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NAPLEX Prep > Constipation and Diarrhea > Flashcards

Constipation and Diarrhea Flashcards

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1
Q

Conditions that cause constipation

A

IBS
Anal disorder
MS
CV events
Parkinsons
Pregnancy
Spinal cord tumors
Diabetes
Hypothyroidism

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2
Q

Non pharm for constipation

A

Increasing fluid intake
Physical activity
High fiber foods

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3
Q

Types of laxatives alone with examples

A

Bulk forming: Psyllium and fiber
Osmotic: PEG
Stimulants: Senna, bisacodyl
Stool softeners: Docusate
Lubricants: mineral oil

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4
Q

What is first line for constipation in pregnancy

A

Bulk forming
Fiber

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5
Q

Drugs that cause constipation

A

Antidiarrheals
Anticholinergiccs
Cation drugs
Colesevelam
Opioids
Clonidine
Verapamil

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6
Q

Recommend for iron-induced constipation

A

Stool softeners due to hard stool
Bulk forming

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7
Q

Recommended for opioid induced

A

Stimulants or osmotic

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8
Q

Fast relief laxatives

A

Adults: Bisacodyl or glycerin suppositories
Children: Glycerin suppository

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9
Q

Types of bulk forming

A

Psyllium
Calcium polycarbophil
Methylcellulose
Wheat dextrin

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10
Q

Psyllium

A

Metamucil

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11
Q

Calcium polycarbophil

A

FiberCon

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12
Q

Methylcellulose

A

Citrucel

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13
Q

Wheat dextrin

A

Benefiber

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14
Q

ADR of bulk-forming

A

Flatulence, bloating, cramps

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15
Q

Counseling of bulk forming laxatives

A

Adequate fluid are required or it can ↑ risk of fecal impaction

Separate calcium polycarbophil for other drugs that could bind

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16
Q

Types of osmotic laxatives

A

Magnesium hydroxde
PEG 3350
Glycerin
Lactulose
Sodium phosphate

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17
Q

Mag hydroxide

A

Milk of Magnesia

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18
Q

PEG3350

A

Miralax

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19
Q

Sodium phosphate

A

Fleet Enema

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20
Q

ADR of osmotic laxatives

A

Electrolyte imbalances, abdominal cramping

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21
Q

Indication of lactulose that is most common

A

Hepatic encephalopathy

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22
Q

Caution using magnesium laxatives?

A

Cation in renal impairment

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23
Q

Stimulant laxatives

A

Senna
Biacodyl

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24
Q

Bisacodyl

A

Dulcolax

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25
ADR of stimulant laxatives
Abdominal cramping
26
Counseling of stimulant laxatives
Take at bedtime to induce bowel movement in the morning Give 30 min after meal to induce peristalsis
27
Emollient laxatives
Docusate
28
Docusate
Colace
29
Indication for stool softners
When straining should be avoided or if stool is hard or dry
30
CI of mineral oil
<6 YO, pregnancy, bedridden, elderly, >1 wk, difficulty swallowingM
31
MOA of lubiprostone
Chloride channel activator → fluid secretion and peristalsis
32
MOA of linaclotide
guanylate cyclase C agonist that ↑ chloride and bicarb secretion into the lumen of the intestine → increasing speed of transit and reduced pain
33
MOA of PAMORAs
Act on mu-opiod receptors in GI tract decreasing constipation
34
Indication for lubiprostone
CIC, IBS-C, OIC
35
Indication for linaclotide
CIC, IBS-C
36
Indication for alvimopan
Surgery to ↓ risk of post-op ileus
37
Lubiprostone
Amitiza
38
Linaclotide
Linzess
39
Alvimopan
Entereg
40
Methylnatrexone
Relistor
41
Naloxegol
Movantik
42
ADR of Amitiza
Nausea Methadone decreases effect
43
ADR of Linzess
Diarrhea
44
What is the max dose od ALvimopan
15 doses
45
CI of Entereg
Potent risk of MI with long term use Therapeutic dose of opioid for >7 days
46
Drugs for OIC
Methylnatrexone Naloxegol Naldemedine
47
What is Prucalopride
Indicated for CIC Serotonin 5-HT4 Receptor agonist
48
ADR of prucalopride
Suicidal ideations, diarrhea
49
Common indication for bowel prep
Colonoscopy
50
Bowel irrigation products
PEG solution Sodium phosphates Sodium sulfate, potassium sulfate, and mag sulfate
51
PEG solution
GoLytely, Colyte
52
Sodium phosphates
Osmoprep
53
Contents of Supper Bowel Prep Kit
Sodium sulfate, potassium sulfate, and magnesium sulfate
54
BBW of bowel preps
Osmoprep: nephropathy
55
CI of OsmoPrep
Acute phosphate nephropathy, gastric bypass o stapling surgery
56
Counseling on bowel prep
1. Start the evening before colonoscopy and the morning of 2. Clear liquid diet must be started the day prior 3. Do not consume solid or semi-solids with red or blue/purple food coloring
57
Non pharm for diarrhea
Fluid and electrolyte replacement ORS
58
ORS products
Pedialyte Gatorade Enfamil Enfalyte
59
Short term diarrheals
Bismuth subsalicylate Loperamide
60
Antimotility drugs
Loperamide Diphenoxylate
61
Bismuth subsylate
Pep Bismol
62
Loperamide
Imodium AD
63
Diphenoxylate/atropine
Lomotl
64
Schedule of Lomotil
CV
65
CI of pesto bismol
Salicycylate allergy, GI ulcer and bleed
66
Warning and ADR of Pepto
Avoid in children recovering from flu, chicken pox, or viral infection due to Reyes syndrome ADR: black tongue and stool, salicylate toxicity, nausea
67
Signs of salicylate toxicity
Tinittis
68
Dosing of loperamide
4 mg PO after the first loose stool, then 2 mg after each subsequent loose stool Max OTC: 8 mg/day Max Rx: 16 mg/day
69
BBW of loperamide
Cardiac arrest and sudden death with doses higher than recommended: don't exceed Avoid in <2YO
70
CI of Imodium
Acute dysentry Pseudomembranous colitis Bacterial enterocolitis
71
ADR of Imodium
Constipation
72
Counseling of Imodium
Limited in blister packs due to caution with overdose Don't use >48 hrs
73
CI of Lomotil
Risk of respiratory and CNS depression in children (avoid <2YO or <6Yo for tabs) Pseudomembranous colitis
74
Counseling of Lomotil
Liquid formulation indicated <13YO
75
The importance of API in Lomotil
Diphenoxylate inhibits excessive GI motility and propulsion Atropine discorages abuse
76
ADR of atropine
Anticholinergic: constipation, dry mouth, sedation, tachycardia, flushing, urinary retention, blurred vision
77
When should you discontinue Lomotil
Improvement seen in 48 hr DC at 10 days
78
MOA of Dicyclomine
Antispasmodic
79
Dicyclomine
Bentyl
80
Warning and ADR of Bentyl
Anticholinergic: caution in >65YO Toxic megacolon or paralytic ileus ADR: DZ, dry mouth, nausea, blurred vision
81
What is eluxadoline
peripherally-acting mixed mu-opioid agonist
82
CI of eluxadoline
Pts without gallbladder, pancreatitis, sphincter of Oddi dysfunction

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