Tx various minor ailments Flashcards
NonPharms prevention constipation (5)
Fibre
fluid -1.5L/day
toilet routine
- bowel schedule
- stool to put feet on
bowel retraining
exercise
nonpharms for tx of constipation (4)
increased fluid
bowel retraining
manual manipulation
prebiotics/probiotics
- activia
- bioGaia tabs
- bisbiome
- yakult liquid
5 classes of laxatives (nonRx pharm)
bulk forming
osmotic agents
stool softeners
saline laxatives
stimulant laxatives
bulk forming (nonRx pharm)
psyllium
- Lax A day / metamucil
- 70% soluble fibre 30% insoluble
- DO NOT INHALE POWDER
wheat dextran vs inulin
- (USA = wheat dextran CAN = inulin)
- Benefiber
- soluble fibre dissolves in liquid
Low level evidence
- sterculia gum
- polycorbophil
- methylcellulose
osmotic agents (nonRx pharm)
- MoA
- evidence
- 4 kinds
- how use to avoid diarrhea
- purgative/lavage
non-absorbed ions or mols break down gut flora –> acidic env osmotic gradients within intestinal lumen retaining water
ONLY laxative family with evidence shown to improve constipation
- glycerin suppository (only works in last few inches of rectum)
- lactulose (can use in diabetics bc no systemic abs)
- sorbitol 70% solution (syrup)
- PEG 3350 powder
+restoralax, miralax, lax a day
+good for pediatrics and adults
+onset 3 days
TO AVOID DIARRHEA
-start low and work way up
Purgative/lavage
- PEG with electrolytes
- much higher dose
- should be closely supervised by physician or caregiver
Stool softeners (nonRx pharm)
- MoA
- names 2
- lubricant/purgative (2)
-EVIDENCE/EFICACIOUS?
act as surfactants and soften stool by allowing mixing of aq and fatty substances
docusate sodium
docusate calcium
LUbricant/purgative
- mineral oil oral
- mineral oil enema
Saline Laxatives (nonRx pharm)
- MoA
- avoid in who
- oral (3)
- enemas (6)
- ENEMA NOTE
create osmotic gradient through electrolyte imbalance
avoid in children and elderly
Oral
- Mg(OH)2
- MgCitrate
- NaPO4 oral
Enemas
- tap water
- soap suds
- Mg enema
- Phosphate soda
- saline enema
- mineral oil
ENEMA NOTE
-can damage rectum, only use as pretense to remove impaction
Stimulant laxatives (nonRx pharm)
- MoA
- concern
- 4 types
- how use
produce rhythmic contractions in intestines
dependency with overuse, talk about reduction in those using lot
DO NOT CAUSE MELANOSIS
senna tablets/suppository
- can be used in children as liquid and may be used in pregnancy
- herbal, tablet, liquid -> probs swallowing
Bisacodyl tablets/suppository
cascara sagrada
-NOT commonly used
Castor oil
HOW USE
- take at night then shit for the next 12 days
- some patients complain about cramping
Complimentary and homeopathic and herbal agents
- evidence
- found in OTC prep
- 11 worthless hunks of plant
NO EVIDENCE, JUST EAT GRASS
senna and psillium –> use OTC bc thats where evidence
slippery elm Fennei seed aloe vera papaya acacia gum psyllium husk pepermint leaves triphala buckthorn bark senna leaves ginger root
Oral forms for laxatives (acute)
PEG 3350 1.5g/kg/day
- evidence for disimpaction
NO EVIDENCE BUt USED IN PRACTICE Mg(OH)2 MgCitrate lactulose sorbitol senna bisacodyl
Rectal laxatives (acute)
EVIDENCE FOR DISIMPACTION -phosphate soda enema - saline enema - mineral oil enema followed by phasphate \+ need medical supervision
MOST EVIDENCE IN ELDERLY
- bisacodyl suppository
- glycerin suppository
NOT RECOMMENDED tox and irrit
- soap suds enema
- tap water enema
- Mg enema
glycerin suppository (acute)
fastest onset
less effective if stool dry and hard
fast acting in nec to get relief before oral osmotic agent works in 48 hours
saline laxatives (acute)
- evidence
- onset
- admin with what
- taste
- concern
- CI
lack evidence to supp effectiveness
fast acting and effective
administer with enough fluid avoid dehydration
tastes v chalky
electrolyte disturbances
- esp in LT use
- -> diarrhea
CONTRAINDICATIONS
- renal failure
- CHF worse due to Mg
- Neg mortality at 3 yrs
bulk laxatives (acute)
- when do not use
- how administer
- good for what constipation
- bad in what constipations
do not use if patient is
- dehydrated
- fluid restricted
- impacted
administer with at least 250mL water or juice to prevent impaction
improves normal transit constipation
poor in slow colonic transit or pelvic floor disorder
stool softeners
- chronic constipation use?
- AEs?
- mineral oil risk
- AVOID IN WHO
insufficient data to use in chronic
AEs equal to placebo
mineral oil risk of lipid aspiration and binding fat soluble drugs
Avoid in pediatric and elderly
timeframe to eliminate cramping and bloating
1 day
timeframe to reduce pain
1-2 hours
timeframe to prevent future constipation
3-4 days
-get >3shits/wk
bulk laxatives for chronic
- safety LT use
- avoid in who
- admin with what
safest drug for LT use
avoid in dehydrated or fluid restricted
admin with 250mL water or juice to prevent impaction
osmotic laxatives (chronic)
- what one use in children
- lactulose and PEG
- low dose
FIRST LINE in pediatric = PEG
lactulose
- abdominal pain
- 80% effective
PEG
-least straining and greatest efficacy and tolerability
low dose
- stops bloating, cramping, flatulence, and electrolyte imbalance
saline laxatives (chronic)
- evidence
- onset
- admin with what
- compliance consideration
- risks
- lack evidence to supp effectiveness
fast acting and effective
admin withe nough fluid prevent dehydration
compliance prob: chalky taste
RISKS
- multiple electrolyte disturbances esp in LT use
- diarrhea
Stimulant laxatives (chronic)
- evidence
- opioid induced
- when admin/onset
- RISKS
- insufficient evidence
- best with opioid induced constipation (combo with osmotic agent may work better)
- admin at bedtime
- onset 6-12hr
RISKS -concern dependence \+ limit use when possible \+use if other classes innefective -abdominal discomfort and some electrolyte imbalance
for an acute episode of constipation
saline laxative, glycerin suppository, and/or enemas if no BM for 3 consecutive days
