Pharm - Laxatives

Question 1

Name the 3 classifications of Laxatives

Answer 1

1. Luminally active
2. Nonspecific stimulants or irritants
3. Prokinetic agents

Question 2

Name 2 Dopamine receptor antagonists used in GI

Answer 2

Metoclopramide and Domperidone

Question 3

Stimulate peristalsis by releasing Ach

Answer 3

Metoclopramide and Domperidone

Question 4

Used by patients with hypomotility disorders associated with nausea

Answer 4

Metoclopramide and Domperidone

Question 5

Adverse effects: Tardive Dyskinesia

Answer 5

Metoclopromide

Question 6

Adverse effects: Decreased energy, diarrhea, dizziness, drowsiness, HA, nausea, restlessness, malaise, trouble sleeping

Answer 6

Metoclopromide

Question 7

Adverse effects: HA, drymouth, dizziness, nervousness, flushing, irritability may occur first several days as your body adjusts. Trouble sleeping, stomach cramps, hot flashes, leg cramps

Answer 7

Domperidone

Question 8

5-HT4 Receptor agonist

Answer 8

Prucalopride

Question 9

Use for constipation and IBS

Answer 9

Prucalopride

Question 10

Activates 5-HT4 receptors on: motor and sensory ENS, smooth muscle and epithelial cells lining mucosa and on ENTEROCHROMAFFIN cells

Answer 10

Prucalopride

Question 11

Adverse Effects: Occur within first 24 hrs and subside

HA, nausea, Abdominal pain, Diarrhea

Answer 11

Prucalopride

Question 12

Luminally active agent. The residue left when flour is made from cereal grains

Answer 12

Bran

Question 13

Luminally active agent derived from the seed of the plantago herb. Contains hydrophilic mucilloid that undergoes significant fermentation in the colon

Answer 13

Psyllium husk

Question 14

Luminally active agent. Extract of barley malt that contain polymeric carbs, proteins, electrolytes and vitamins

Answer 14

Malt soup extract

Question 15

Contraindication for Fiber

Answer 15

Megacolon or Megarectum - obstructive symptoms

Question 16

Hydrophilic colloids; bulk formers

Answer 16

Bran, Psyllium, Malt

*Attract water and increase fermentation

Question 17

Describe osmotic agents?

Answer 17

non-absorbable inorganic salts

Question 18

Name the saline laxatives

Answer 18

Mg Sulfate, Mg Hydroxide, Mg Citrate, Na Phosphates

Question 19

MOA : Osmotically mediated water retention which then stimulates peristalsis

Answer 19

Saline laxatives

Question 20

Which are absorbed easier? Phosphate or Mg salts?

Why know the difference?

Answer 20

Phosphate salts.

*They increase risk of phosphate nephropathy

Question 21

FDA warning about using these OTC for constipation in a 24hr period if pt has bad kidneys or bad heart

Answer 21

Na Phosphate

Question 22

Combine Mg/Phosphate agents should be used with caution if pts have which conditions

Answer 22

Renal insufficiency, Cardiac Dz, Preexisting electrolyte abnormalities, already on diuretics

Question 23

Osmotically active, non-absorbable sugars

Answer 23

Lactulose, Sorbitol, Mannitol

Question 24

MOA: hydrolyzed in the colon to short chain FAs, stimulating motility and drawing in water via omosis

Answer 24

non-absorbable sugars

lactulose, sorbitol, mannitol

Question 25

Equal to lactulose when treating constipation caused by opioids, vincristine, constipation of the elderly and idiopathic chronic constipation

Answer 25

Sorbitol

Question 26

Can treat constipation AND hepatic encephalopathy

Answer 26

Lactulose

Question 27

Is metabolized to short chain FAs which lower pH and "traps" ammonia ions, thus increasing gut motility

Answer 27

Lactulose

Question 28

Can treat constipation caused by vincristine or opioids

Answer 28

Sorbitol and Lactulose

Question 29

What is PEG short for?

Answer 29

Polyethylene Glycol/Electrolyte Soln *osmotic agent

Question 30

MOA: osmotic agent retained in the lumen which produces a high osmotic effect when used in high volume.

Answer 30

PEG

Question 31

Is itself an electrolyte, which assures little to no net ionic shift

Answer 31

PEG

Question 32

Used for colonic cleansing prior to radiology, surgery, endoscopic procedures

Answer 32

PEG

Question 33

240ml taken every 10mins until 4L is consumed or rectal effluent is clear

Answer 33

PEG

Question 34

Stool wetting agents and emollients

Answer 34

Docusate and Mineral Oil

Question 35

ionic surfactants the lowers surface tension of stool allowing mixing of aqueous and fatty substances

Answer 35

Docusate salts

Question 36

Stimulates intestinal fluid and electrolyte secretion; and alters intestinal mucosal permeability

Answer 36

Docusate salts

Question 37

Maginally effective

Answer 37

Docusate salts

Question 38

A mixture of aliphatic hydrocarbons obtained from pertolatum

Answer 38

Mineral oil

Question 39

luminally active petrolatum derivative. Indigestible. Interferes with fat absorption. May cause foreign body rxn. Anal leakage

Answer 39

Mineral oil

Question 40

MOA: produce a low-grade inflammation in the small and large bowel to promote accumulation of water and electrolytes and thus stimulates intestinal motility

Answer 40

Diphenylmethanes (bisacodyl) Anthraquinones (senna and cascara) Castor oil

Question 41

These have direct effects on enterocytes, enteric neurons, and GI smooth muscle

Answer 41

bisacodyl, senna and cascara, castor oil

Question 42

Require activation by endogenous esterases in the bowel

Answer 42

Diphenylmethanes (bisacodyl)

Question 43

Should not be used more than 10 days due to risk of atonic colon

Answer 43

Diphenylmethanes (bisacodyl)

Question 44

Not FDA approved

Answer 44

Anthraquinones (aloe, senna, cascara)

Question 45

Can produce giant migrating colonic contractions and induce water and electrolyte secretion

Answer 45

Anthraquinones (senna and cascara)

Question 46

Melatonic pigmentation of the colonic mucosa and "cathartic colon"

Answer 46

Anthraquinones (senna and cascara)

Question 47

irritating when activated by colonic bacteria

Answer 47

senna, aloe, cascara - Anthraquinones

Question 48

Oil derived from the bean of Ricinus communis

Answer 48

Castor oil

Question 49

Hydrolyzed in small bowel to glycerol and ricinoleic acid | - stimulating secreation of fluid, electrolytes and transit time

Answer 49

Castor oil

Question 50

Not recommended because of unpleasant taste and potential toxic effects

Answer 50

Castor oil