Self-Care II Exam 4: Constipation/Pinworm

Bulk forming laxatives

• Ex. _____ (sugar free and normal), _____ tabs, _____ liquid, Metamucil fiber wafer, + smooth texture, sugar free orange flavor

  • FiberCon has 150 mg of calcium per tab

• MOA: Similar to _____ → swells in GIT to stimulate peristalsis → helps to incr bulk mass of stool. Stimulation of GI motility closest to normal physio

• ADR: _____, _____, _____, Esophageal/intestinal obstruction, and Acute _____ (with powder)

• Counseling

  • Common ADR: _____, _____

  • Use 8 oz of water to mix/drink with each dose (even fiber capsules)

  • If taking other medications, need to space out their admin by _____ 

    • _____ 

    • _____

    • _____, etc.

  • Check _____ content bc it contains a lot of _____

  • Onset of action: _____

Citrucel Powder, FiberCon, Maltsuplex, insoluble fiber, abdominal cramping, bloating, flatulence, bronchospasm, bloating, flatulence, 2 hours, Antibiotics, Warfarin, Digoxin, glucose, sugar, 12-72 hours

Hyperosmotic laxatives

• MOA: _____: Draws water into lumen through osmosis. _____: incr secretion through a local irritant effect

• ADR:

  • PG: _____, _____ pain

  • Gly: _____, generally minor rectal irritation

  • Liquid glycerin may cause incr local _____

• Counseling

  • PG: dissolve _____ in 4-8 oz of beverage (hot or cold)

  • Do NOT use for more than_____

Polyethylene Glycol 3350, Glycerin Suppositories, bloating, abdominal, minimal, irritation, 17 g, 7 days

Emollient laxatives

• Ex. _____

• MOA: Surfactant → incr wetting of fecal mass to soften stool (all mush no push)

• ADR: _____, nontoxic, and inert, May cause mild _____, _____, May incr absorption of _____ + Dcr absorption of _____

• Counseling

  • Take with a full glass of water to incr stool softening effects

  • Potential exceptions to _____ limit → _____ or Pt on _____

  • Doc Na: _____ mg daily in single or divided doses

  • Doc Ca: _____ mg daily

Docusate Na/Ca, Nonabsorbable, abdominal cramping, diarrhea, mineral oil, fat-soluble vitamins, one-week, preggo, acute/chronic opioids, 50-300, 240

Saline Laxatives

• Ex. Mg _____, Mg_____, Mg _____, and _____

• MOA: Lumen of GI tract → Cations and anions (mg, sulfate, etc) → osmotic action draws water in → incr intraluminal pressure → incr motility + stool formation

• ADR: _____, _____, _____, _____ electrolyte imbalances (long-term or HD use of Mg products), _____PO4, _____Ca, and _____Na (Na phosphate prods)

• Counseling

  • Take _____ as food will delay product’s _____

  • Take at least 8 oz of water following to prevent dehydration

  • Mg citrate/sulfate and NaPO4 are NOT to be used for the routine treatment of constipation

Citrate, OH, Sulfate, NaPO4, abdominal cramping, dehydration, N/V, Mg, Hyper, Hypo, Hyper, on empty stomach, onset of action

Stimulant laxative

• Ex.

  • Diphenylmethane derivatives → _____

    • MOA: Stimulation of the colonic myenteric plexus

  • Anthraquinone derivatives → _____

    • MOA: Irritation of FI lumen → causes secretion

  • Combo _____: _____

    • MOA: Secretion of water

• ADR:

  • At therapeutic doses: _____, _____, _____ of urine (_____), and Rectal irritation w/suppositories 

  • At higher doses or prolonged use: Severe _____, Sudden _____ electrolyte/fluid deficiencies, and reduced absorption of nutrients

• Counseling

  • Do NOT _____ bisacodyl tabs

  • Do NOT take bisacodyl w/in _____ of consuming _____ or other medications that may raise gastric pH

  • Inform pt senna/sennosides will _____ (pink, red, orange)

bisacodyl, senna, Peri-Colace, docusate and senna, cramping, nausea, discoloration, senna, cramping, N/V/D, chew or crush, 1 hour, milk, discolor urine

Dietary Fiber (not a laxative)

• MOA:

  • Insoluble fiber: Absorbs water, _____ to stool, incr transit time in GIT

  • Soluble fiber: Dissolves, forms a gel-like substance, _____

  • Other benefits: aids digestion, lowers LDLc, and stabilizes BG

• ADR: _____ and abdominal _____

• Counseling

  • _____ to diet

  • Effects can take a _____

  • _____ and _____ are common

  • Drink 8 oz of water _____

adds bulk, softens stools, flatulence, discomfort, gradually add, few weeks, flatulence, abdominal discomfort, 8x/day

Bulk forming laxative

• _____

• Indications: _____, _____, _____, and severe _____

• Onset: _____

• C/I: Individuals w/ difficulty swallowing, Intestinal ulcerations, Stenosis, Fecal impaction, Individuals that are fluid restricted (CHF, CRF), and Hypersensitivity to product (i.e psyllium)

DOC for treatment of constipation, DS, preggo, postpartum, HTN/CVD, 12-72 hours

Hyperosmotic laxative: Polyethylene Glycol 3350

• Indicated: _____ >_____

• Onset: _____

Treatment of Occasional Constipation, 17 y/o, 12-96 hours

Hyperosmotic laxative: Glycerin

• AVOID in pt w/ _____ or _____

• Onset: _____ (_____)

rectal inflammation, ulceration, 15-30 mins, fastest

Emollient laxative

• Commonly recc for those _____ (w/ _____)

• Indications: _____, _____, Severe _____, _____, and _____

• Onset: _____

• C/Is: _____, intolerance to _____, Renal impairment, CHF or CRF, and GI perforation or obstruction

• DDIs: _____, _____, _____, and _____

on acute/chronic Rx meds, stimulant, Anal fissures/ulcers, hemorrhoids, HTN/CVD, preggo, postpartum, 12-72 hours, fluid retention, fluid loss, Warfarin, Digoxin, Antibiotics, Diuretics

Saline laxatives: MgOH

• MgOH can be used for _____

• Onset: _____

• C/Is: Fluid retention, intolerance to fluid loss, Renal impairment, CHF or CRF, and GI perforation or obstruction

• DDIs: _____, _____, _____, and _____

occasional constipation, 0.5-6 hours, Warfarin, Digoxin, Antibiotics, Diuretics

Stimulant laxative

• _____

• Indications: Useful for pt _____ → always in _____ to wase defecation AND Acute evacuation of the bowl → _____ procedures or _____ surgery

• Onset: _____ (oral) and _____ (rectal)

• C/Is: hypersensitivity to product

• DDIs: _____, _____, _____ (d/t _____)

very effective but least physiological, taking opioids, combo with stool softener, colonoscopy, GI, 6-10 hours, 15-60 mins, Antacids, H2RAs, PPI, enteric coating

Exclusion for Constipation

• Age < _____

• _____, _____

• Severe abdominal pain, distension, or cramping 

• Severe of _____

• _____

• Medical conditions that may exclude use of laxative → 

  • para/quadriplegia, IBD, colostomy

• _____ use

  • EXCLUDING bulk-forming supplements

• Bloody, dark/tarry stools

• Significant chng in stool character

• Sx > _____ OR reoccur over a > _____ period

• Recurring sx > _____ after self care

2 y/o, anorexia, weight loss, unexplained flatulence, N/V/F, Daily non-Rx laxative, 2 weeks, 3-month, 7 days

Pyrantel Pamoate

• No/minimal effect on effs

  • MOA: depolarizing neuromuscular agents; Paralyzes worm and allows them to be passed in stool

• _____% effective with single dose

• DOSE:

  • _____ (pyrantal base) x _____ dose 

  • MAX DOSE: _____

  • MAY REPEAT in _____ if Sxs persist

90-100, 11 mg/kg, 1 single oral, 1 g, 2 weeks,

Pyrantel Pamoate

• ADR → mild not highly systemically absorbed

  • _____

  • _____

  • _____

N/V/D, anorexia, abdominal cramps

EX → active ingred (pyrantel pamoate _____ is equivalent to _____ pyrantel base) → this was given but idk if it will be on exam

144 mg/mL, 50 mg

How much medication should be recommended for a child that weights 65lbs for Pinworm (Pyranteal Pamoate)

• 65 lb /2.2= 29.55  kg

• 29.55 kg x 11 mg/kg = 325 mg

• 325mg/50 mg/mL = 6.5 mL

• 1 ⅓ teaspoons (1 teaspoon = 5 mL)

KNOW