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Flashcards in ConstipationDABPFC Deck (56):
1

Medical Conditions Associated w/ Constipation

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

2

Medications Associated w/ Constipation

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

3

Opioids and Constipation ppx

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

4

opioid const tx

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

5

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

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

6

Bulk Laxatives moa

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

7

bulk laxatives names and role in tx

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

8

bulk lax se

SE: increased gas, bloating, Bowel obstruction, choking

9

counsel bulk laxatives

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

10

Emollients, Lubricants (Stool Softeners) MOA and names

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

11

SE emollients and lubrcants

SE: bitter taste

12

counseling emolients and lubricants

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

13

mineral oil and multivitamin separation

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

14

Stimulants and Irritants MOA and names

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

15

dulcolax & exlax

bisacodyl and senna

16

se of stimulants and irritants

SE: stomach upset, cramping, electrolyte imbalance with overdose

17

can u you crush or chew bisacodyl

Do not crush or chew Bisacodyl

18

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

Do not take within 1 hour of milk or antacids

19

GutOpioidReceptor Blocker MOA and names

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

20

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

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

21

Alvimopan (Entereg)

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

22

Entereg needs to registered with? And max dose?

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

23

ci of alvimopan

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

24

Osmotics MOA

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

25

names of osmotics

lactulose, magnesium Salts (MOM), sorbitol

26

se osmotics

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

27

Fleets MOA

Causes reflex evacuation

28

fleets generic

PhosphoSoda

29

SE of fleets

SE: dehydration

30

other than constipation, another use for fleets

Also used for Bowel prep

31

what pts not to use phosphosoda ?

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

32

Nonabsorbable Solutions

Hyperosmotic

33

PEG brands

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

34

PEG SE

SE: nausea, abdominal fullness, bloating

35

Prepopik

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

36

prepopik generic

Picosulfate, magnesium oxide, and andhydrous citric acid

37

se of prepopik

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

38

Lubiprostone (Amitiza) MOA

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

39

se of amitiza

SE: nausea, abdominal pain, distention

40

how must amitiza be taken

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

41

Medications Associated w/ Diarrhea

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

42

Medications Used for Diarrhea

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

43

Bismuth subsalicylate (BSS or PeptoBismol)

Antisecretory and antimicrobial

44

ci of pepto

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

45

SE of pepto

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

46

Loperamide (Imodium)

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

47

ci loperamide

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

48

se lopearmide

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

49

Diphenoxylate/atropine (Lomotil)

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

50

ci lomotil

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

51

se lomotil

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

52

laxative unsafe in whichpatients

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

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

2 weeks.

54

danger w/ peptobismol

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

55

best agent for iron induced constipation is

docusate

56

preffered agent in pregnancy

fiber. psyllium first line.