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Pharm 3 Module 2: GI > colonoscopy prep > Flashcards

colonoscopy prep Flashcards

1
Q

what are the types of bowel preps

A

isosmotic
hyper-osmotic
stimulant laxatives

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2
Q

What is isosmotic prep

A

no permeation of cell membranes
these are PEG (polyethylene glycol) - based electroylet lavage solutions
negligible absorption from GI tract

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3
Q

what is the MOA for PEG

A

osmotic effect of PEG causes water to be trained in colon - produces watery stool
no significant changes in water or electrolyte balance occur

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4
Q

what are the full volume isosmotic preps

A

colyte
GoLYTELY
NuLYTELY
TriLyte

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5
Q

what are the low volume preps

A

HalfLytely
Miralax
MoviPrep

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6
Q

what are the advantages of PEG-based preps

A

no mucosal damage
minimal osmotic fluid shifts
safer than sodium phosphate-based solutions in patients with impaired renal function, CHF, cirrhosis or baseline elecytrolyte abnormalities

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7
Q

what are the disadvantages of PEG-based preps

A

large volume of fluid (4L)
unpalatable taste (if not flavored)

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8
Q

what are contraindications of PEG-based solution

A

patients with gastric outlet obstruction
high-grade small bowel obstruction
suspected bowel perforation

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9
Q

how often is PEG-based solutions taken

A

240ml (8oz) every 10 minutes

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10
Q

what is a hyperosmotic prep

A

contains a higher concentration of salts or other dissolved material than normal tissues

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11
Q

what is the MOA of hyperosmotic preps

A

increase intraluminal water (pulls water into intestine) by promoting passage of extracellular fluid across the bowel wall
high Na+ concentration - causes watery diarrhea

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12
Q

what is the main formulation of hyperosmotic preps

A

sodium phosphate

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13
Q

what are the hyperosmotic preps

A

OsmoPrep
Suprp
Prepopik
Clinpiq

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14
Q

what is the first FDA approved ready to drink low volume bowel prep

A

clenpiq

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15
Q

what is the MOA of clinpiq

A

prodrug, has no significatn direct physiological effect on the intestine
metabolized by gut bacteria into active compound 4,4’-dihydroxydiphenyl-(2-pyridiyl) methane (DPM, DPHM)

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16
Q

what does DHPM act on

A

directly on the colon, stimulating peristalsis

17
Q

what are contraindications for Clenpiq

A

creatinine clearance < 30ml/min - may lead to accumulation of magnesium

18
Q

what are the advantages of hyperosmotic preps

A

small volume (though additional fluids must be consumed as well)
more palatable than PEG-based solutions

19
Q

what are the disadvantages of hyperosmotic preps

A

potential for causing fluid and electrolyte shifts by drawing water into the intestine
renal damage

20
Q

what are the risks of NaP bowel prps

A

acute phyosphate nephropathy
patients at most risk: increased age, hypovolemia, decreased bowel transit time, activity colitis, baseline kidney disease)

21
Q

what are contraindicatiosn to NaP bowel preps

A

pediatric patients
elderly patients
patients with bowel obstruction
renal insufficiency or failure
CHF
liver failure

22
Q

what is the MOA oof stimulatn laxatives

A

increase smooth muscle activity (peristalsis)
ex. senna,busacodyl, sodium picosulfate

23
Q

what does senna do

A

increase rate of motility - enhances colonic transit and inhibits water and electorylte secretion
often used as adjunct to PEG regimens

24
Q

what does Bisacodyl do

A

2 MOA: stimulation of small intestine enzyme secretion and increased motor activity within the colon

25
Q

what is the rationale of “split-dose regimen”

A

better tolerated by patients
part of purgative is taken the evening before and the remainder is taken the morning of the procedure

26
Q

what is “split-dose regimen”

A

part (usually 1/2) of laxative takne evening prior and remaineder am of procedure (3-8 hours before)
colonoscopy should be performed within 8 hours of last dosing

27
Q

what are the barriers of split dosing

A

patient acceptance of sleep disturbances
bowel activity in transit to procedure
non-compliance with pre-procedure fasting fuidelines

28
Q

what are dietary recommendations prior to colonoscopy

A

~2 days before colonoscopy - low fiber, no while grains, nuts, seeds, dried fruit or raw fruits/vegetables
day before: no solid foods (clear liquids only)
the day of: clear liquid only - dont eat or drink 2 hours prior to procedure

29
Q

what patients characterisitcs increase the risk of a bad prep

A

elderly
obesity
lower education
hx constipation
hx of non-compliance or poor response to prep

Pharm 3 Module 2: GI (4 decks)

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