or rectal bleeding
- magnesium hydroxide is milk of magnesia, oral liquid and tablet
- Also found in Haley's M-O
- Magnesium oxide is used as a supplement, not laxative
100
Stimulant laxatives: Bisacodyl (Dulcolax)
- most commonly used
- oral tablet or rectal suppository
- used for constipation or for whole bowel evacuation prior to endoscopic examination
- OTC
101
Stimulant laxative: Senna (Senokot)
- commonly used OTC
- obtained from dried leaves of the Cassia acutifolia plant
- used for relief of acute constipation or bowel preparation for surgery or examination
- may cause abdominal pain
- can produce complete bowel evacuation in 6-12 hours
- available in variety of dosages as tablets, syrup, granules
- the product Senoko-S includes both senna and the stool softener docusate sodium
102
Laxative Nursing Implications
- Obtain a thorough history of presenting symptoms, elimination patterns, and allergies.
- Assess fluid and electrolytes before initiating therapy.
- Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, or abdominal pain.
- A healthy, high-fiber diet and increased fluid intake should be encouraged as an alternative to laxative use.
- Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
- All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated.
- Patients should take all laxative tablets with 6 to 8 oz of water.
- Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water.
103
Give bisacodyl (stimulant laxative) with water because of?
interactions with milk, antacids, and juices.
- Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss.
- Monitor for therapeutic effect
104
Laxative use requires further assessment in addition to the abdominal assessment and bowel pattern history. For example? Focus questions on?
Changes in bowel patterns, long-term use of laxatives (because they can become laxative dependent), and dietary and fluid intake
-note the presence of any weakness because of the possibility of hypotension and volume or electrolyte depletion (long term use)
105
Laxatives: In pediatric or adolescent patients, assess for?
eating disorders with use of laxatives.
| -also assess for laxative abuse in older adults
106
With hyperosmotic laxatives (e.g., polyethylene glycol, lactulose, sorbitol, and glycerin), assess baseline?
fluid and electrolyte levels to identify any deficits prior to use
- assess for presence of abdominal pain, degree of peristalsis, history of recent abdominal surgery, N/V, weight loss
- older adult patients react more adversely so their use should be avoided
107
The bulk-forming laxatives are often used to treat chronic constipation and have few adverse effects, but a basic what needs to be assessed?
A basic abdominal and bowel pattern assessment and related history taking
108
Use docusate salts or emollient laxatives cautiously in the?
Older adult patients
109
Saline laxatives (magnesium salts) are to be used with caution in?
Older adults because of the possible dehydration and electrolyte loss
-they may also cause magnesium toxicity in those with compromised renal status, so assess baseline renal function in those at risk
110
Senna and bisacodyl are examples of stimulant laxatives. They may cause?
Electrolyte imbalances, so baseline electrolyte levels are important to assess and monitor
111
Bulk-forming laxatives such as methylcellulose must be taken with at least 8 ounces or 1 full glass of liquid after?
the powder form has been thoroughly stirred into it. The fluid must be taken immediately because of a congealing effect that continues to harden with time. To avoid choking or swelling of the product in the throat or esophagus, the patient must swallow or receive the drug immediately upon stirring. The medication is never taken or administered in its dry form.
112
Docusate (emollient laxative) is available in a variety of oral dosage forms (capsules, tablets, syrups, elixir), and is recommended to take it with?
At least 6 oz of water or other fluid. An additional 6-8 oz glass of water a day is also suggested to help with stool softening
113
Bisacodyl (stimulant laxative) is best taken?
On an empty stomach for faster action, and whole tablets are NOT to be chewed or crushed
- do NOT take milk, antacids, or juices with the dose or within 1 hour of taking the medication
- rectal suppositories, if too soft, may be placed in a medicine cup with ice to harden. Once wrapper is removed apply a water-soluble lubricant & use glove hand or finger
- Encourage the patient to try and keep a suppository in place by lying still on the left side for at least 15 to 30 minutes to allow the drug to dissolve for maximal effectiveness.
114
Lactulose (hyperosmotic laxative) may be taken with
Juice, milk, or water to increase palatability
- normal color of oral solution is PALE YELLOW
- Administer rectal dosage forms as a retention enema with dilution. Instruct to retain for 30-60 minutes
- proper insertion of retention enema, lubricate tip of the apparatus and insert it carefully with the nozzle pointed toward the umbilicus, and discontinue administration if pt experiences severe abdominal pain
- if long term use of drug is indicated, monitoring serum electrolyte levels is needed
115
Magnesium-based laxatives are generally used only in?
Certain situations because they are very potent
- force fluids, and follow prescribers orders
- refrigeration may increase palatability of oral solution
- taken EXACTLY as prescribed for constipation, with consumption of plenty of fluids and careful attention to AEs
116
PEG-electrolyte solution (hyperosmotic laxative) is to be mixed with?
Water or a flavored sports drink as directed and to shake well before drinking
- chilled solutions are tolerated better
- rapid drinking of each dose is recommended
