Constipation, Nausea, Vomiting

Question 1

Dietary Fiber, Psyllium (Metamucil)- Mech of Action

Answer 1

increase stool weight, draw water into the stool

stimulate peristalsis

Question 2

Dietary Fiber, Psyllium (Metamucil)- Absorption, Distribution

Answer 2

Effective in 12-24hrs

Max effect in several days

Question 3

Dietary Fiber, Psyllium (Metamucil)- Adverse Effects/Contraindications

Answer 3

Flatulence

Requires increased fluid intake- do not use on patients that cannot drink increased fluid

Question 4

Bulk Laxatives- Available drugs

Answer 4

Dietary Fiber

Psyllium (Metamucil)

Question 5

Osmotic Laxatives- Available drugs

Answer 5

Non-absorbable sugars: lactulose, sorbitol

Sodium & Magnesium salts: magnesium citrate, magnesium hydroxide, sodium phosphate

Polyethylene Glycol: Miralax, Glycolx, Colyte, Golytely

Question 6

Non-absorbable sugars: lactulose, sorbitol- Mech of Action

Answer 6

increase osmotic pressure and acidity of stool, draw water into stool

Question 7

Non-absorbable sugars: lactulose, sorbitol- Clinical Use

Answer 7

constipation

Question 8

Non-absorbable sugars: lactulose, sorbitol- Adverse effects/contraindications

Answer 8

bloating, cramps, flatulance; “sickly sweet” taste

Question 9

Sodium & Magnesium salts: magnesium citrate, magnesium hydroxide, sodium phosphate- Mech of Action

Answer 9

osmotically active particles, Mg stimulates cholecystokinin

increase intraluminal volume, stimulate intestinal activity

Question 10

Sodium & Magnesium salts: magnesium citrate, magnesium hydroxide, sodium phosphate- Clinical use

Answer 10

Magnesium citrate & sodium phosphate- bowel prep

Magnesium hydroxide- Constipation

Question 11

Sodium & Magnesium salts: magnesium citrate, magnesium hydroxide, sodium phosphate- Adverse effects/Contraindications

Answer 11

High doses= rapid bowel evacuation; last resort for constipation

rarely cause ischemic colitis

Contraindicated in bowel obstruction, dehydration, electrolyte abnormalities, renal failure

Sodium phosphate can cause acute phosphate nephropathy

Question 12

Polyethylene Glycol: Miralax, Glycolx, Colyte, Golytely- Mech of Action

Answer 12

osmotically active, retains water in stool

Question 13

Polyethylene Glycol: Miralax, Glycolx, Colyte, Golytely- Clinical use

Answer 13

Miralax & Glycolax- (small dose) constipation

Colyte & Golytely- (large volume) bowel prep

Question 14

Stimulant Laxatives- Available Drugs

Answer 14

Senna

Bisacodyl

Question 15

Senna- Mech of Action

Answer 15

converts to active metabolite in colon, stimulates myenteric plexus

Question 16

Biscodyl- Mech of Action

Answer 16

stimulate sensory nerve endings, parasympathetic stimulation, peristalsis

Question 17

Senna & Biscodyl- Clinical Use

Answer 17

constipation

Question 18

Senna & Biscodyl- Adverse effects/Contraindications

Answer 18

cramping

melanosis coli

Question 19

Lubricants- Available drugs

Answer 19

Detergent Laxatives: Docusate
Glycerin
Mineral oil

Question 20

Detergent Laxatives: Docusate- Mech of Action

Answer 20

Suractant, increases penetration of fluid into stool, softens feces

Question 21

Detergent Laxatives: Docusate- Clinical Use

Answer 21

prevent formation of hard stool

Question 22

Glycerin- Mech of Action

Answer 22

osmotic action

irritant to stimulate rectal contrations

Question 23

Glycerin- Absorption, Distribution

Answer 23

suppository or enema

Question 24

Glycerin- Clinical Use

Answer 24

fecal impaction

Question 25

Mineral oil- Mech of Action

Answer 25

coats fecal matter, softens stools, lubricates

Question 26

Mineral oil- Absorption, distribution

Answer 26

large volume enema

Question 27

Mineral oil- Clinical Use

Answer 27

fecal impaction

Question 28

Mineral oil- Adverse Effects/Contraindications

Answer 28

never administered orally in debilitated patients- severe pneumonia, lipoid pneumonitis

Question 29

Nausea & Vomiting- Available Drugs

Answer 29

``` metoclopramide prochlorperazine promethazine ondansetron scopolomine corticosteroids: prednisone, dexamethasone benzodiazepenes: lorazepam, diazepam ```

Question 30

Metoclopramide- Mech of Action

Answer 30

Dopamine receptor antagonist. Blocks pathway 3- chemoreceptors. Also promoted motility of upper G.I.

Question 31

Metoclopramide- Clinical use

Answer 31

Chemotherapy induced nausea, vomiting. | UGI tract dysmotility.

Question 32

Metoclopramide- Adverse Effects/Contraindications

Answer 32

Extrapyramidal anti-dopaminergic: dystonia, akathisia, Parkinsonism. Caution in Parkinson's disease. Acute dystonic reactions- Trismus, torticollis- treat with anticholinergic diphenhydramine.

Question 33

Prochlorperazine- Mech of Action

Answer 33

Dopamine receptor antagonist. Peripheral vagus block. Blocks pathways 3 and 4.

Question 34

Prochlorperazine- Clinical Use

Answer 34

Opioid related nausea and vomiting. | GI disorders, inflammation, infection

Question 35

Prochlorperazine- Adverse Effects/Contraindications

Answer 35

Extrapyramidal anti-dopaminergic: dystonia, akathisia, Parkinsonism. Caution in Parkinson's disease. Acute dystonic reactions- Trismus, torticollis- treat with anticholinergic diphenhydramine.

Question 36

Promethazine- Mech of Action

Answer 36

H1 antagonist. Blocks pathway 1.

Question 37

Promethazine- Clinical Use

Answer 37

motion sickness

Question 38

Promethazine- Adverse Effects/Contraindications

Answer 38

sedation

Question 39

Ondansetron- Mech of Action

Answer 39

Serotonin 5-HT3 receptor antagonist. Blocks pathways 3 and 4.

Question 40

Ondansetron- Absorption, Distribution

Answer 40

may have central and peripheral activity

Question 41

Ondansetron- Clinical Use

Answer 41

chemotherapy or radiation induced nausea, vomiting

Question 42

Ondansetron- Adverse Effects/Contraindications

Answer 42

Headache | QT prolongation

Question 43

Scopolamine- Mech of Action

Answer 43

Pure anticholinergic. | Block pathway 1.

Question 44

Scopolamine- Clinical Use

Answer 44

motion sickness

Question 45

Scopolamine- Adverse Effects/Contraindications

Answer 45

confusion, urinary retention, acute narrow angle glaucoma, dry mouth

Question 46

Corticosteroids: prednisone, dexamethasone- Clinical use

Answer 46

nausea due to increased intracranial pressure

Question 47

Benzodiazepenes: lorazepam, diazepam- Clinical Use

Answer 47

anxiety associated nausea and vomiting; anticipatory nausea/vomiting