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Pharm > Palliation of Constipation, Nausea, and Vomiting > Flashcards

Palliation of Constipation, Nausea, and Vomiting Flashcards

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1
Q

Bulking agent (laxatives)

A

Dietary Fiber/ Psyllium (Metamucil)

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2
Q

Bulking agent (Fiber/Psyllium-Metamucil) MOA

A

Increase stool weight, cause retention of fluid in stool, stimulate peristalsis

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3
Q

Bulking agent (Fiber/Psyllium-Metamucil) SE/Contra

A

SE: flatulence
CI: do not use in debilitated patients who cannot drink adequate fluid
*MUST increase fluid intake, otherwise hard massive stool

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4
Q

Osmotic laxatives- Nonabsorbable sugars

A

Lactulose/Sorbitol

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5
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) MOA

A

Draw water into the bowel lumen and into the stool; (nonabsorbable sugars)
Lactulose: bacteria degrade in colon, increases osmotic pressure and acidification of stool, increase stool water content
Sorbitol: does not need to be degraded, works more quickly

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6
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) SE

A

Sickly sweet, bloating, cramps, flatulence

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7
Q

Osmotic laxatives-Nonabsorbable sugars (Lactulose/Sorbitol) Indication

A

Treat Constipation (NOT used to prevent constipation)

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8
Q

Osmotic laxatives

A 
Nonabsorbable sugars (Lactulose/Sorbitol)
Saline and magnesium salts (Magnesium citrate/Magnesium hydroxide-MOM/Sodium phosphate)
Polyethylene Glycol (Miralax, Glycolax/Colyte, Golytely)
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9
Q

Osmotic laxatives- Saline and magnesium salts

A

Magnesium citrate
Magnesium hydroxide=Milk of Magnesia
Sodium phosphate=Fleets Phospho-Soda

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10
Q

Osmotic laxatives- Saline and magnesium salts MOA

A

Osmotically active particles (Mg, Phos, Na)
*Mg also stimulates CCK (stimulates peristalsis)
Increased intraluminal volume
Stimulates intestinal activity
High dose: rapid bowel evacutation

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11
Q

Osmotic laxatives- Saline and magnesium salts SE/CI

A

CI: Bowel obstruction, Dehydration, Electrolyte abnormalities, renal failure (caution with CHF and LF)
SE: ischemic colitis, acute phosphate nephropathy (sodium phosphate)–intratubular deposition of calcium-phosphate

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12
Q

Osmotic laxatives- Saline and magnesium salts Indication

A

Magnesium citrate/Sodium phosphate: Bowel preps

Magnesium hydroxide-MOM: constipation

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13
Q

Osmotic laxatives-Polyethylene Glycol

A

Miralax, Glycolax (constipation)

Colyte, Golytely (bowel prep)

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14
Q

Osmotic laxatives-Polyethylene Glycol MOA

A

Osmotically active > retains water in stool > softer stool = more frequent bowel movements
Contents NOT absorbed systemically, SAFE in anyone

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15
Q

Osmotic laxatives-Polyethylene Glycol Indications

A

Miralax, Glycolax: constipation (small daily doses)

Colyte, Golytely: bowel prep (large volumes)

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16
Q

Stimulant Laxatives

A

Senna, Bisacodyl

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17
Q

Stimulant Laxatives MOA

A

Stimulate bowel motility

Senna: Converts to active metabolites by bacteria in colon>
Stimulates myenteric plexus > peristalsis

Bisacodyl: parasympathetic stimulation > peristalsis

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18
Q

Stimulant Laxatives SE

A

Cramping, Melanosis Coli (colonic lumen-macs filled with lipofusion)

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19
Q

Stimulant Laxatives Indications

A

Constipation (for opioids)

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20
Q

Detergent Laxatives (stool softeners)

A

Docusate (Colase)

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21
Q

Detergent Laxatives MOA

A

Lube up the bowels, makes them more slippery
Increases penetration of fluid into the stool
Emulsifies feces, water, fat

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22
Q

Lubricants

A

Glycerin suppository/enema

Mineral oil enema

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23
Q

Lubricant MOA

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A 
Glycerin suppository/enema:
Osmotic- softeners, lubricates stool
Irritant- stimulates rectal contractions
Mineral oil enema:
Coats fecal material
Softens stool, lubricates
24
Q

Lubricant SE

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A

Mineral oil should NEVER be administered oral to debilitated patients > aspiration > lipoid pneumonitis

25
Lubricant Indication
Fecal Impaction
26
Large volume enemas MOA
Soften stool by increasing water content Distend distal colon Induce peristalsis
27
Large volume enemas indication
Fecal impaction
28
Palliation of Constipation (steps)
Stool softener (Docusate) Stimulant (Senna, Bisacodyl) Osmotic agent (Lactulose, sorbitol, MOM, polyethylene glycol-low dose) Enemas (Tap water, sodium phosphate) Magnesium citrate/sodium phosphate (last choice)
29
Chemoreceptor Trigger Zone (stimulants, receptors)
Can be stimulated by drugs (opiates, chemo), renal failure (metabolic products), bacterial toxins Receptors: dopamine, 5-HT3
30
Vestibular center (stimulants, receptors)
Motion sickness, inner ear infection | Receptors: acetylcholine, histamine
31
Gut (stimulants, receptors)
Gastroenteritis, radiation, GERD, metastasis, obstruction, local toxins, drugs Receptors: 5-HT3, vagus, dopamine
32
Vomiting Center Receptors
Acetylcholine H1 5-HT2
33
Dopamine Receptor Antagonists
Prochlorperazine | Metaclopramide
34
Prochlorperazine (Dopamine Antagonist) MOA
Central dopamine receptor antagonist in CTZ | Peripherally blocks vagus nerve (GI)
35
Prochlorperazine (Dopamine Antagonist) Indications
Opioid related nausea and vomiting | GI disorders, inflammation, infection
36
Prochlorperazine (Dopamine Antagonist) SE
``` Extrapyramidal effects (movement disorders) Dystonic reactions ```
37
Metoclopramide (Dopamine Antagonist) indications
Chemotherapy induced nausea and vomiting | Treatment of upper GI tract dysmotility (diabetic gastroparesis, gastric stasis)
38
Metoclopramide (Dopamine Antagonist) MOA
Blocks the chemoreceptor trigger zone | Promotes motility of upper GI tract > increases gastric emptying
39
Metoclopramide (Dopamine Antagonist) SE
Extrapyramidal effects (dystonia, akathisia, parkinsonism) Acute dystonic reactions (trismus, torticollis-jaw, neck spasm) CAUTION: parkinson's disease
40
Ondansetron MOA
Serotonin (5-HT3) receptor antagonist
41
Ondansetron Indication
Chemotherapy induced nausea/vomiting and prophylaxis Radiation induced nausea/vomiting and prophylaxis Post operative N/V
42
Ondansetron SE
QT prolongation | Headache
43
Promethazine MOA
Histamine (H1) receptor antagonist
44
Promethazine Indications
Motion sickness Rx/prevention | Inner ear vestibular disorder
45
Promethazine SE
Sedation
46
Scopolamine MOA
Anticholinergic
47
Scopolamine Indication
Treatment of motion sickness | Vestibular apparatus mediated N/V
48
Scopolamine SE
Confusion Urinary retention Acute narrow angle glaucoma Dry mouth
49
Corticosteroids
Prednisone | Dexamethasone
50
Corticosteroid (Prednisone, Dexamethasone) Indication
Nausea due to increased intracranial pressure
51
Benzodiazepines
Lorazepam | Diazepam
52
Benzodiazepines (Lorazepam, Diazepam) Indication
Anxiety associated nausea and vomiting (anticipatory)
53
Palliation of N/V: Vestibular (Receptors/Drugs)
Receptors: Cholinergic, Histaminic Drugs: Scopolamine (anti-Ach); Promethazine (anti-H)
54
Palliation of N/V: Obstruction of Bowel caused by constipation (Receptors/Drugs)
Receptors: 5-HT3, Dopamine, Vagus Drugs: Appropriate laxatives!
55
Palliation of N/V: dysMotility of upper GI tract (Receptors/Drugs)
Receptors: Dopamine Drugs: Metoclopramide
56
Palliation of N/V: Infection, Inflammation (receptors/drugs)
Receptors: 5HT3, vagal, dopamine? Drugs: Prochlorperazine (blocks vagal stimulation)
57
Palliation of N/V: Toxins stimulating CTZ (receptors/drugs)
Receptors: Dopamine, 5-HT3 Drug: Ondansetron (emetogenic chemo); prochlorperazine (opiates)

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