Constipation & Diarrhea F12 (1)

Role in therapy most potent laxatives used only when

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Role in therapy Most potent laxatives Used ONLY when fast clearance of the bowel is required (bowel prep for endoscopic procedures) Not to be used for chronic management of constipation Avoid in patients with heart failure or renal dysfunction
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Saline Laxatives Adverse effects Diarrhea, cramping, N/V, dehydration Magnesium hydroxide Hypermagnesemia Sodium phosphate Use with caution in patients on sodium-restricted diets Can cause hyperphosphatemia
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Hyperosmotic Laxatives Examples Glycerin (suppositories) Polyethylene glycol (PEG) 3350 (MiraLax®) (powder for oral soln) MOA: Cause osmotic effect Draws water into rectum Bowel movement Onset of action Glycerin = 30 min PEG = 2-4 days Role in therapy Can be used first line Adverse effects: N/V/D
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Stimulant Laxatives Examples: Senna (Senokot®) Bisacodyl (Dulcolax®) Castor oil MOA: peristalsis Onset of action Senna = 6-12 hr (may require up to 24 hr) Bisacodyl = 6-10 hr (PO); 15-60 min (rectal) Castor oil = 2-6 hr Role in therapy Chronic opiate-induced constipation Avoid in pregnancy (esp. 3 rd trimester) Castor oil is not recommended for use anymore
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Stimulant Laxatives Adverse effects Diarrhea Cramping Flatulence May be subject to abuse Drug interactions Bisacodyl tablets are enteric-coated Do not administer within 1 hr of any products that may pH (destroys coating GI irritation) – Milk, antacids, H 2 antagonists, proton pump inhibitors
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Patient Assessment Obtain lifestyle, medical, and medication history before making any recommendations Obtain information regarding characteristics of bowel movements (size, color, texture, frequency) Determine the reason for use of a laxative product Inquire about patient’s current and past use of laxative products
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Questions to Ask Patient How long have you experienced these symptoms? How severe are these symptoms? Do you see blood in your bowel movements? Does constipation limit your daily activities? How much fiber do you get through your diet? What laxatives have you tried? Are you currently using laxatives? How often? What dosage? Any other meds tried?
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Patient Counseling Diet and lifestyle changes Should discuss proper use of laxatives Use of enemas or suppositories Onset of effect Side effects Laxatives that take longer than 6-8 hours to work should be taken at bedtime Should be used short-term (in most cases) If no effect after 1 week, refer patient to health care provider Do not give to children < 6 yr unless recommended by health care provider
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Diarrhea
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Definition Passage of loose stools Greater water content than normal > 3 movements per day
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Definitions Acute Duration < 14 days Symptoms > 48 hours need to be referred but may be managed with fluid/electrolyte replacement, dietary modifications, and OTC treatment Persistent Duration = 2-4 wks Self-care not appropriate Refer to health care provider Chronic Duration >4 wk Self-care not appropriate Refer to health care provider
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Types of Diarrhea Osmotic
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