469 final flashcards.txt

  1. acute constipation defn
    <3 BM per week
  2. chronic constipation defn
    sx lasting >6wks
  3. recommeded daily fiber intake
  4. step 1 in chronic constipation
    dietary intervention
  5. step 2 in chronic constip
    bulk-forming laxative + adequate fluid intake
  6. step 3 in chronic constip
    sorbitol, lactulose, PEG
  7. step 4 in chronic constip
    short term stimulant laxative
  8. step 5 in chronic constip
  9. constip tx for paralyzed pts
    ROUTINE USE of bowel stimulants (suppositories)
  10. constip tx for pregnant pts
    nondrug (diet, fiber) then docusate, then senna in severe cases
  11. constip tx for children
    glycerin suppositories oor Karo syrups
  12. constip tx for diabetics
    metoclopramide and a stimulant
  13. constip tx for pts on chronic opioids
    stimulant; add lactulose, sorbitol or PEG if needed. Methylnaltrexone.
  14. what to avoid in pts on opioids
    bulk laxatives
  15. constip tx for post op pts
    MOM, PEG then stimulants if needed; PUSH FLUIDS
  16. constip tx for for pts undergoing GI procedures
    day before: clear liquid diet/ afternoon before: prep. FLUIDS FLUIDS FLUIDS
  17. osmoprep
    oral prep agent; rx only
  18. suprep
    oral prep agent; rx only
  19. avoid oral prep agents in pts with:
    heart failure, renal disease, electrolyte abnormalities
  20. psyllium (metamucil)
  21. methylcullulose (citrucel)
    bulk; mix with cold water; produces less gas
  22. fiber tabs
  23. bulk laxative moa
    form emollient gel which retains water and stimulates BM
  24. bulk laxative advantages
    SOFTEN stools better than docusate, well tolerated with few SE
  25. bulk laxative disadvan
    MUST HAVE ADEQUATE FLUID INTAKE; taste, gas, impact on drug absorp, not ideal for bedridden
  26. docusate (DOSS)
    QD or BID surfactant/emollient
  27. docusate MOA
    STOOL SOFTENER; dec fecal surface tension
  28. docusate advantages
    SAFE; prevemts hemorrhoids and hard poop(ew)
  29. docusate disadvan
    not effective for active constipation
  30. mineral oil
    lubricant; lubricates lumen of colon
  31. mineral oil advantages;
    lubricates and SOFTENS
  32. mineral oil disadvantages
    OILY AND GROSS. no one likes it. may dec absorp of fat sol vitamins
  33. what are the fat sol vitamins
  34. MOM
    saline laxative
  35. Mg citrate
    saline laxative
  36. phospha-soda
    saline laxative
  37. saline laxative moa
    draws fluid into colon which stimulates motility
  38. saline lax advantages
    for ACUTE constip; QUICK ONSET; cheap
  39. saline lax disadvan
    avoid in renal pts
  40. fleet's saline enema
    saline lax with RAPID ONSET
  41. sorbitol
    hyperosmotic agent
  42. lactulose
    hyperosmotic agent
  43. PEG (miralax)
    hyperosmotic agent; USE THIS ONE FOR DIABETICs
  44. hyperosmotic agents moa
    draw fluid into colon via high conc of sugar, PEG, or glycerin
  45. hyperosmotic agents advan
    well tolerated; SOFTENS and STIMULATES BM (2for1); EXCELLENT FOR CHRONIC
  46. hyperosmotic agents disadvan
    1-4day onset; tastes sweet, nausea, cramps
  47. glycerin suppository
    QUICK ONSET hyperosmotic agent; can be used for the kiddos too
  48. nulytely, golytely, halflyely
    PEG (hyperosmotic); bowel prep that tastes bad and must be refrigerated
  49. karo corn syrup
    hyperosmotic; can be used for kids
  50. senna
    stimulant laxative
  51. bisacodyl
    stimulant lax; EC = dont take with antacids
  52. castor oil
    stimlant lax
  53. stimlant lax moa
    locally irritates nerves which stimulate motility
  54. stimulant lax advan
    6-12hr onset; works in pts with motility disorders; can use for pts on opioids
  55. DOC for constipated people on opioids
    stimulant laxative
  56. stimulant lax disadvan
    cramps; avoid long term use in pts with GI motility issues
  57. bisacodyl suppositories
    stimulant lax with quick onset
  58. lubiprostone (Amitiza)
    sm intestine Cl channel activator that inc intestinal fluid; take with noms (food)
  59. what will work for chronic idiopathic constipation in ALL Adults
  60. lubiprostone SE
    diarrhea, nausea, HA
  61. lubiprostone disadvan
    $$$$$$$, avoid in pregnant pts
  62. when to follow up for acute constip
  63. when to follow up for chronic constip
  64. what to ask during follow up
    stool freq, diarrhea?, dietary changes
  65. causes of urge incontinence
    stroke, Alzheimers, Parkinsons, BPH w/overactive bladder
  66. urge incont features
    OVERACTIVE BLADDER; overactivity of detrusor; large vol + urgency + freq
  67. how to treat urge incont
    anticholinergics, antimuscarinics to dec detrusor contractions
  68. stress incont features
    OUTLET INCOMPETANCE (leaky); small vol, women, triggers like sneezing
  69. causes of stress incont
    urologic procedures, multiple childbirths, estrogen deficiency
  70. stress incont tx
    KEGELS, alpha agonists, estrogen replacements, duloxetine
  71. overflow incont features
    MALES, outlet obstruction, BPH w/o overactive bladder
  72. overflow incont tx
    treat OBSTRUCTION; alpha blockers (BPH), Kegel
  73. atonic bladder feature
    complete loss of bladder control
  74. atonic bladder causes
    severe diabetes, neuropathy, stroke, spinal cord injury
  75. for which type of incontinence is drug therapy ineffective
    atonic bladder
  76. atonic bladder tx
    intermittent catherization
  77. functional incont features
    inability to get to the bathroom in time. uhoh
  78. causes of fctional incont
    physical impairment, dementia, UTIs, meds
  79. tx of fctional incont
    eliminate the causes, scheduled voidings, no drugs usually
  80. oxybutynin (ditropan,XL)
  81. gelnique (oxybutynin)
    lower rate of SE; rotate sites
  82. tolterodine (Detrol, LA)
    fewer SE with LA formulation?
  83. trospium cl (sanctura, XR)
    absorp dec by food
  84. solifenacin (vesicare)
    more m3 selective; may have worse CNS SE
  85. darifenacin (Enablex)
    HAS DRUG INTERACTIONS (others dont)
  86. fesoterodine (toviaz)
    dose-related SE; prodrug
  87. anticholinergic SE
    DRY MOUTH/EYES, CONSTIPATION, mydriasis, delirium, urinary retention, tachy, confusion, somnolence, blurry vision
  88. in which pts should anticholinergics be avoided
    men with BPH w/o overactive bladder; Alzheimers pts
  89. when to follow up incont tx
    review efficacy over 1-2mo
Card Set
469 final flashcards.txt
469 final flashcards