Pharmacotherapy I (DQ 3)

Benzocaine - Brand Name

Americaine, Anbesol, Cepacol

Benzocaine - Dosage Forms

- Topical Spray

- Topical Liquid

- Topical Ointment

- Oral Liquid

- Oral Gel

- Lozenge

- Oral Solution

- Oral Strip

- Oral Swab

Benzocaine - Therapeutic Class

Local Anesthetic

Benzocaine - MOA

Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction

Benzocaine - Approved Indications

- Skin, mouth, throat, or gum pain

- Hemorrhoids

Benzocaine - Dosing (Skin pain or itching/mouth, throat, gum pain)

Apply to affected area prn, but not >3-4 times/d

Benzocaine - Dosing (Anorectal pain and itching - Adults and Children >12)

Apply to affected area prn up to 6 times/d

Benzocaine - Precautions/Contraindications

CI: Secondary bacterial infection; Caution if history of allergic reaction to anesthetics

Benzocaine - Adverse Reactions

Skin irritation, rash, tenderness; Rare but Serious: Cardiac arrest, cardiac dysrhythmia, severe hypersensitivity, methemoglobinemia

Benzocaine - Patient Education

Shake spray well prior to use. Hold spray about 6 in from skin and spray for 1-3 s. Do not apply to broken skin or ingest topical products; may lead to systemic absorption and toxicity, particularly cardiac effects. For toothache, apply a small amount of product to the cavity and surround gum; children >2 and <12 y of age should be supervised by an adult when applying. Some formulations contain alcohol and are flammable. Since topical anesthetics work for up to 1 h and can only be used 4 times/d, pain relief is not continuous, and oral pain relievers such as acetaminophen or ibuprofen should be considered

Bisacodyl - Brand Name

Dulcolax

Bisacodyl - Dosage Forms

- Enteric Coated Tablet

- Rectal Suppository

- Rectal Enema

Bisacodyl - Therapeutic Class

Stimulant Laxative

Bisacodyl - MOA

Stimulant laxative that stimulates sensory nerve endings of the colon to produce parasympathetic reflexes, resulting in peristalsis

Bisacodyl - Approved Indications

Constipation

Bisacodyl - Dosing (Adults and Children >12)

5-15 mg PO or 10 mg PRN in a single dose

Bisacodyl - Dosing (Children 6-12)

Reduce Dose

Bisacodyl - Precautions/Contraindications

CI: intestinal obstruction

Bisacodyl - Adverse Effects

Abdominal cramps, nausea, rectal burning, vertigo, vomiting; Rare but Serious: Electrolyte imbalance, fluid imbalance, metabolic acidosis, metabolic alkalosis, hypocalcemia

Bisacodyl - Patient Education

To protect the enteric coating, do not chew, split, or crush tablet and do not administer within 1 h of milk, any dairy product, or antacid-containing product. No formulation should be administered more than once daily

Docusate - Brand Name

Colace

Docusate - Dosage Forms

- Oral Capsule

- Oral Liquid

- Oral Tablet

- Rectal Enema

Docusate - Therapeutic Class

Stool Softener

Docusate - MOA

Anionic surfactant that acts as a stool softener; it is believed to stimulate intestinal secretion and increase the penetration of fluid into the stool by emulsifying feces, water, and fat

Docusate - Approved Indications

Constipation

Docusate - Dosing (Adults and Children >12)

50-360 mg (sodium) po daily in 1 or 2 divided doses or 240 mg po daily (calcium)

Docusate - Dosing (Children 2-12)

Reduce Dose

Docusate - Precautions/Contraindications

CI: intestinal obstruction

Docusate - Adverse Effects

Abdominal cramps, bitter taste, nausea, throat irritation

Docusate - Patient Education

May require several days of treatment before stool softening is noticeable. Patients can take as a single daily dose or in divided dose if desired. Discontinue and contact an HCP if rectal bleeding occurs or bowel movement fails to occur after appropriate use. Do not use with products containing mineral oil without consulting HCP

Hydrocortisone - Brand Name

Preparation H, Cortisone-10

Hydrocortisone - Dosage Forms

- Topical Cream

- Rectal Cream

Hydrocortisone - Therapeutic Class

Topical Corticosteroid

Hydrocortisone - MOA

Anti-inflammatory, antipruritic, and vasoconstrictive properties. Thought to act by the induction of phospholipase A2-inhibitory proteins, lipocortins which

control the biosynthesis of potent mediators of inflammation by inhibiting the release of their common precursor, arachidonic acid

Hydrocortisone - Approved Indications

Pruritus, caused by insect bites, contact dermatitis, poisonous plants, and hemorrhoids

Hydrocortisone - Dosing

Apply thin layer topically to affected area up to QID

Hydrocortisone - Precautions/Contraindications

CI: hypersensitivity to other corticosteroids

Hydrocortisone - Adverse Effects

Dry skin, burning sensation, stinging, pruritus at site of administration Rare but Serious: HPA suppression has been reported when used with occlusive dressings or when applied over larger surface areas

Hydrocortisone - Patient Education

Apply thin layer to affected area of skin. Skin should be clean and intact at site of application. Avoid contact with eyes and do not ingest by mouth. Rectal administration should not be done by finger or any mechanical device. Gently dry by blotting with toilet tissue prior to application. Avoid occlusive dressings or tight-fitting clothes over site of administration

Phenylephrine - Brand Name

Preparation H

Phenylephrine - Dosage Forms

- Rectal Ointment

- Rectal Suppository

Phenylephrine - Therapeutic Class

Antihemorrhoid

Phenylephrine - MOA

Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity. The topical formulation produces local vasoconstriction

Phenylephrine - Approved Indications

Hemorrhoidal pain, burning, and itching

Phenylephrine - Dosing (Adults and Children >12)

Apply topically to affected area or insert 1 suppository PRN up to 4 times/d (generally morning, night and after bowel movements)

Phenylephrine - Precautions/Contraindications

None

Phenylephrine - Adverse Effects

Rectal pain, contact dermatitis, rash

Phenylephrine - Patient Education

Apply topically, for external use only. Do not apply to open wounds, rashes, damaged skin, eyes, or mucous membranes. Apply topical product or insert suppository after cleansing the area well and gently drying the area by blotting with toilet tissue or a soft cloth. If product comes with applicator for intrarectal use, remove cover from applicator, attach applicator to tube, lubricate applicator well, and gently insert applicator into the rectum. Thoroughly cleanse applicator after each use and replace cover

Polyethylene glycol 3350 (PEG 3350) - Brand Name

Miralax

Polyethylene glycol 3350 (PEG 3350) - Dosage Forms

Powder for reconstitution

Polyethylene glycol 3350 (PEG 3350) - Therapeutic Class

Hyperosmotic Laxative

Polyethylene glycol 3350 (PEG 3350) - MOA

Produces a hyperosmotic solution that acts as a laxative by causing osmotic retention of fluid, softening the stool, and distending the colon, increasing peristaltic activity

Polyethylene glycol 3350 (PEG 3350) - Approved Indications

Constipation

Polyethylene glycol 3350 (PEG 3350) - Dosing (Adults >16)

7 g of powder (1 packet or 1 capful filled to line) dissolved in 120-240 mL of beverage, po daily; do not use for >1 wk

Polyethylene glycol 3350 (PEG 3350) - Precautions/Contraindications

CI: known or suspected bowel obstruction

Polyethylene glycol 3350 (PEG 3350) - Adverse Effects

Anal irritation, bloating, diarrhea, epigastric fullness, nausea, stomach cramps, vomiting, flatulence, urticaria; Rare but Serious: Anaphylaxis, dehydration, seizures

Polyethylene glycol 3350 (PEG 3350) - Patient Education

Should be used in 4-8 oz of beverage once daily; chilled water may improve taste and tolerability. May dissolve MiraLAX in juice, soda, coffee, or tea of any temperature in addition to water

Pramoxine - Brand Name

Tronolane, Proctofoam, Caladryl

Pramoxine - Dosage Forms

- Topical Gel

- Topical Lotion

Pramoxine - Therapeutic Class

- Topical Anesthetic

- Antihemorrhoid

Pramoxine - MOA

Anesthetic that decreases the neuronal membrane's permeability to sodium ions. Both initiation and conduction of nerve impulses are blocked; thus, depolarization of the neuron is inhibited

Pramoxine - Approved Indications

- Pain and itching associated with minor dermatoses, minor cuts, insect bites, rashes

- Hemorrhoidal pain, burning, and itching

Pramoxine - Dosing (Skin Itching and Pain)

Apply to affected area up to 3-4 times/d

Pramoxine - Dosing (Hemorrhoidal Pain or Itching)

Apply to affected area up to 3-5 times/d

Pramoxine - Precautions/Contraindications

None

Pramoxine - Adverse Effects

Dry skin, contact dermatitis, swelling or warmth of the skin; Rare but Serious: Anal bleeding

Pramoxine - Patient Education

Apply topically, for external use only. Do not apply to large areas of the body, open wounds, rashes, damaged skin, eyes, or mucous membranes. Clean skin with soap and water prior to use and ensure skin is dry for optimal absorption. Formulations intended specifically for topical use should not be used for vaginal, genital, or rectal symptoms. For use of OTC foam for hemorrhoids, shake product well, cleanse and gently dry area by blotting with toilet tissue or a soft cloth before application. Dispense foam onto a clean tissue and apply externally. Do not insert into rectum. Do not put this product into the rectum by using fingers or any mechanical device or applicator. Do not insert any part of the aerosol container into the rectum. Topical sprays are flammable; use with caution and store at room temperature. Rectal formulation may be applied after each bowel movement, up to 5 times/d

Psyllium fiber - Brand Name

Metamucil

Psyllium fiber - Dosage Forms

Powder for reconstitution

Psyllium fiber - Therapeutic Class

Fiber Laxative

Psyllium fiber - MOA

Soluble fiber that absorbs water in the intestine to soften stools, lubricates the intestine, and adds bulk, promoting peristalsis and reducing transit time

Psyllium fiber - Approved Indications

Constipation

Psyllium fiber - Dosing (Adults and Children >12)

2.5-30 g soluble fiber po per day in divided doses

Psyllium fiber - Dosing (Children 6-11)

Reduce Dose

Psyllium fiber - Precautions/Contraindications

CI: diagnosed or suspected bowel obstruction

Psyllium fiber - Adverse Effects

Diarrhea, cramping, abdominal pain, constipation, nausea, vomiting, dehydration; Rare but Serious: Electrolyte imbalance, fluid imbalance, bronchospasm, anaphylaxis upon accidental inhalation

Psyllium fiber - Patient Education

Avoid inhaling dust from product. Dissolve product in at least 240 mL of water or juice; if mixture thickens, add more liquid prn and re-mix. Separate dosing of psyllium and other medications by 2 h. Generally, produces bowel movement within 12-24 h but may require as long as 72 h to be effective. Without previous use, start with once-daily dosing before increasing to TID

Senna - Brand Name

Senokot, Ex-Lax

Senna - Dosage Forms

- Tablet

- Gummies

- Chewable Tablet

Senna - Therapeutic Class

Stimulant Laxative

Senna - MOA

Direct action on intestinal mucosa, increasing the rate of colonic motility, enhancing colonic transit, and inhibiting water and electrolyte secretion

Senna - Approved Indications

Constipation

Senna - Dosing (Adults and Children >12)

8.6-15 mg po once daily, max 60-100 mg/d po in 2 divided doses

Senna - Dosing (Children 2-12)

Reduce Dose

Senna - Precautions/Contraindications

CI: diagnosed or suspected bowel obstruction

Senna - Adverse Effects

Abdominal cramps, urine discoloration, nausea, vomiting, Rare but Serious: Electrolyte imbalance, fluid imbalance, metabolic acidosis, metabolic alkalosis, hypocalcemia

Senna - Patient Education

Often administered at bedtime ("dose in the PM for a BM in the AM"). Decrease dose after bowel movement and should not be used for chronic treatment. Administration should be 2 h before or after other medications to reduce risk for drug interactions

Sodium phosphate enema - Brand Name

Fleet Enema

Sodium phosphate enema - Dosage Forms

Liquid Enema

Sodium phosphate enema - Therapeutic Class

Laxative

Sodium phosphate enema - MOA

Acts as a laxative by causing osmotic retention of fluid, distending the colon with increased peristaltic activity.

Sodium phosphate enema - Approved Indications

Constipation

Sodium phosphate enema - Dosing (Adults and Children >12)

Contents of one 118 mL enema as a single dose PRN daily, not to exceed 1 enema/d

Sodium phosphate enema - Dosing (Children 2-11)

Reduce Dose

Sodium phosphate enema - Precautions/Contraindications

Caution in renal dysfunction; CI: ascites, heart failure, imperforate anus, GI obstruction, megacolon, renal impairment, electrolyte abnormalities, bowel cleaning

Sodium phosphate enema - Adverse Effects

Bloating, cramping, nausea, abdominal pain, dehydration, vomiting, superficial rectal mucosal irritation

Sodium phosphate enema - Patient Education

Use care to administer the correct volume/formulation in younger children. For children 2-5 y of age, measure out 30 mL, or 2 tablespoons, and discard remainder to ensure only one-half of bottle is used. Do not use >1 enema/d.

Witch Hazel - Brand Name

Tucks

Witch Hazel - Dosage Forms

- Topical Solution

- Topical Pads

- Topical Towelettes

Witch Hazel - Therapeutic Class

- Astringent

- Antihemorrhoid