Laxatives

Question 1

5 types of laxative

Answer 1

• Bulk-forming laxatives: psyllium (Metamucil)
• Surfactant laxative: docusate sodium (Colace)
• Stimulant laxative: bisacodyl (Dulcolax)
• Osmotic laxative
• Misc: Chloride channel activator: lubiprostone (Amitiza)

Question 2

how do we classify laxatives?

Answer 2

based on how fast you have a BM

Question 3

when do we want to use laxatives?

Answer 3

When do we want to use laxatives?

• short term basis
• prevention of straining: post op, opioids, cardiac

Question 4

When do we NOT want to give laxatives?

Answer 4

• acute abdomen - s/s of appendicitis, diverticulitis, UC –> bowel perf
• fecal impaction/obstruction –> bowel perf
• habitually to manage constipation

Question 5

Constipation is more defined by stool ______ than _____

Answer 5

consistency, frequency

Question 6

prototype for bulk forming laxative

Answer 6

Psyllium (Metamucil)

Question 7

how does Psyllium (Metamucil) fxn?

Answer 7

Acts like dietary fiber --> Pull water into stool
• increases mass
• softens stool 
• feeds colonic bacteria
• increases peristalsis 
• *works to decrease cholesterol

Question 8

admin for Psyllium (Metamucil)

Answer 8

give w/ full glass of water

Question 9

risk of _______ w/ Psyllium (Metamucil)

Answer 9

intestinal obstruction

Question 10

Psyllium (Metamucil)- prevent or treat constipation?

Answer 10

preventative

- okay to use daily

Question 11

onset of action for Psyllium (Metamucil)

Answer 11

1-3 days (III)

Question 12

prototype for Surfactant Laxatives

Answer 12

docusate sodium (Colace)

Question 13

how does docusate sodium (Colace) fxn?

Answer 13

Lower surface tension

• -> increase fluid in stool by inhibiting fluid absorption
• softens stool, causes secretion of water and electrolyte into the intestine
• site of action is small intestine and colon

(makes it easier to go- falls right out of your dooky hole)

Question 14

indication for using ducosate sodium?

Answer 14

• post surgical, cardiac, postpartum: prevent straining

Question 15

is ducosate sodium preventative or treatment for constipation?

Answer 15

preventative

Question 16

admin for docusate sodium (Colace)

Answer 16

full glass of water

Question 17

onset of docusate sodium (Colace)

Answer 17

1-3 days (III)

Question 18

prototype for osmotic laxatives

Answer 18

polyethylene glycol (Miralax)

Question 19

how do osmotic laxatives fxn?

Answer 19

Nonabsorbable compound

• pull water into intestinal lumen –> fecal mass swells and stimulates peristalsis

Question 20

indication for low dose vs high dose osmotic laxatives

Answer 20

low dose: Used for chronic constipation, Daily use, PREVENTATIVE

high dose: Bowl Prep in high dose, TREATMENT

Question 21

side effects of polyethylene glycol (Miralax) (low dose)

Answer 21

Nausea, abd. Bloating, cramping, flatulence

Question 22

onset of osmotic laxatives: low vs high dose

Answer 22

low: 2-4 days
high: 2-6 hours

Question 23

milk of magnesia is _______ laxative. It is contraindicated in _____ patients

Answer 23

osmotic

renal

Question 24

considerations for high dose osmotic laxatives

Answer 24

• Risk of dehydration
• Not used in renal dysfunction or cardiac patients
• Deaths associated with use

Question 25

lactulose is a ______ laxative

Answer 25

osmotic

Question 26

lubiprostone (Amitiza) falls in what class of laxative?

Answer 26

misc!

Question 27

how does lubiprostone (Amitiza) fxn?

Answer 27

Selective Chloride channel activator • promotes the secretion of Cl rich fluid into the intestine • enhances motility of small and large intestine

Question 28

lubiprostone (Amitiza) onset

Answer 28

w/in 24 hours

Question 29

indication for lubiprostone (Amitiza)

Answer 29

Irritable bowel syndrome, Chronic idiopathic constipation , Opioid induced constipation

Question 30

lubiprostone (Amitiza)- preventative or treatment

Answer 30

preventative, daily use

Question 31

side effects of lubiprostone (Amitiza)

Answer 31

nausea

Question 32

admin of lubiprostone (Amitiza)

Answer 32

take w/ food and water | gotta have food when ur ready for lube

Question 33

why does laxative abuse occur? explain the patho

Answer 33

• normal filling of bowel results in defecation reflex ◦ only a portion of bowel empties out during BM, then fills, and reflex to poop again ______ • with stimulant or osmotic laxative that clears the entire bowel, it takes a long time for bowel to refill and cause defecation reflex --> + bowel forgets to work due to being used to exogenous stimulation