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constipation and diarrhea Flashcards

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1
Q

signs and symptoms of constipation

A

anorexia, dull headache, low back pain, abdominal discomfort, bloating, and flatulence

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2
Q

primary cause of constipation

A

inadequate dietary fiber, fluid intake, and/or exercise

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3
Q

structural conditions causing constipation

A

anal fissure and pregnancy

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4
Q

systemic conditions that cause constipation

A
  • endocrine: thyroid disorders, diabetes
  • IBS
  • MS, neuropathy
  • parkinsonism
  • dementia
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5
Q

psychological conditions that cause constipation

A

depression, eating disorders, stress, changes in routine

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6
Q

medications that can cause constipation

A

anticholinergics, TCA, benzodiazepines, cholestyramine, calcium, and iron supplements

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7
Q

exclusions for constipation

A
  1. significant abdominal pain or cramping or distention
  2. unexplained flatulence
  3. fever or NV
  4. unexplained changes in bowel habits
  5. marked change in the character of stool
  6. rectal bleeding
  7. < 2 years of age
  8. anorexia
  9. inflammatory bowel disease, colostomy
  10. 14 days of symptoms or recurrences over 3 months
  11. 7 days of OTC treatment
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8
Q

non pharm therapy

A

gradually increase high-fiber food, increase fluid intake, exercise regularly

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9
Q

increase these foods for a high-fiber diet

A

fruits, vegetables, whole grains

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10
Q

decrease these foods for a high-fiber diet

A

meat, chest, processed foods

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11
Q

fiber intake for women

A

25 grams

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12
Q

fiber intake for males

A

38 grams

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13
Q

examples of bulk forming agents (fiber supplements)

A

methylcellulose, polycarbophil, and psyllium

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14
Q

onset of fiber supplements

A

12-72 hours

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15
Q

ADE of fiber supplements

A

abdominal discomfort and flatulence

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16
Q

fiber supplement precautions

A

swallowing difficulties, GI ulcer, high calcium content in polycarbophil, sugar content in some formulations

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17
Q

first choice for pregnant women

A

fiber supplements

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18
Q

MOA fiber supplements

A

dissolves and swells in intestines and adds bulk and water to stool

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19
Q

examples of emollient agents (stool softeners)

A

docusate

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20
Q

MOA of stool softeners

A
  • surfactant
  • facilitates mixture of aqueous and fatty substances to soften stool
  • lower surface tension of stool, allowing more water to enter stool
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21
Q

onset of stool softeners

A

12-72 hours

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22
Q

ade for stool softeners

A

minimal

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23
Q

precautions of stool softeners

A

larger than recommended doses can lead to sweating, muscle cramps, and irregular heartbeat.

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24
Q

contraindications with stool softeners

A

mineral oil`

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25
examples of hyperosmotic agents
PEG 3350 and glycerin
26
MOA of hyperosmotic agents
contain large, poorly absorbed ions or molecules that draw water into the colon or rectum through osmosis
27
peg3350 onset
12-72 hours
28
glycerin onset
15-30 min
29
ade of peg3350
bloating, abdominal discomfort, cramping, flatulence
30
glycerin ade
rectal irritation
31
peg3350 precaution
fda approved labeling indicates patients with renal disease or OBS should consult PCP prior to use
32
glycerin precaution
avoid if preexisting rectal irritation
33
peg3350 age requirements
must be at least 17 yoa
34
examples of stimulants
senna and bisacodyl
35
MOA of stimulants
increase motility by stimulation of intestinal SM (causing intestines to contract and push out stool), increase secretion of water and electrolytes in the intestines
36
onset of po stimulants
6-10 hours
37
Bisacodyl suppository onset
15-60 min
38
ade of stimulants
cramping and local irritation of the mucosa
39
stimulant precautions
electrolyte or fluid deficiencies, malabsorption due to hypermotility
40
DDI with stimulants
avoid with antacids
41
opioid induced constipation
docusate and stimulant combo typically
42
examples of lubricant agents
mineral oil
43
moa of mineral oil
coats stool and prevents absorption of water into the colon
44
po onset of mineral oil
6-8 hours
45
rectal onset of mineral oil
5-15 min
46
when using mineral oil avoid..
1. < 6 years of age 2. pregnancy 3. bedridden/elderly 4. difficulty swallowing 5. aspiration risk
47
contraindication of mineral oil
docusate
48
eating and mineral oil
impairment of absorption of fat-soluble vitamins (do not take within 2 hours of eating)
49
mineral oil use
avoid if possible, better and safer treatment alternatives are available
50
examples of saline laxative agents
magnesium citrate, magnesium hydroxide, magnesium sulfate, sodium phosphates
51
MOA of saline laxatives
ions draw water into the intestines by osmosis, increasing intraluminal pressure and promoting GI motility
52
po onset of saline laxatives
30 min - 6 hours
53
rectal onset of saline laxatives
up to 15 min
54
ade of saline laxatives
abdominal cramping, NV, dehydration, hypermagnesemia
55
precautions for saline laxatives
elderly, electrolyte changes, renal failure, restricted diet (na, phos, mg), CHF, use with diuretics
56
saline laxative use
used prior to colonoscopy to evacuate bowel and take with water to prevent dehydration
57
acute diarrhea
symptoms lasting less than 14 days
58
persistent diarrhea
symptoms lasting 14 days to 4 weeks
59
chronic diarrhea
symptoms lasting > 4 weeks
60
minimal to no dehydration
``` self treatable good, alert mental status drinks normally normal HR mouth is moist skin has instant recoil capillary refill is normal\ extremities are warm urine output is normal/decreased < 3 stools/day ```
61
mild-moderate dehydration
``` self treatable normal, fatigue mental status eager to drink normal or increased HR mouth is dry skin recoils < 2 seconds capillary refill is prolonged extremities are cool urine output is decreased 3-5 stools/day ```
62
severe dehydration
``` not self treatable apathetic or lethargic mental status unable to drink tachy or bradycardia mouth is parched skin recoils in > 2 seconds capillary refill is prolonged and minimal cold extremities urine output is minimal 6-9 stools/day ```
63
exclusions for diarrhea
1. infants < 6 months of age 2. moderate diarrhea < 2 yo 3. children with high fluid output, fever, or mental status changes 4. severe diarrhea 5. stool containing blood/mucus 6. DM, cardiac/renal disease, URTI 7. severe abdominal pain, cramping, tenderness, distention 8. pregnancy 9. immunocompromised
64
nonpharm treatment
ORS, preventative measires
65
loperamide MOA
synthetic opioid agonist | produces antidiarrheal effects by slowing intestinal motility, lacks CNS effects bc it is a substrate for p-glycoprotein
66
loperamide indication
symptomatic relief of acute, nonspecific diarrhea
67
ade of loperamide
dizziness and constipation
68
precautions for loperamide
should not be used in invasive bacterial diarrhea, children < 6 or in patients taking saquinavir
69
length of use for loperamide
no more than 2 days
70
loperamide warnings
serious heart problems with misuse and abuse
71
BSS MOA
reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid, exerts antibacterial effects and antisecretory effects
72
BSS indication
acute diarrhea, travelers diarrhea prophylaxis, or indigestion
73
ade of BSS
tinnitus (dose related), gout, reyes syndrome, black staining of stool and darkening of tongue
74
precautions of BSS
children < 12
75
patients with lactate deficiency
lactase enzymes
76
probiotics
lactobacillus, Bifidobacterium lactis, saccharomyces boulardii
77
zinc supplementation
reduces duration, severity, and persistence of acute diarrhea in children < 5

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