Constipation & Diarrhea Flashcards Preview

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Flashcards in Constipation & Diarrhea Deck (66):
0

What's constipation?

Infrequent or hard stools or difficulty passing stools

No bowel movements after more than 3 days

1

What's the tx duration for constipation, as per FDA?

OTC laxatives should be limited to 7 days unless under medical supervision

2

What's the recommended first-line tx for constipation?

Bulk-forming laxatives that contain either;

Psyllium
Methylcellulose or
Polycarbophil

3

What's another commonly used laxative?

Stool softener (Docusate)

4

What's the stool softener (Docusate) especially helpful for?

Iron-induced constipation

Bcuz iron causes compact, hard stools which are difficult to pass

5

List medical conditions where constipation is common

Cerebrovascular events

Parkinson dx

Spinal cord tumors

Diabetes

Hypothyroidism

Multiple sclerosis

Irritable bowel syndrome (constipation-predominant)

Anal disorders (anal fissures, fistulae, rectal prolapse)

6

List main meds that are constipating

Opioids

Anticholinergic drugs

Verapamil

Iron (use Docusate to avoid hard, compact stools)

7

List other meds that are constipating

Antihistamines, phenothiazines, tricyclic antidepressants, antispasmodics, urge incontinence drugs, esp darifenacin (Enablex)

Non-DHP CCBs

Clonidine

Bismuth

Aluminum antacids (Mg often in combo with Al to counter this effect)

Tramadol, tapentadol

Colesevelam

Milnacipran

Ranolazine

Varenicline

5-HT3 receptor antagonist e.g. Ondansetron

Phentermine/topiramate

Aripiprazole

8

What drugs are the worst offenders of constipation?

Opioids

9

Whats usually scheduled with an opioid?

A stimulant laxative (usually senna) is given first with or without stool softener (docusate)

10

What factors should a pharmacist dispensing opioids consider?

Dose

Frequency

Pt at baseline

11

What's used if the pt is constipated now and req tx?

Options are different from those used to prevent

Lactulose

Sorbitol

Milk of magnesia (MOM)

Magnesium citrate

Polyethylene glycol

12

What's does a successful colonoscopy entails?

Requires a complete and thorough bowel prep

13

Issues with sodium phosphate?

Sodium phosphate can cause:

Fluid and electrolyte abnormalities (particularly risky in pts with renal or cardiac dx)

14

Why do some bowel prep agents req MedGuide?

Because of fluid and electrolyte abnormalities

15

What types of pts should extra caution be used in wrt concurrent use of bowel prep agents?

Pts with cardiovascular dx

Renal insufficiency

Pts on diuretics (loops, due to additional fluid loss)

NSAIDs

16

What's ok to consume prior to bowel prep?

"Clear liquid diet" ONLY

E.g. Water, clear beef/chicken broth, fat-free consommé, juices (Apple, prune, grape, cranberry and cider), coffee or tea (without milk or cream), clear gelatin (without fruit pieces), Popsicles (without fruit pieces or cream) fruit ices (no fruit pieces)

17

List bulk-producing laxatives

Psyllium (Metamucil, others)

Calcium polycarbophil (FiberCon, others)

Methylcellulose (Citrucel)

18

What's the brand name of Psyllium (bulk-producing laxatives)?

Metamucil

19

What's the brand name of Calcium polycarbophil (bulk-producing laxatives)?

FiberCon

20

What's the brand name of Methylcellulose (bulk-producing laxatives)?

Citrucel

21

What's the first-line tx of constipation and drug of choice in pregnancy?

Bulk-producing laxatives:

Psyllium (Metamucil, others)

Calcium polycarbophil (FiberCon, others)

Methylcellulose (Citrucel)

22

How should bulk-producing laxatives (Psyllium (Metamucil); Calcium polycarbophil (FiberCon); Methylcellulose (Citrucel)) be used with other drugs?

2 hrs before/after drugs

23

List agents under emollients, lubricants (stool softeners)?

Docusate Sodium (Colace)

24

What's the brand name of Docusate sodium (emollients, lubricants, stool softeners)?

Colace

25

What's the caution when recommending agents?

Take caution when recommending pdts by brand name, as many brand names can refer to multiple pdts

26

List agents under stimulants and irritants

Senna (Ex-Lax)

Bisacodyl (Dulcolax)

27

Whats the brand name of Senna (agents under stimulants and irritants)?

Ex-Lax

28

Whats the brand name of Bisacodyl (agents under stimulants and irritants)?

Dulcolax

29

When is SE of senna increased?

When high doses are used

30

What's the caution in recommending brand name of senna?

Same brand names can refer to multiple pdts

31

List rx agents for constipation

Lubiprostone (Amitiza)

Linaclotide (Linzess)

32

What's the brand name of Lubiprostone (rx agents for constipation)?

Amitiza

33

Whats the main SE of Lubiprostone (Amitiza)?

Nausea

34

What's the black box warning associated with Linaclotide (Linzess)?

Don't use in pts < 18 yrs

35

What's the SE of Linaclotide (Linzess)?

Diarrhea

36

Which rx agents should be dispensed with a MedGuide?

Linaclotide (Linzess)?

37

MOA of stimulants/irritants?

They work by reducing water and electrolyte absorption by stimulating colonic neurons and irritating the mucosal lining of the colon

38

MOA of Osmotic laxatives?

Cause fluid to be retained in the bowel lumen, with a net increase of fluid secretions in the small intestines

39

List acute (stat) tx and bowel preps

Bisacodyl rectal

Osmotics (mg salts eg MOM; lactulose; sorbitol)

Sodium phosphates (Fleet enema, OsmoPrep)

Nonabsorbable soln (PEG)

40

List osmotic agents used in constipation

Magnesium salts (MOM)

Lactulose

Sorbitol

41

What's warning ass with sodium phosphates (Fleets enema, OsmoPrep)?

Don't use sodium phosphates in CHF, renal dx, low Calcium or high PO4

42

List Nonabsorbable solutions; also used for bowel prep

Polyethylene glycol (Golytely, MiraLax, Carbowax)

43

What should be avoided for bowel prep?

Red or blue/purple drinks

44

List agents used in opioid-induced constipation tx

Methylnaltrexone (Relistor)

Alvimopan (Entereg)

45

What's the brand name of Alvimopan (opioid-induced constipation tx)?

Entereg

46

When is Methylnaltrexone (Relistor) used?

Only in pts on opioid who have failed DSS + laxative (senna, bisacodyl)

47

How should Methylnaltrexone (Relistor) be used?

Don't use routinely

48

What's the black box warning of Alvimopan (Entereg)?

REMS drug

Short-term hospital use only (max 7 days - no more than 15 doses)

49

What's the CI of Alvimopan (Entereg)?

Pts who have taken therapeutic doses of opioids for more than 7 consecutive days prior to use

50

What's diarrhea?

Diarrhea occurs when there is an increase in the number of bowel movements or bowel movements are more watery and loose than normal

51

List main meds that can cause diarrhea

Antacids containing magnesium

Antibiotics esp. broad spectrum ABs and Clindamycin, Erythromycin

52

List other meds that can cause diarrhea

Colchicine

Laxatives

Metoclopramide

Misoprostol

Quinidine

Etc

53

What's the cause of most cases of diarrhea?

Most cases are viral

54

Whats the most common bacterial cause of diarrhea?

E.coli

55

MOA of bismuth subsalicylate in diarrhea?

Exhibits both antisecretory and Antimicrobial effects when used as an antidiarrheal

56

List antidiartheals agents

Bismuth subsalicylate (Pepto-Bismuth, others)

Loperamide (Imodium, Anti-Diarrheal, Diamode, others)

Diphenoxylate 2.5mg + Atropine 0.025mg (Lomotil)

57

What's the brand name of Bismuth subsalicylate (antidiartheals agents)?

Pepto-Bismol

58

What's the brand name of Loperamide (antidiartheals agents)?

Imodium

Anti-diarrheal

Diamode

59

What's the brand name of Diphenoxylate 2.5mg + Atropine 0.025mg (antidiartheals agents)?

Lomotil

60

Which antidiartheals is a C V?

Diphenoxylate 2.5mg + Atropine 0.025mg (Lomotil)

61

SE of bismuth subsalicylate (Pepto-bismol)?

Black tongue/stool

62

What's the counseling note for loperamide (Imodium, Anti-Dirrheal, Diamode)?

Don't self-treat for > 2 days

63

What should diarrhea tx include?

Fluid and electrolytes

Imp for all, but esp in children

64

When's Imodium and Lomotil not recommended?

C. Difficle infections

65

What may be done b4 starting antidiartheals?

Rule out lactose intolerance as a cause of the diarrhea by stopping use of diary pdts

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