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Flashcards in GI Motility 2 Deck (36)
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1

Which laxative?

  • rapid movement of water into the distal small bowel and colon leads to a high volume of liquid stool followed by rapid relief of constipation
  • high doses of osmotically active agents produce prompt bowel evacuation within 1–3 hours
  • important that patients maintain adequate hydration by taking increased oral liquids to compensate for fecal fluid loss

Purgatives 

  • Magnesium citrate
  • Sodium phosphate

2

ADEs of which laxative?

  • hyperphosphatemia
  • hypernatremia
  • hypocalcemia
  • hypokalemia
  • may lead to cardiac arrhythmias
  • may lead to acute renal failure 

Sodium Phosphate 

 

3

In which 4 patients should you not prescribe Sodium Phosphate?

 

  • Frail / elderly
  • Renal insufficiency
  • Significant cardiac disease
  • Unable to maintain adequate hydration during bowel preparation

4

Which laxative?

  • used to clean colon before GI endoscopic procedures
  • balanced, isotonic solutions contain an inert, nonabsorbable, osmotically active sugar with sodium sulfate, sodium chloride, sodium bicarbonate, and potassium chloride
  • designed so that no significant intravascular fluid or electrolyte shifts occur

Polyethylene glycol (PEG)

5

Which laxative?

  • safe for all patients
  • solution should be ingested rapidly (2–4 L over 2–4 hours) to promote bowel cleansing
  • treatment or prevention of chronic constipation

Polyethylene Glycol (PEG)

(MiraLAX)

6

Which laxative?

  • Induce bowel movements through direct stimulation of the enteric nervous system and colonic electrolyte and fluid secretion
  • may be required on a long-term basis
    • Neurologically impaired
    • Bed-bound patients in long-term care facilities

Cathartics (stimulant laxatives)

7

Which laxative?

•Long-term use is controversial

 

Stimulant laxatives (cathartics)

8

Which laxative?

  • Aloe, senna, and cascara
  • Occur naturally in plant
  • Laxatives are poorly absorbed and after hydrolysis in the colon, produce a bowel movement in 6–12 hours

Anthraquinone Derivatives

(Laxative Stimulants)

9

Anthraquinone Derivatives (Laxative Stimulant)

  • Chronic use causes what? 
  • There is concern these agents may cause what? 

  • Characteristic brown pigmentation of the colon (Melanosis Coli)
  • Carcinogenic, but epidemiologic studies do NOT suggest a relation to colorectal cancer

10

Which laxative?

  • Bisacodyl (Ducolax)
  • treatment of acute and chronic constipation
  • used in conjunction with PEG solutions for colonic cleansing prior to colonoscopy
  • induces a bowel movement within 6–10 hours when given orally and 30–60 minutes when taken rectally
  • minimal systemic absorption and appears to be safe for acute and long-term use**

Diphenylmethane Derivative

11

Acute and Chronic therapy w/ opioids may cause constipation due to what mechanism?

Decreasing intestinal motility

12

Which 3 Opioid Receptor Antagonists (peripherally acting)?

  • do not readily cross the blood-brain barrier

  • inhibit peripheral μ-opioid receptors without impacting analgesic effects within the central nervous system

  • Methylnaltrexone bromide
  • Alvinopan
  • Naloxegol

13

Which Opioid Receptor Antagonist?

•approved for the treatment of opioid-induced constipation in patients receiving palliative care 

Methylnaltrexone (Relistor)

14

Which Opioid Receptor Antagonist?

•approved for short-term use to shorten the period of postoperative ileus in hospitalized patients who have undergone small or large bowel resection

no more than 7 days

•possible cardiovascular toxicity

Alvimopan (Entereg) 

15

Which Opioid Receptor Antagonist?

Opioid-induced constipation

•Dosage adjustment with renal impairment (CrCl < 60ml/min)

•Avoid use in severe hepatic impairment (Child-Pugh class C)

 

Naloxegol (Movantik)

16

  • Acute diarrhea is how many days?
  • Chronic diarrhea is how many days?

  • Acute: <3 days
  • Chronic: >14 days

17

Clinical Controversy

  • Withholding food is considered inappropriate in pts w/ no signs of what?
  • In osmotic diarrhea, what may control the problem?
  • If the mechanism is ____, diarrhea persists

  • Severe dehydration
  • food
  • secretory

18

What type of Antidiarrheal Agent?

  • Antimotility

Opioid agonists

19

What type of Antidiarrheal Agent?

  • Kaolin-pectin mixture

Absorbents

20

What type of Antidiarrheal Agent?

  • Colloidal Bismuth Compounds
  • Bile Salt-Binding Resins
  • Octrotide

Antisecretory

21

What are the 4 types of Antidiarrheal Agents

  • Antimotility
  • Adsorbents
  • Antisecretory
  • Bacterial replacement and enzymes

22

Antidiarrheal Agents

  •  
  • Should not be used in patients w/ what 3 things?

  • Bloody diarrhea
  • High fever
  • Systemic toxicity

23

Antidiarrheals are used to treat which 2 conditions? 

IBS and IBD

24

Which antidiarrheal agent?

  • significant constipating effects
  • increased colonic transit time and fecal water absorption

Opioid Agonists

25

Which antidiarrheal agent?

  • nonprescription opioid agonist
  • does not cross the blood-brain barrier
  • no analgesic properties or potential for addiction
  •  

Loperamide

26

Which antidiarrheal agent?

 

  • higher doses have central nervous system effects
  • prolonged use can lead to opioid dependence

Diphenoxylate

27

What type of antidiarrheal agent?

  • Kaolin-pectin
  • Adsorb nutrients, toxins, drugs, and digestive juices

Adsorbents

28

Which antidiarrheal agent?

  • Mucosal Protective Agents

Colloidal Bismuth Compounds

29

What are the 3 Bile Salt-Binding Resins? 

- cholestyramine

- colestipol

- colesevelam

30

Which bile salts bind to drugs and decrease their absorption? 

 

Cholestyramine

Colestipol