Test 2 Laxatives

Question 1

docusate sodium

Answer 1

• laxative
• surfactant laxatives

Question 2

docusate sodium: MOA

Answer 2

• produce soft stool in 1-3 days after the onset of tx
• alter stool consistency by lowering surface tension which facilitates penetration of water into the feces
• can act on intestines to:
  
  • inhibit fluid absorption
  • stimulate secretino of water and electrolytes into intestinal lumen

Question 3

docusate sodium: indications

Answer 3

• constipation

Question 4

docusate sodium: SEs

Answer 4

• mild cramps
• diarrhea
• rashes
• nausea
• dehydration

Question 5

docusate sodium: nursing implications

Answer 5

• contraindications: abdominal pain, nausea, vomiting, individuals with narrowing of intestinal lumen
• can take with food, but faster results if taken w/o
  
  • should take with glass of water
• do not take w/in 2 hours of another laxatives
• should be used only short term, b/c otherwise can cause electrolyte and fluid imbalance

Question 6

bisacodyl: class

Answer 6

• stimulant laxative

Question 7

bisacodyl: MOA

Answer 7

• Stimulates peristalsis.
• Alters fluid and electrolyte transport, producing fluid accumulation in the colon.
• produces semi fluid stool in 6-12 hours

Question 8

bisacodyl: indications

Answer 8

• Treatment of constipation.
• Evacuation of the bowel before radiologic studies or surgery.
• Part of a bowel regimen in spinal cord injury patients.

Question 9

bisacodyl: SEs

Answer 9

• abdominal cramps
• nausea
• diarrhea
• chronic use:
  
  • hypokalemia
  • muscle weakness

Question 10

bisacodyl: nursing implications

Answer 10

• contraindicated in individuals with narrowing of intestinal lumen
• tablets are enteric coated to prevent gastric irritation
  
  • swallow whole
  • if drink milk or take antacids which accelerate dissolution of enteric coating, then tablets should be administered no sooner than 1 hour after ingesting substances
• do not take long term
• suppository administration can cause burning
• take with a full glass of water to prevent esophageal obstruction
• widely abused in the elderly population

Question 11

lactulose: class

Answer 11

• osmotic laxative

Question 12

lactulose: MOA

Answer 12

• in the colon, resident bacteria metabolize lactulose to lactic, formic, and acetic acid
  
  • exerts a mild osmotic effect to produce soft stool in 1-3 days
• Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels.

Question 13

lactulose: indications

Answer 13

• Treatment of chronic constipation.
• Adjunct in the management of portal-systemic (hepatic) encephalopathy (PSE) secondary to chronic liver dz

Question 14

lactulose: SEs

Answer 14

• flatulence
• cramping
• belching
• distention

Question 15

lactulose: nursing implications

Answer 15

• contraindicated in pts on low galactose diets
• Mix with fruit juice, water, milk, or carbonated citrus beverage to improve flavor

Question 16

polyethylene glycol with electrolytes: class

Answer 16

• osmotic laxative

Question 17

polyethylene glycol with electrolytes: MOA

Answer 17

• the mixture is isoosmotic with body fluids, so water and electrolytes are neither absorbed from nor secreted into the intestinal lumen
  
  • so dehydration does not occur, and electrolyte balance is preserved

Question 18

polyethylene glycol with electrolytes: indications

Answer 18

• chronic constipation
  
  • better than lactulose in regard to relief of abdominal pain and improvements of stool consistency
• bowel cleansing for GI exam
  
  • can be used in pts who are dehydrated or who are sensitive to alterations in electrolyte levels (renal impairment and CV dz)

Question 19

polyethylene glycol with electrolytes: SEs

Answer 19

• nausea
• abdominal bloating
• cramping
• flatulence
• diarrhea

Question 20

polyethylene glycol with electrolytes: nursing implications

Answer 20

• contraindicated in pts with:
  
  • GI obstruction;
  • Bowel perforation
  • Gastric retention;
  • Toxic colitis;
  • Toxic megacolon.
• only take in clear liquids
• avoid solid food and milk w/in 1-2 hours after taking, but need to be well hydrated
• more expensive than other laxatives

Question 21

mineral oil: class

Answer 21

• lubricant laxative

Question 22

mineral oil: MOA

Answer 22

• made of indigestible hydrocarbons to provide lubrication
  
  • Coats surface of stool and intestine with lubricant film to allow passage of stool through intestine.
  • Improves water retention of stool.

Question 23

mineral oil: indications

Answer 23

• administered via enema to treat fecal impaction
• Used to soften impacted feces in the management of constipation.

Question 24

mineral oil: SEs

Answer 24

• pruritus
• soiling
• dec absorption of fat soluble vitamins
• lipid pneumonia

Question 25

mineral oil: nursing implications

Answer 25

* should not take within 2 hours of ingesting food * take only short term * pts need to wear protective clothing if experience any leakage * do not use if abdominal pain, nausea

Question 26

magnesium citrate (PO): class

Answer 26

* saline laxative * mineral and electrolyte replacement

Question 27

magnesium citrate (oral): MOA

Answer 27

* Essential for the activity of many enzymes. * Play an important role in neurotransmission and muscular excitability. * Are osmotically active in GI tract, drawing water into the lumen and causing peristalsis. * accumulation of water causes feces to soften and swell--\>stretch intestines--\>inc peristalsis

Question 28

magnesium citrate (PO): indications

Answer 28

* laxative * bowel evacuant * purge bowel of ingested poisons

Question 29

magnesium citrate (PO): SEs

Answer 29

* substantial water loss * diarrhea * flushing * sweating

Question 30

magnesium citrate (PO): nursing implications

Answer 30

* contraindicated in pts with hypermagnesemia, hypocalcemia, w/in 2 hours of delivering baby, heart block, renal dysfunction * inc fluid intake to avoid dehydration * use for short term

Question 31

magnesium sulfate (IV): class

Answer 31

* mineral and electrolyte replacements

Question 32

magnesium sulfate (IV): MOA

Answer 32

* many enzymes need Mg * role in neurotransmission and muscle excitability

Question 33

magnesium sulfate (IV): indications

Answer 33

* Treatment/prevention of hypomagnesemia. * Treatment of hypertension. * **Prevention of seizures** associated with severe eclampsia, pre-eclampsia, or acute nephritis. * **Torsades de Pointes**

Question 34

magnesium sulfate (IV): SEs

Answer 34

* diarrheas * muscle weakness * flushing * dec in respiratory rate * drowsiness * bradycardia

Question 35

magnesium sulfate (IV): nursing implications

Answer 35

* contraindicated: hypermagnesemia, hypocalcemia, heart block, in OB pts avoid for using more than 5-7 days for preterm labor or within 2 hours of delivery, renal impairment * inc fluid intake