OTC: Constipation, Diarrhea, & N/V – Flashcards
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What is constipation?
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1. Pt has difficult or infrequent passage of stools 2. Patient may complain of abdominal or rectal fullness
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What are the three (3) main causes of constipation?
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1. Drug-Induced 2. Disease-Induced 3. Lifestyle-Induced
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What are the three (3) daily habits that can cause constipation?
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1. inadequate fluid intake 2. inadequate fiber intake 3. lack of physcial exercise
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Which two (2) types of drugs induce constipation?
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1. narcotics opioids 2. anticholinergics
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What should always be recommended to prevent or treat constipation?
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Diet & Lifestyle 1. increase fluid intake 2. increase fiber intake 3. exercise 4. establish good bowel habits
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What are the seven (7) types of laxatives used in constipation?
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1. bulk-forming laxatives 2. emollient laxatives 3. stimulant laxatives 4. hyperosmotic laxatives 5. saline laxatives 6. lubricant laxatives 7. enemas
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What is the MOA for bulk-forming laxatives?
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absorb water to soften stool and increase bulk, and facilitate peristalsis and elimination
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Name the four (4) bulk-forming laxatives
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1. psyllium seed (Metamucil) 2. methylcellulose (Citrucel) 3. calcium polycarbophil (FiberCon) 4. malt extract (Maltsupex)
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How long does it normally takes for bulk-forming laxatives to work?
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2-3 days
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What is the key ingredient within bulk-forming laxatives that gives it its laxative property?
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natural or semisynthetic hydrophillic polysaccharide
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Which type of laxative is most often recommended for chronic use d/t it being the safetest, most natural therapy for constipation?
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bulk-forming laxatives
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What are the two (2) CI of bulk-forming laxatives?
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1. digoxin 2. warfarin
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Which agent is CI to tetracycline, inhibiting its absorption?
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bulk-forming laxatives: calcium polycarbophil (FiberCon)
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Most important counseling point for bulk-forming agents?
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TAKE WITH A FULL GLASS OF WATER
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What is the MOA for emollient laxatives?
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emollient = surfactant (act as surfactants by allowing absorption of water into stool, which makes the softened stool easier to pass)
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What is another/common name for emollient laxatives?
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stool softeners
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Name the three (3) emollient laxatives agents
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1. docusate sodium (Colace) 2. docusate calcium (Surfak) 3. docusate potassium (Dialose)
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Which class of laxatives cause systemic absorption of mineral oil, therefore, concurrent use is CI?
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emollient laxatives (stool softeners)
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Docusate is good for patients who need to avoid _______.
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straining
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Emollient laxatives are useful for patients who should avoid straining during what three (3) conditions?
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1. rectal surgery 2. postpartum time period 3. recent myocardial infarction
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Which class of laxatives is best to use in pt undergoing rectal surgery?
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emollient laxatives (e.g., docusate)
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Which class of laxatives is best to use in postpartum pt?
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emollient laxatives (e.g., docusate)
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Which class of laxatives is best to use in pt with recent myocardial infarction?
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emollient laxatives (e.g., docusate)
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Emollients are only recommended for up to ______ days.
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7
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What is the MOA of stimulant laxatives?
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stimulate bowel motility through localized mucosal irritation & increase secretion of fluids into bowel
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Which class of laxatives can cause cramping?
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stimulant laxatives
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Which class of laxatives can impaired colon function d/t chronic use?
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stimulant laxatives
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What are the two (2) main diseases CI to stimulant laxatives?
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1. loss of fluids on electrolytes 2. cramping pains
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Name the three (3) stimulant laxatives agents
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1. senna (Senokot) 2. bisacodyl (Dulcolax) 3. castor oil
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This agent is absorbed into the bloodstream with action on the large intestine...
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senna (Senokot)
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This medication should be taken at bedtime with an onset 6-12 hours...
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senna (Senokot)
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What is the main SE of senna (Senokot)?
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discoloration of the urine
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Bisacodyl (Dulcolax) comes in what two forms?
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1. tablets 2. suppositories
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Which stimulant is the only stimulant approved to be used in breastfeeding AND why?
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bisacodyl (Dulcolax) b/c minimal systemic absorption
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Which laxative cannot be mixed with antacids?
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stimulant laxatives: bisacodyl (Dulcolax)
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Where does castor oil acts on?
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small intestine
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Which laxative agent is a strong cathartic & may induce fluid or electrolyte disturbance?
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stimulant laxatives: castor oil
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Which stimulant has the fastest onset of 2-6 hours?
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castor oil
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Which agent is CI in pregnancy because it may induce labor?
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stimulant laxatives: castor oil
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What is the MOA for hyperosmotic laxatives?
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creat an osmotic gradient to pull water into small & large intestines to distend the intestinal lumen, causing peristalsis & bowel motility
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Name the two (2) hyperosmotic laxatives
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1. glycerin (Fleet Glycerin) 2. polyethylene glycol 3350 (PEG) (MiraLAX)
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Which suppositories are safe for infants?
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hyperosmotic laxative: glycerin (Fleet Glycerin Suppository)
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What is the onset of glycerin suppositories?
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30 mins
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Can glycerin suppositories be cut?
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Yes
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How long can polyethylene glycol 3350 (PEG) (MiraLAX) be used to treat constipation?
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short-term: 1-3 days
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What is the adult dosage for PEG (MiraLAX)?
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17 grams of powder in 4-8 oz of water
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What are the four (4) SEs of PEG (MiraLAX)?
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1. bloating 2. abdominal discomfort 3. cramping 4. flatulence
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What is the MOA for saline laxatives?
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non-absorbable cations create osmotic gradient to pull water into small & large intestines to distend the intestinal lumen, causing peristalsis & bowel motility
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Name the four (4) saline laxative agents
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1. magnesium hydroxide (Milk of Magnesia) 2. magnesium citrate (Citroma) 3. magnesium sulfate (Epsom salts) 4. sodium phosphate (Fleet PhosphoSoda)
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Saline laxatives are CI in which three (3) groups of diseases?
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1. renal failure (Mg or P containing) 2. CHF 3. HTN (Na containing)
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Using saline laxatives may have 20% of what absorbed systemically?
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magnesium
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What is the MOA of lubricant laxatives?
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soften the feces by emulsifying the contents of intestinal tract
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Define emulsion
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a mixture of two or more liquids which are normally immiscible (un-blendable)
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Name the two (2) lubricant laxatives
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1. mineral oil (liquid petroleum) 2. olive oil ("sweet oil")
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These agents may decrease the absorption of fat-soluble vitamins...
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lubricant laxatives: 1. mineral oil (liquid petroleum) 2. olive oil ("sweet oil")
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Why are lubricant laxatives CI in children & elderly pts?
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d/t the risk of aspiration & lipid pneumonitis
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What is "lipid pneumonitis"?
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Lipid pneumonia is a specific form of lung inflammation (pneumonia) that develops when lipids enter the bronchial tree. The disorder is sometimes called Cholesterol pneumonia in cases where the lipid is a factor.
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Lubricant laxatives should NOT be administered with what other laxatives?
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emollient laxatives (stool softeners)
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What are the three (3) characteristics of Fleet Enema?
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1. oil retention 2. soap suds 3. warm tap water
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Care must be taken with patients who are pregnant. What three (3) things must you remeber about pregnant women for constipation?
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1. hormonal changes cause smooth muscle relaxation early in pregnancy 2. an enlarged uterus compresses the colon 3. ONLY use bulk-forming laxatives or stool softeners
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What is the generic brand for Perdiem?
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senna + psyllium
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What is the generic brand for Senokot-S?
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senna + docusate
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Which two (2) classes of laxatives are safest products to prevent AND treat constipation and can be used chronically?
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1. bulk-forming 2. stool softeners
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Which class of laxatives should be used only occasionally to prevent laxative dependence or other complications?
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stimulant laxatives
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Define diarrhea
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Diarrhea is the abnormal increase in frequency of stools and stool looseness
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Compare & contrast acute vs. chronic diarrhea
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acute: 4 weeks
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What are the three (3) common causes of diarrhea?
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1. infection 2. medications 3. diet
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What types of infections cause diarrhea?
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1. viral 2. bacterial 3. protozoal
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Which Antibiotic most commonly causes diarrhea?
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Augmentin (amoxicillin/clavulanate)
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Which four (4) groups of medications commonly cause diarrhea?
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1. antibiotics 2. laxatives 3. magnesium-containing antacids 4. cytotoxic agents
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What are the three (3) common type of food that can cause diarrhea?
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1. spicy foods 2. high carbohydrates 3. lactose intolerance
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What is lactose intolerance?
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the inability to digest and metabolize lactose, a sugar found in milk
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Chronic diarrhea will result into what two (2) complications?
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1. dehydration 2. electrolyte abnormalities
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What are the two (2) common agents used for diarrhea treatment?
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1. loperamide (Imodium) 2. bismuth subsalicylate (Pepto-Bismol)
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What is the MOA for loperamide (Imodium)?
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Loperamide binds to opiate receptors in the gut & slows GI motility
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How does loperamide (Imodium) usually dose when treating diarrhea?
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4 mg initially 2 mg after each loose stool
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What is the MAX dose of loperamide (Imodium) per day?
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8 mg/day (16 mg/day with MD)
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What are the three (3) common SEs of loperamide (Imodium)?
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1. constipation 2. dizziness 3. dry mouth
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Loperamide should not be given to children less than _____ years old.
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6
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Loperamide (Imodium) should be avoid in patients that have...
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black or bloody stool
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What is the MOA of bismuth subsalicylate (Pepto-Bismol)?
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reacts with stomach acid to form salicylic acid (absorbed) & bismuth oxychloride (not absorbed); decreases secretion of water into the bowel.
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What is the most common infecting organism in Travelers Diarrhea?
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E. Coli
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Which agent has a direct antimicrobial effect, therefore, is effective in traveler's diarrhea?
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bismuth subsalicylate (Pepto-Bismol)
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What are the three (3) SEs of bismuth subsalicylate (Pepto-Bismol)?
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1. salicylate toxicity (tinnitus) 2. bismuth toxicity (neurotoxicity) 3. gray-black discoloration of tongue
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What is tinnitus?
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Tinnitus is hearing ringing, buzzing, or other sounds without an external cause.
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Which agent is also CI in patient who has allergy to aspirin?
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bismuth subsalicylate (Pepto-Bismol)
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What are the three (3) CI of bismuth subsalicylate (Pepto-Bismol)?
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1. children w/ Reye's syndrome 2. GI bleed 3. warfarin
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Bismuth subsalicylate (Pepto-Bismol) should not be used in children less than _____ years old.
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12
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Which agent can cause black stool and darkening of the tongue?
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bismuth subsalicylate (Pepto-Bismol)
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Adult Pepto-Bismol liquid dose?
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2 tbsp q 30-60 min. max 16 tbsps daily for 2 days
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Term for intense, involuntary, unsuccessful effort to vomit
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Retching
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Term for unpleasnt feeling associated with epigastrium and abdominal symptoms, usually occurs before vomiting
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Nausea
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Term for physical expulsion of stomach, esophageal, and oropharyngeal contents
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Vomiting
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What is the vomiting center that coordinates vomiting?
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Medulla Oblongata
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Name five (5) types of NT/receptors involved in vomiting
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1. dopamine 2. histamine 3. cholinergic 4. serotonin 5. adrenergic
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What are the five (5) complications that N/V can cause?
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1. dehydration 2. electrolyte imbalance 3. aspiration 4. malnutrition 5. acid-base disturbances
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What are the four (4) treatment options for N/V?
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1. H1-antihistamines 2. phosphorated carbohydrate solution (Emetrol) 3. bismuth subsalicylate (Pepto-Bismol) 4. histamine 2-receptor antagonists (H2RAs) 5. antacids
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How does antihistamines work (MOA) to prevent N/V?
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cross the BBB & block histamine-mediated N/V
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What are the four (4) OTC drug of choice for prevention of motion sickness?
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1st-Gen Antihistamines 1. dimenhydrinate (Dramamine) 2. diphendyramine (Benadryl) 3. cyclizine (Marezine) 4. meclizine (Bonine)
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Which antiemetics is NOT recommended for those under 12 y/o?
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meclizine (Bonine)
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What is the dosage for meclizine (Bonine) in adult for motion sickness tx?
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25 - 50 mg qd MAX 50 mg
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Which antiemetics is most commonly used for motion sickness?
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meclizine (Bonine)
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When should you take your first antiemetic dose when you travel?
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Give dose 30-60 minutes prior to trip, continue during travel.
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Which antiemetics is NOT recommended for children under 6 y/o?
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cyclizine (Marezine)
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Which two (2) antiemetics can be used in children up to 2 y/o?
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1. dimenhydrinate (Dramamine) 2. diphendyramine (Benadryl)
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What is phosphorated carbohydrate solution (Emetrol)?
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a hyperosmolar solution that is a mixture of fructose, dextrose, & phosphoric acid that's used to treat N/V from foods
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What is the MOA for phosphorated carbohydrate solution (Emetrol)?
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reduces gastric muscle contraction
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This antiemetics should not be given to diabetics because of its high sugar content _________.
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phosphorated carbohydrate solution (Emetrol)
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What should you counsel patient on about phosphorated carbohydrate solution (Emetrol) dosage?
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do not mixed or dilute the content, which raises the pH
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Define dysentery
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bloody stool
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What is the MOA for histamine 2-receptor antagonists (H2RAs) for preventing N/V?
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inhibiting gastric acid secretion
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What are the four (4) H2RAs that can be used to prevent N/V?
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1. cimetidine (Tagamet) 2. famotidine (Pepcid) 3. ranitidine (Zantac) 4. nizatidine (Axid)
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What are the three (3) common SEs of H2RAs?
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1. HA 2. constipation 3. diarrhea
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What three (3) things do antacids treat or use for?
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All associated with excessive intake of food & drink 1. nausea 2. dyspepsia 3. stomach upset
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What is the MOA for antacids?
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neutralized gastric acidity, increase pH
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What are the common salts in antacids?
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1. magnesium hydroxide 2. sodium salt 3. aluminum hydroxide 4. calcium carbonate 5. magnesium carbonate
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What is the usual dosage of antacids?
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15 ml 30 minutes after meals & at bedtime
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What are the three (3) main SE of antacids?
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1. constipation 2. diarrhea 3. sodium overload
