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Pharm Exam 3 > GI Disorders I > Flashcards

GI Disorders I Flashcards

1
Q

questions to ask pts about quality of stool

A

frequency
quality (size,consistency)
frequency and duration of constipation
quality of diet and exercise (fiber, fluid, timing of meals)
laxative use (brand, frequency of use) & other meds

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2
Q

timing of meals and colonic motility

A

colonic motility increases 2-3 times after waking and after a meal, particularly breakfast

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3
Q

bristol stool chart

A

Type 1: separate hard lumps like nuts (hard to pass)
Type 2: sausage-shaped but lumpy
Type 3: like a sausage but with cracks on surface
Type 4: like a sausage or snake, smooth or soft
Type 5: soft blobs with clear cut edges
Type 6: fluffy pieces with ragged edges, a mushy stool
Type 7: watery, no solid pieces, entirely liquid

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4
Q

causes of constipation

A
  1. underlying dz:
  2. low fiber, fluid, inactive
  3. drug induced
  4. pregnancy
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5
Q

what underlying disease can cause constipation

A
  • IBS
  • metabolic disorder (DM)
  • endocrine disorder (hypothyroidism)
  • neurological (MS, Parkinsons, anxiety, depression)
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6
Q

what type of drugs can cause constipation

A

opiates

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7
Q

types of drugs that cause constipation

A
  • opiods (morphine, cocaine)
  • anticholinergics (diphenhydramine)
  • antacids with aluminum or calcium
  • antiparkinsonian agents
  • phenothiazines
  • barium
  • CCBs
  • diuretics
  • iron & calcium supps
  • NSAIDS
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8
Q

goals for constipation

A
  1. increase frequency of bowel movements
  2. titrate dose to soft stool
  3. prevent recurrence
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9
Q

non drug tx of constipation

A

prevention
good habits: hydration (8-12 glasses water/day)
balanced diet
exercise (walking/swimming)

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10
Q

types of food with lots of fiber

A

apples
oranges
peas

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11
Q

types of food with little to no fiber

A

cheese, meats, processed foods

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12
Q

drug tx of constipation

A
  • most OTC

- usually take at bedtime

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13
Q

drug tx of constipation MOA’s

A
  1. soften stool
  2. ease passage (lubricants)
  3. add bulk to stool
  4. stimulate GI tract
  5. stimulate GI secretory process
  6. increase GI motility
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14
Q

stool softeners MOA

A

anionic sufactants - detergents mixing aqueous and fatty substances - softens fecal mass

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15
Q

when to us stool softeners

A

preventative: avoids straining - post MI, surgery, if hemorrhoids flare up
- used as combo

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16
Q

onset of stool softeners

A

1-3 days

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17
Q

downside of stool softeners

A

does it actually work?

does not get bowels moving

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18
Q

example of stool softener

A

Docusate (Colace)

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19
Q

how do lubricants work for constipation

A

coats stool and prevents absorption of water

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20
Q

positive for lubricants

A

easier passage of stool

quick onset: 24 hrs

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21
Q

example of lubricant used for constipation

A

Glycerin suppositories

  • good for any age
  • 30 min onset
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22
Q

bulking agents for constipation - how does it work

A
  • adds bulk, promotes peristalsis

- preventative

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23
Q

downsides to bulking agents

A
  • bloating and gas
  • need to drink
  • need to be mobile - cant use on bedridden pts
  • can bind other meds: separate other meds by 1-2 hrs
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24
Q

onset of bulking agents

A

1-3 days

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25
Q

example of bulking agents

A

Psyllium (FIbercon, Metamucil)

Benefiber, Bran

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26
Q

osmotics for constipation - what is it & how does it work

A

nonabsorbable sugars

  • pull water into colon, softens stool, increases volume
  • prevention and tx of chronic constipation
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27
Q

downside to osmotics

A

may cuase cramping, diarrhea, electrolyte imbalance

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28
Q

example of osmotics

A

Lactulose

33% Sorbitol is sodium polystyrene sulfonate-Kayexalate

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29
Q

onset of lactulose

A

1-3 days

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30
Q

onset and downside of 33% sorbital

A

quick effects

lowers K+

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31
Q

saline cathartics for constipation - what is it and how does it work

A

non absorbable cations and anions pull fluid into GI tract

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32
Q

onset of saline cathartics

A

6 hrs

33
Q

mode of admission of saline cathartics

A

oral and rectal

34
Q

examples of saline cathartics

A

Mg citrate, Mg hydroxide, Mg sulfate, sodium phosphate

  • Magnesium hydroxide (Phillips Milk of Magnesia)
  • Sodium phosphate (Fleet enema, liquid, or tablets)
35
Q

when to use saline cathartics

A 
not on a regular basis
occasional use (every few weeks)
36
Q

downside of saline cathartics

A

-take in adequate fluid to maintain hydration

37
Q

electrolyte solutions for constipation - what is it

A

non absorbable osmotically active sugar

38
Q

how does electrolyte solutions work

A

draws water into intestinal lumen

39
Q

what does electrolyte solutions contain and what does this prevent

A

Na2SO4, NaCl, NaHCO3, KCl: prevents electrolyte shifts into colon

40
Q

example of electrolyte solutions

A

Polyethylene Glycol (PEG)

41
Q

what electrolyte solutions can be used for colonic cleansing prior to diagnostic procedures

A

GoLYTELY, NuLYTLEY (1 gallon jug onset 1-6 hrs)

42
Q

what electrolyte solutions can be used as tx for constipation

A

Miralax, PEG 3350 (17gm with 8oz beverage - onset 1-3 hrs)

43
Q

what is the most popular electrolyte solution for constipation - why?

A

PEG 3350

  • powder to be mixed
  • fewer SE (bloating/cramping)
  • cheaper
  • give with narcotics
  • OTC
  • may be seen used as first line
44
Q

stimulants for constipation - MOA

A

directly stimulates intestinal mucosa - increase intestinal propulsive peristaltic activity thru local mucosal irritation

45
Q

SE of stimulants for constipation

A

cramping and diarrhea

46
Q

onsets of stimulants for constipation

A

orally - onset 6-12 hrs

rectal 15-60 min

47
Q

when to use stimulants for constipation

A

for pts on chronic constipating meds, daily use is ok

-give with narcotics

48
Q

examples of stimulants for constipation

A
  1. Diphenylmethan derivative (Ducolax - tabs or suppositories)
  2. Anthraquinone derivative (Senokot, Exlax)
49
Q

secretories for constipation - ex

A

castor oil

50
Q

how does it work - secretories

A

stimulates secretion of fluid into gut

51
Q

downsides for secretories

A

strong purgative action

not for regular use

52
Q

onset of secretories

A

1-3 hrs

53
Q

motility stimulant for constipation - MOA

A

increase colonic motility and shorten transit time

54
Q

motility stimulant downsides

A

prescription

variable results

55
Q

onset of motility stimulants

A

6-48 hrs

56
Q

example of motility stimulant

A

dopamine antagonist (metoclopramide)

57
Q

define constipation

A

reduced number of bowel movements (

58
Q

what is OIC

A

opiod induced constipation

59
Q

who gets OIC

A
  1. 95% of pts with cancer pain

2. 80% of pts with non malignant pain

60
Q

which opiods can be constipating

A

all

61
Q

OIC is a result of what?

A

opioid actions on u-opioid receptors in GI tract

62
Q

affects of opioids on GI tract

A

decre GI motility
incr absorption of fluid from gut
decr intestinal secretion
decr defecation reflux

63
Q

targeted therapies for constipation - examples

A 
1. u-opioid receptor antagonists
Methylnaltrexone (Relistor)
Movantik (Naloxegol)
2. chloride channel activators
Lubprostone (Amitiza)
64
Q

how does u-opioid receptor antagonists work

A

inhibit peripheral receptors without affecting analgesic u-opioid actions
-don’t cross BBB
“wake up the bowel”

65
Q

when is Methylnaltrexone (Relistor) indicated

A

second - line tx (after laxatives) of OIC when osmotic laxatives or sitmulants are not enough

66
Q

how is methylanltrexone administered, onset?

A

SQ injection

-onset within 4 hrs - complete evacuation - very predictable

67
Q

about Movantik (Naloxegol):

  • administration
  • when is it taken
  • where is it metabolized
A
  • new oral product
  • minimal risk of counteracting analgesic effects of opioids
  • everyday in the morning on empty stomach, renal dosing
  • metabolized by CYP 3A4 - grapefruit juice
68
Q

how does chloride channel activators work

A

stimulates type 2 chloride channels in small intestine
increases chloride-rich fluid secretion that stimulates intestinal motility
waking up the bowel

69
Q

when is lubiprostone (amitiza) indicated

A

chronic idiopathic constipation, IBS with constipation in women
used for OIC

70
Q

onset of lubiprostone (amitiza)

A

within 24 hrs

71
Q

downside to Lubiprostone

A

% nausea high if delayed emptying

72
Q

define diarrhea

A

increase in stool frequency and decrease in stool consistency as compared with a person’s normal bowel pattern
-imbalance in absorption and secretion of water and electrolytes in GI tract

73
Q

pt eval for diarrhea

A

-determine onset (acute

74
Q

meds that cause diarrhea

A
  • PPI
  • antacids with magnesium
  • digoxin
  • quinidine
  • ABX
  • ACE
  • misoprolol
  • colchicine
  • NSAIDS
  • CHEMO
  • laxatives
75
Q

goals of tx for diarrhea

A
  • stopping diarrhea not always the goal - esp if infectious cause
  • ID and tx potential cause (ABX)
  • symptomatic relief
  • correct fluid and electrolyte loss
  • manage diet
76
Q

monitoring for diarrhea tx

A
  • resolution of symptoms

- assess dehydration (weight, serum osmolality, electrolytes, CBC, urinalysis)

77
Q

tx of diarrhea

A
  1. control diet
    - low residue diet if tolerable (saltine crackers, soups, broths)
    - avoid solid foods, diary, spicy foods, caffeine
    - replenish fluids and electrolytes
    - increase diet as tolerated
  2. BRAT diet
  3. hold laxatives, other contributing meds
78
Q

what is the brat diet

A

bananas, rice, applesauce, toast = little calories, protein, fat

Pharm Exam 3 (1 decks)

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