Constipation & Diarrhea Flashcards by Sara Bojarski

constipation occurring for several weeks with unknown causw

chronic idiopathic constipation (CIC)

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abdominal discomfort relieved by defecation

IBS-C

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non-drug treatment of constipation

inc fluid
physical activity
high fiber foods

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drugs that are constipating

antidiarrheals
anticholinergics (antihistamines, phenothiazines, TCAs, incontinence meds)
cation-containing drugs (antacids w/ Al or Ca, Fe, sucralfate)
colesevelam
opioids
some anti-HTN (clonidine, non-DHP CCBs)

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most common AE of constipation meds

diarrhea
abdominal cramping

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first line constipation treatment (and choice in pregnancy)

bulk forming drugs (psyllium), fiber

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example of an osmotic for constipation

Miralax

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examples of stimulants for constipation

senna, bisacodyl

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example of a stool softener

docusate

may be given with stimulants

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docusate is often used in patients taking what supplements

iron

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lubricant example for constipation

mineral oil

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what OTC to recommend for constipation IN MOST ADULTS

fiber

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what OTC to recommend for constipation FOR IRONE INDUCED OR HARD STOOL

stool softener
bulk forming

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what OTC to recommend for constipation IF OPIOID INDUCED

stimulant or osmotic

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what OTC to recommend for constipation IN PREGNANCY

FIBER

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what OTC to recommend for constipation IF FAST RELIEF IS NEEDED

adults- bisacodyl or glycerin suppository
children- glycerin suppository

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brand name of psyllium

Metamucil

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brand name of calcium polycarbophil

FiberCon

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brand name of methylcellulose

Citrucel

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brand name of wheat dextrin

Benefiber

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AEs of bulk forming drugs

flatulence, abdominal cramping, bloating

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DDI for calcium polycarbophil

binding interactions due to Ca - separate

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adequate ___ is required when taking bulk forming drugs

fluids

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examples of osmotic laxatives

mag hydroxide
PEG
glycerin
lactulose
sodium phosphates

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brand name of magnesium hydroxide

Milk of Magnesia

brand name PEG

MIralax

brand name of sodium phosphate

Fleet Enema

AEs of osmotic laxatives

electrolyte imbalance, abdominal cramping

lactulose is also used for

hepatic encephalopathy

caution with Mg containing osmotics in patients with

renal impairment

glycerin suppositories are commonly used in

children who need to defecate quickly

brand names of senna

Ex-Lax, Senokot

brand name of senna + docusate

Senna S, Senokot S

brand name of bisacodyl

Dulcolax

AE of stimulant laxatives

abdominal cramping

when should oral stimulant laxatives be taken

bedtime

brand name of docusate

Colace

when is docusate preferred to be used

when straining should be avoided when stool is hard or dry

brand name lubiprostone

Amitiza

what can lubiprostone be used for

CIC, OIC, IBS-C

AE of lubiprostone

nausea

brand name of linaclotide

linzess

what can linaclotide and plecanatide be used for

CIC, IBS-C

AE of linaclotide, plecanatide

diarrhea

brand name of Alvimopan

Entereg

when is alvimopan used

hospitalized surgery patients to decrease risk of post-op ileus

use of alviopan us limited to a max of

15 doses

contraindication of alviopan (and other PAMORAs)

therapeutic doses of opioisd >7 consecutive days

PAMORAs

alvimopan methylnaltrexone naloxegol

methylnaltrexone and naloxegol is used in

OIC only

brand name methylnaltrexone

Relistor

brand name naloxegol

MOvantik

warning of prucalopride

suicidal ideation

AE of prucalopride

diarrhea

laxatives for whole bowel irrigation can cause

fluid and electrolyte losses caution in CV disease, renal insufficiency, or loop/NSAID use

brand names of PEG-electrolyte solution

Colyte, GoLytely

brand name of sodium phosphates for bowel prep

OsmoPrep

brand name of sodium sulfate, K sulfate, and Mg sulfate

Suprep Bowel Prep Kit

BBW for sodium phosphate (OsmoPrep)

nephropathy

contraindications to sodium phosphate (OsmoPrep)

acute phosphate nephropathy gastric bypass or stapling surgery

bowel prep regimens typically require what dosing

evening before and morning of colonoscopy

diet required before a colonoscopy

clear liquid

do not consume what before a colonoscopy

solid or semi solid foods red or blue/purple food coloring

most common cause of diarrhea

viral (E. coli)

type of diarrhea associated with abdominal discomfort relieved by defecation

IBS-D

drugs that can cause diarrhea

AchEst inhibitors Mg antacids antibiotics antidiabetics, antineoplastics colchicine constipation meds misoprostol mycophenolate prokinetic drugs protease inhibitors quinidine roflumilast

non-drug treatment of diarrhea

fluid & electrolyte replacement with oral rehydration solution (ORS)

short term symptomatic diarrhea relief options

bismuth subsalicylate, loperamide

antimotility drugs that slow intestinal motility for diarrhea

loperamide diphenoxylate

mixed mu opioid receptor agonist used late line for IBS-D

eluxadoline

brand name bismuth subsalicylate

Pepto Bismol

contraindications to bismuth subsalicylate

salicylate allergy taking other salicylates GI ulcer bleeding problems black/bloody stool

warnings for bismuth subsalicylate

risk of Reyes in children and teens recovering from flu or other viral infections

AEs of bismuth subsalicylate

black tongue/stool, salicylate toxicity (tinnitus), nausea

DDI bismuth subsalicylate increased risk of ___ with___

bleeding anticoagulants, antiplatelets

brand name loperamide

imodium A-D

dosing of loperamide

4mg PO after 1st loose stool then 2mg after each subsequent loose stool

MDD for OTC loperamide? supervised?

OTC- 8mg/day RX- 16mg/day (healthcare supervision)

BBW for loperamide

cardiac arrest, sudden death- do not exceed recommended dose do not use in children <2

contraindications to loperamice

acute dysentery bacterial enterocolitis

AE of loperamide

constipation

when using loperamide OTC, do not use longer than

>48 hours

what is required for packaging of loperamide

blister packs

brand name of diphenoxylate/atropine

Lomotil

control class of diphenoxylate/atropine

contraindication to diphenoxylate/atropine

do not use if age <2 or age <6 for tablets

liquid formulation of diphenoxylate/atropine is not recommended in

children <13

diphenoxylate/atropine causes mild ___ effects due to atropine

anticholinergic

brand name dicyclomine

Bentyl

warnings for dicyclomine

anticholinergic (caution age >65) caution UC (toxic megacolon, paralytic ileus)

AEs of dicyclomine

dizziness, dry mouth, nausea, blurred vision

what control class is eluxadoline

CIV

contraindication of eluxadoline

patients without a gallbladder

antibiotic option for diarrhea

rifaximin

5HT3 receptor antagonist option for diarrhea

alosteron

Constipation & Diarrhea Flashcards

(95 cards)