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Board Review > ConstipationDABPFC > Flashcards

ConstipationDABPFC Flashcards

1
Q

Medical Conditions Associated w/ Constipation

A

Cerebrovascular events
Parkinson disease
Spinal cord tumors
Diabetes
Hypothyroidism
Multiple sclerosis
Irritable Bowel Syndrome
Anal disorders

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2
Q

Medications Associated w/ Constipation

A

Opioids
Anticholinergics
Antihistamines, phenothiazines, tricyclic antidepressants, antispasmodics, urge incontinence drugs
NonDHP CCBs (especially verapamil)
Clonidine
Metals
Bismuth
Iron, aluminum
Alkaloids, oxaliplatins, taxanes

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3
Q

Opioids and Constipation ppx

A

Prevention: regular use of senna/biscodyl (stimulant) + stool softener (docusate), laxative should be recommended with scheduled Opioids

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4
Q

opioid const tx

A

Treatment: lactulose, sorbitol, Milk of Mag. (MOM), Mag. citrate, or Miralax
Fecal Impaction: Enema, may require digital evacuation

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5
Q

Bowel Prep why is pt doing it? And what can they eat?

A

A screening colonoscopy is used to detect colorectal cancer, Crohn’s disease, and other GI conditions
OK to consume: “clear liquid diet”
Do not consume: anything with red or blue food coloring, milk, cream, tomato, orange or grapfruit juice (no liquids that cannot be “seen through”); alcohol, and no solid or semisolid foods

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6
Q

Bulk Laxatives moa

A

Creates gellike matrix in stool; soaks up fluid in loose stool, adds bulk to hard stools

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7
Q

bulk laxatives names and role in tx

A

Wheat bran, calcium polycarbophil (FiberCon), psyllium (Metamucil), methylcellulose (Citrucel)
Usual firstline therapy for constipation

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8
Q

bulk lax se

A

SE: increased gas, bloating, Bowel obstruction, choking

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9
Q

counsel bulk laxatives

A

Counseling: increase bulk slowly; adequate fluid intake; take 2 hours before/after drugs (esp w/ carbamazepine, lithium, digonxin!!)

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10
Q

Emollients, Lubricants (Stool Softeners) MOA and names

A

Lubricates and softens Fecal mass, docusate sodium (Colace), docusate calcium, mineral oil

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11
Q

SE emollients and lubrcants

A

SE: bitter taste

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12
Q

counseling emolients and lubricants

A

Counseling: do not take docusate with mineral oil; not to be used more than 2 weeks

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13
Q

mineral oil and multivitamin separation

A

mineral oil: take A multivitamin at A different time to avoid vitamin depletion

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14
Q

Stimulants and Irritants MOA and names

A

Reduce water and electrolyte absorption by stimulating colonic neurons and irritating the colon mucosal lining
Bisacodyl (Dulcolax), senna (ExLax), cascara

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15
Q

dulcolax & exlax

A

bisacodyl and senna

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16
Q

se of stimulants and irritants

A

SE: stomach upset, cramping, electrolyte imbalance with overdose

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17
Q

can u you crush or chew bisacodyl

A

Do not crush or chew Bisacodyl

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18
Q

separate bisacodyl and senna from milk or antacids by how many hours?

A

Do not take within 1 hour of milk or antacids

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19
Q

GutOpioidReceptor Blocker MOA and names

A

Blocks opioid receptors in the gut only for use with Opioids
Methylnaltrexone (Relistor), SQ every other day

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20
Q

se of methynatrexone, CI, role in tx, renal dosing?

A

SE: abdominal pain, nausea, diarrhea
Contraindicated if any GI blockage
only for patients who failed DSS + laxative
Reduce dose if CrCl is <30

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21
Q

Alvimopan (Entereg)

A

Blocks muopioid receptor, similar to Methylnaltrexone but oral, and used shortterm for hospitalized patients, to increase postsurgical GImotility

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22
Q

Entereg needs to registered with? And max dose?

A

REMS drug (EASE programs) , max 15 doses (1 tab BID so ~7 days).

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23
Q

ci of alvimopan

A

CI: patients who have taken opioids for more than 7 consecutive days

24
Q

Osmotics MOA

A

Salts lead to retained fluid in the Bowel lumen, with A net increase of fluid secretions in the small intestines

25
Q

names of osmotics

A

lactulose, magnesium Salts (MOM), sorbitol

26
Q

se osmotics

A

SE: electrolyte imbalance, excessive gas, hypermagnesemia, hypcalcemia, hyperphos

27
Q

Fleets MOA

A

Causes reflex evacuation

28
Q

fleets generic

A

PhosphoSoda

29
Q

SE of fleets

A

SE: dehydration

30
Q

other than constipation, another use for fleets

A

Also used for Bowel prep

31
Q

what pts not to use phosphosoda ?

A

Do not use PhosphoSoda in CHF, renal disease, decreased calcium, increased phos

32
Q

Nonabsorbable Solutions

A

Hyperosmotic

33
Q

PEG brands

A

Polyethylene glycol (Golytely, MiraLAX, Carbowax, NuLytely, Trilyte, HalfLytely, MoviPrep) KNOW

34
Q

PEG SE

A

SE: nausea, abdominal fullness, bloating

35
Q

Prepopik

A

Combination of stimulant laxative and osmotic, enables lower fluid intake for Bowel prep

36
Q

prepopik generic

A

Picosulfate, magnesium oxide, and andhydrous citric acid

37
Q

se of prepopik

A

SE: headache, hypokalemia, hypochloremia, hyponatremia, nausea, increase SCr

38
Q

Lubiprostone (Amitiza) MOA

A

Activates chloride channels in the gut, leading to increased fluid in gut and movement

39
Q

se of amitiza

A

SE: nausea, abdominal pain, distention

40
Q

how must amitiza be taken

A

Take with food KNOW b/c of the nausea. taken BID

41
Q

Medications Associated w/ Diarrhea

A

Antacids containing magnesium
Antibiotics
Colchicine
Laxatives
Metoclopramide
Misoprostol
Quinidine, lithium, theophylline

42
Q

Medications Used for Diarrhea

A

psyllium
Bismuth subsalicylate (BSS or PeptoBismol)
Loperamide (Imodium)
Diphenoxylate/atropine (Lomotil)

43
Q

Bismuth subsalicylate (BSS or PeptoBismol)

A

Antisecretory and antimicrobial

44
Q

ci of pepto

A

CI: children with viral infections, history of severe GI bleed or coagulopathy

45
Q

SE of pepto

A

SE: black tongue/stool, hearing loss, tinnitus 2 tabs every hr up to 8 doses a day. MAX 2 days for IBD….

46
Q

Loperamide (Imodium)

A

Acts on intestinal muscles to inhibit peristalsis and to slow intestinal motility

47
Q

ci loperamide

A

CI: abdominal pain without diarrhea, acute dysentery, acute ulcerative colitis, C. diff.

48
Q

se lopearmide

A

SE: abdominal cramping, constipation, nausea. Max 2 days for self treating!!

49
Q

Diphenoxylate/atropine (Lomotil)

A

Constipating meperidine congener, and atropine to discourge abuse. QID BEFORE meals (ac ante meals)

50
Q

ci lomotil

A

CI: <2 year old, C. diff., obstructive jaundice

51
Q

se lomotil

A

SE: sedation, constipation, urinary retention, tachycardia, blurred vision, xerostomia, dizziness, depression

52
Q

laxative unsafe in whichpatients

A

heart failure, renal disease, hypocalcemia or hyperphosphatemia. It can be fatal if used in patients who cannot tolerate the phosphate load…ie fleets phosphosoda. so basically think of issues where phosphate overload wud suck.

53
Q

docusate if use longer than x time for self tx try to find the cause

A

2 weeks.

54
Q

danger w/ peptobismol

A

increase risk of bleeding. salicylates increase the risk of bleeding.

55
Q

best agent for iron induced constipation is

A

docusate

56
Q

preffered agent in pregnancy

A

fiber. psyllium first line.

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