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Pharmacotherapeutics > Diarrhea & Constipation (Exam 2) > Flashcards

Diarrhea & Constipation (Exam 2) Flashcards

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1
Q

acute diarrhea

A

less than 14 days
resolves within 72 hours

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2
Q

persistent diarrhea

A

more than 14 days

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3
Q

chronic diarrhea

A

over 30 days
frequent attacks over an extended period

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4
Q

diarrhea can be caused by disease ______________ the intestines

A

inside or outside

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5
Q

secretory diarrhea

A

stimulating substance either increases secretion or decreases absorption of large amounts of water and electrolytes

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6
Q

does fasting alter stool volume in secretory diarrhea?

A

no

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7
Q

osmotic diarrhea

A

poorly absorbed substances retain intestinal fluids
gut adjusts osmolarity by increasing water and electrolyte influx into the lumen

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8
Q

does fasting alter stool volume in osmotic diarrhea?

A

yes

ceases diarrhea

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9
Q

exudative diarrhea

A

inflammatory diseases of the GI tract
presence of mucus, serum proteins or blood

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10
Q

exudative diarrhea affects other _____________________ functions increasing stool volume

A

absorptive, secretory or motility

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11
Q

altered intestinal motility

A

reduction of contact time in the small intestine
premature emptying of the colon
bacterial overgrowth

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12
Q

signs and symptoms of diarrhea

A

abrupt onset of N/V, headache, fever, chills and malaise
abdominal pain and cramps

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13
Q

signs and symptoms of chronic diarrhea

A

history of previous bouts, weight loss, anorexia, and chronic weakness

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14
Q

how to prevent travelers diarrhea

A

antibiotics and pepto bismol
treatment of drinking water
caution with consumption of fresh vegetables

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15
Q

therapeutic goals of diarrhea

A

manage diet
prevent excessive water, electrolyte, and acid base disturbances
provide symptomatic relief
treat curable diseases
manage secondary disorders

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16
Q

treating acute diarrhea when there is no fever or systemic symptoms

A

fluid/electrolyte replacement
loperamide, diphenoxylate or absorbent
diet

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17
Q

treating acute diarrhea when there is fever or systemic symptoms

A

check feces for WBC/RBC and parasites

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18
Q

when feces/parasites come back negative for acute diarrhea, treat with

A

symptomatic therapy

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19
Q

when feces/parasites come back positive for acute diarrhea, treat with

A

use appropriate antibiotic and symptomatic therapy

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20
Q

for persistent diarrhea, first you have to

A

identify the possible causes

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21
Q

when there is no diagnosis in persistent diarrhea, treat with

A

symptomatic therapy
replete hydration
discontinue potential inducer
adjust diet
loperamide or absorbent

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22
Q

nonpharmacologic treatment for diarrhea

A

dietary management
water and electrolyte replacement

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23
Q

oral rehydration solutions are recommended with

A

a lower osmolarity, sodium content, and glucose content

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24
Q

Imodium (loperamide) MOA

A

delay transit of intraluminal contents
prolong contact and absorption

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25
indications for loperamide
acute, chronic, traveler's diarrhea
26
loperamide has a ______________ with higher doses because it can lead to ______________
black box warning torsades, cardiac arrest, sudden death
27
contraindications when using loperamide
bloody diarrhea and high fever diarrhea caused by bacteria/infectious source
28
adverse effects for loperamide
dizziness constipation
29
recommended dose for loperamide
4mg orally followed by 2mg after each loose stool up to 16 mg/day
30
diphenoxylate/atropine (LOMOTIL) MOA
delay transit of intraluminal contents prolong contact and absorption
31
do not use lomotil in
children under 2 years (liquid) children under 6 years (tabs)
32
adverse effects of LOMOTIL
blurred vision dry mouth decreased urination
33
clinical pearls of LOMOTIL
schedule V formulated with a small amount of atropine to discourage abuse
34
Pepto-bismol (bismuth subsalicylate)
binds to toxins and bacteria in the gut antisecretory, anti-inflammatory, antibacterial
35
indications pepto-bismol
indigestion abdominal cramping diarrhea
36
contraindications for pepto-bismol
salicylate allergy taking other salicylates GI ulcer bleeding black/bloody stool
37
adverse effects of pepto-bismol
black tongue/stool salicylate toxicity
38
drug interactions with pepto-bismol
anticoagulants antiplatelets
39
probiotics MOA
restore normal GI flora and suppresses growth of pathogenic organisms (controversial)
40
atropine blocks _____________ and prolongs ___________
vagal tone gut transit time
41
what is useful for diarrhea secondary to lactose intolerance?
lactase enzyme
42
what to monitor when a patient has diarrhea
changes in frequency and character of bowel movements vital signs body weight, serum osmolality, electrolytes, CBC, urinalysis, and culture results
43
constipation varies from person to person, but it is most commonly
less than 3 bowel movements per week
44
constipation is more common in
women and older adults
45
primary constipation
normal transit slow transit pelvic floor dysfunction
46
secondary constipation
constipating drugs lifestyle factors medical disorders
47
signs and symptoms of constipation
hard, small, and dry stools straining feeling of incomplete evacuation
48
Rome 4 criteria for constipation
at least 2 of the signs and symptoms apply to a minimum of 25% of bowel movements for at least 3 months
49
alarm symptoms of constipation
sudden onset above age 50 hematochezia/melena family history of colon cancer or IBD anemia anorexia N/V constipation refractory to treatment
50
therapeutic goals for constipation
relieve symptoms reestablish normal bowel habits improve quality of life
51
how to treat opioid induced constipation (over 4 weeks)
osmotic/stimulant laxative lubiprostone or opioid receptor antagonists
52
how to treat acute constipation ( 3-6 months)
add osmotic laxative if no relief (2-4 weeks) add stimulant laxative if no BM 2 days or no relief
53
how to treat chronic constipation (over 6 months)
trial of intestinal secretagogue
54
nonpharmacologic treatment for constipation
increase fiber in diet gradually increase daily fiber intake to 20-30g trial for 1 month
55
agents that cause softening of feces in 1-3 days
bulk-forming agents/osmotic laxatives emollients PEG 3350
56
agents that result in soft or semi-fluid stool in 6-12 hours
bisacodyl Senna magnesium solfate (low dose)
57
agents that cause watery evacuation in 1-6 hours
magnesium salts sodium phosphate bisacodyl supp PEG-electrolyte preparations
58
bulk forming agents examples
psyllium (Metamucil) methylcellulose (citrucel) polycarbophil (fiber con)
59
MOA of bulk forming agents
increase stool bulk and promotes peristalsis
60
adverse effects of bulk forming agents
flatulence abdominal bloating distention bowel obstruction - rare
61
when on bulk forming agents, the patient should
drink adequate fluid
62
docusate salts (Colace) MOA
mixing of aqueous and fatty materials within the intestinal tract
63
docusate salts (Colace) adverse effects
diarrhea nausea abnormal taste cramps
64
example of am emollient/stool softeners
docusate salts(Colace)
65
examples of osmotic laxatives
lactulose sorbitol polyethylene glycol (PEG; Miralax)
66
osmotic laxatives MOA
retains fluid in the colon through an osmotic effect
67
adverse effects of osmotic laxatives
flatulence nausea vomiting abdominal cramping bloating
68
PEG solutions with electrolytes are used as
bowel prep before GI procedures
69
stimulant laxatives examples
bisacodyl (dulcolax) Senna (senokot)
70
stimulant laxatives MOA
stimulate the mucosal nerve plexus alters fluid and electrolyte transport
71
adverse effects of stimulant laxatives
severe abdominal cramping electrolyte imbalances
72
stimulant laxatives are reserved for
intermittent use patients who fail bulking and osmotic laxatives
73
magnesium salts are used as
bowel preparations prior to diagnostic procedures
74
why shouldn't magnesium salts be used on a routine basis
may cause fluid and electrolyte depletion magnesium/sodium accumulation in patients with renal failure
75
examples of insulin secretagogues
lubiprostone (amitiza) linaclotide (linzess)
76
MOA of insulin secretagogues
increases intestinal fluid secretion to soften stool and accelerate GI transit time
77
adverse effects of linzess
diarrhea flatulence abdominal pain
78
adverse effects of amitiza
nausea headache diarrhea
79
lubiprostone is used for
chronic constipation that failed first line therapies opioid induced constipation IBS-C
80
linzess is used for
constipation IBS-C
81
how do you take linzess? amitiza?
on an empty stomach with food and water
82
examples of opioid receptor antagonists
alvimopan (entereg) methylnaltrexone (relistor) naloxegel (movantik)
83
ADRs of alvimopan
potential risk for MI with long term use dyspepsia
84
ADRs of methylnaltrexone
abdominal pain flatulence nausea
85
ADRs of naloxegel
diarrhea flatulence N/V
86
alvimopan is used for
accelerating recovery of bowel function after bowel resection
87
methylnaltrexone and naloxegel are used for
OIC

Pharmacotherapeutics (28 decks)

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