1. Why would someone with Cardo Disease benefit from a stool softener?
    • Due to Valsalva Maneuver (bearing down to pass stool) blood is pushed to perifery and then returns to core which may trigger:
    • Heart attack
    • Stroke
    • Release of thrombi (clot)
  2. What are hemeroids and why would pt's with them benefit from a stool softener?
    They're retcal vericose veins and it hurts them to poop
  3. Contraindications for Laxatives
    • Unexplained abdominal pain
    • Nausea
    • Cramps
    • Symptoms of appendicitis: Feer, lower rt quadrant pain abd pain
    • Regional enteritis:Increasing peristalsys can cause perferation.
    • Diverticulitis:Increasing peristalsys can cause perferation.
    • Ulcerative colitis: Increasing peristalsys can cause perferation.
    • Acute surgical abdomen.
  4. What are bulk forming laxatives?
    • Any laxatives that contains fiber.
    • Draws fluid into the bowel and creates viscous volume there--> increase perstal.
  5. What is a surfactant lax?
    It lubricates the bowel to aid passage.
  6. Stimulant
    Irritant to colon--> increase paristal
  7. Osmotics
    • Increases tonicity of contents of bowel.
    • Adds fluid to stool, increases volume--> increase peristal.
  8. Laxtulose
    • Not really a laxative.
    • Removes amonia in chronic liver disease and draws it into the bowel.-->diarreah.
  9. Polyetholine glycole electrolyte solution
    • Large volumes. (Up to 4 liters.)
    • BM starts ~1hr after administration.
    • Used as prep for rectal exame
    • Also called Go Lightly
    • Considered cathartic (feel squeekly clean)
  10. Polyetholine glycol (miralax)
    • Powder, clear, tasteless, mixes with liquid
    • No bloating or cramping
    • Most pt's prefer to other laxatives.
    • 3-4 days until effective
  11. Relistore (Methylmaltrexone Bromide)
    • Opiod antagonist
    • Used to treat opiod-induced contipation
    • Antagonizes Mu opiod receptors in gut.
    • Does not trigger receptors for pain and analgisia.
    • Decreases constipation without reducing analgisia.
    • Admin subcut, given every other day.
    • 33% have bm within 30 min. 60% in 4 hrs
    • Reduce dose by half if pt has renal failure.
    • Vial is one use. dispose of leftovers with documentation and have witness.
    • Discontinue if pt stops taking opiods.
    • Side effects: abd pain, nausea, dizziness, diarreah.
    • Dose based on weight.
    • Do not give to pt with intestinal blockage.
    • Must be used within 24 hrs after drawn.
  12. What to look for when pt has diarreah...
    • How frequent and what's the viscosity?
    • Formed, semiformed, liquid, etc?
    • Is a symptom, so treat cause not just symptom
  13. Potential causes of diarreah.
    • Infxn.
    • Maldigestion-->increased acid.
    • Functional disorder of intestin.
    • Dehydration.
    • Impaction: Non-movable fecal obstruction. Diarreah leaks around impaction. (Smeary, continuous diarreah.)
  14. What are the 2 forms of anti-diarreals?
    • Specific: Treats cause, ie antibiotics.
    • Non-specific: Rx which will effect bowel in very specific ways. (ie opiods--> decrease peristal).
    • Bulk formers can treat both constipation and
    • Antisposmotics: Decreases parasympathetic stimulation of bowel.
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