The flashcards below were created by user
daynuhmay
on FreezingBlue Flashcards.
-
sx of constipation
- <3 BM's per week (LOL)
- straining
- difficult passage of hard, dry stools
-
causes of constipation (3)
- 1) med conditions/meds
- 2) psychological/physiological conditions (menopause)
- 3) lifestyle characteristics (inadequate fiber, sedentary lifestyle)
-
how does exercise help constipation?
- increases muscle tone
- promotes BM's
-
2 vitamins that can cause constipation
-
how ignoring the urge to empty the bowel causes rectal muscles to become less effective in elimination
nerve pathways degenerate & stop sending the signal to defecate
-
list some drugs that may induce constipation:
- analgesics
- antacids
- antihistamines
- Ca channel blockers
- diuretics
- opiates
- hypotensives
-
initial management of constipation (3)
- 1) adjust diet to include foods high in *insoluble* fiber
- 2) increase fluid intake
- 3) exercise
-
duration of laxative tx before medical referral
7 days
-
exclusions for self-treatment of constipation
- abdominal pain (obstruction)
- N/V (infection)
- sudden change in bowel habits that persists for 2 weeks (IBD, colorectal cancer)
- use of laxative >7days
- rectal bleeding (hemorrhoids)
- weight loss (severe dehydration, cancer, CF)
- para/quadriplegic
- change in stool character (cancer, obstruction)
-
recommended adult daily fiber intake
-
negative effects of significantly increasing dietary fiber
- 1) erratic bowel habits
- 2) flatulence
- 3) abdominal discomfort
-
when are gastrococlic reflexes the strongest?
- first thing in the morning
- 30min after a meal
-
2 examples of enemas
- 1) sodium phosphate
- 2) mineral oil
-
onset of action for enemas
minutes
-
why are sodium phosphate enemas cautioned in those w/ heart failure, uncontrolled HTN, renal impairment, or edema?
increase BP and fluid retention by sodium (exacerbates conditions in which fluid retention is already an issue)
-
onset of action for suppositories
15-60minutes
-
recommended as first-line pharmacological treatment for most instances of constipation
bulk-forming agents
-
MOA of bulk-forming agents
swells in intestinal fluid of small & large intestines, forming emollient gels that facilitate passage of intestinal contents & stimulate peristalsis (works like a sponge)
-
onset of action for bulk-forming agents
1-3days
-
special populations for bulk-forming agents
dextrose content should be evaluated before use by diabetic pts or those w/ restricted caloric intake
-
name 2 hyperosmotic laxatives
- PEG (polyethylene glycol) 3350
- glycerin
-
MOA of hyperosmotic agents
large, poorly absorbed molecules that draw water into the colon/rectum to stimulate a BM
-
normal onset of action for PEG3350
12-72 hrs
-
youngest age PEG3350 can be used
2yo (1g/kg)
-
only laxative safe for all age groups
glycerin suppository
-
MOA of emollient agents (stool softeners)
anionic surfactants that act in the small & large intestines to increase wetting efficiency of intestinal fluid, as was as mixture of aqueous & fatty substances to soften fecal mass
-
docusate onset of action
1-3 days
-
precaution for emollients
can increase systemic absorption of mineral oil
-
name a lubricant agent laxative
mineral oil
-
MOA of lubricant agents
acts in the colon to soften fecal contents by coating the stool & preventing colonic absorption of water
-
onset of action of oral lubricant agent
6-8 hrs
-
onset of action of rectally administered lubricant agent
5-15min
-
most significant safety concern w/ lubricant agents
lipid pneumonia from aspiration into lungs after an oral dose
-
DDI's w/ lubricant agents?
may impair absorption of fat-soluble vitamins & many oral meds (eg: OC's)
-
name 2 saline laxative agents
- magnesium citrate
- dibasic sodium phosphate
-
MOA of saline laxative agents
ions are retained in the small & large intestinal walls & draw water in, increasing intraluminal pressure & intestinal motility
-
onset of action for orally administered saline laxative
30min - 3 hrs
-
-
MOA of stimulant agents
- increases large intestinal motility by local irritation of the mucosa
- also increases secretion of water & electrolytes into the intestine
-
onset of action of stimulant agents
~6-10 hrs after oral administration
-
pt counseling regarding senna
may color urine pink to red, red to violet, or red to brown
-
pt counseling for bisacodyl (2 main points)
- 1) administration of tablets within 1 hour of antacids, H2RAs, PPIs, or milk results in erosion of bisacodyl's enteric coating, resulting in gastric/duodenal irritation
- 2) don't break, crush, or chew tablet
-
age at which magnesium hydroxide (saline lax) can be used in children
>1yo
-
age at which PEG3350 can be used in children
>2yo
-
age at which bulk-forming agents and docusate can be used in children
>6yo
|
|