Final: GI - Laxatives and Antidiarrheals

Question 1

Psyllium (Metamucil)

Answer 1

Bulk forming laxatives

Action: Keeps water in stool to mechanically distend colon and promotes evacuation, prolonged onset

Adverse reactions: Esophageal obstruction, intestinal obstruction or impaction

Off-label: Cholesterol lowering, decrease diarrhea (IBS/diverticulosis)

Administer with 8 ounces of water

Do not give to patient with fecal impaction, GI bleeding, or new onset acute abdominal pain (undiagnosed)

Question 2

Bisacodyl (Dulcolax)

Answer 2

Stimulant and Irritant Laxative

Action: Suppositories work in 15-60 minutes, oral bisacodyl administered at bedtime and works within 6-12 hours. Stimulates motility, increases water and electrolytes within intestinal lumen

Education: Anthraquinones (Senna) = change in urine color may occur. Increase water intake daily, report new abdominal pain

Question 3

Polyethylene Glycol (PEG)

Answer 3

Osmotic Laxatives

Action: Poorly absorbed salts whose osmotic action draws water into the intestinal lumen

Adverse reactions: Substantial loss of water

Caution: Magnesium hydroxide used cautiously with renal failure and heart failure

Drug-drug: Sulfonylureas, quinidine

PEG used routinely in bowel programs and acute/LTC

Question 4

Diphenoxylate HCl (Lomotil)

Answer 4

Schedule V controlled substance, chemically related to narcotic meperidine, antidiarrheal agent

Action: Slow intestinal motility

Atropine added to discourage misuse (anticholinergic)

Contraindications: Diarrhea of infectious nature, obstructed jaundice, children under 2, severe electrolyte imbalance or dehydration

Adverse effects: Opioid effects, anticholinergic effects

Education: Rehydrate with commercial oral electrolyte solution, take only as directed, avoid caffeine, when stools decrease stop taking this medication

Question 5

All antidiarrheals must be used in caution in patients with ________________

Answer 5

Inflammatory Bowel Disease (IBD)