Self Care OTC Medications
Lubricants 6-8 hrs(oral) 5-15min (rectal) -mineral oil (liquid petrolatum)
(Colon) Acts in colon to soften fecale contents by coating the stool and preventing colonic absorption of fecal water
Hyperosmotic -polyethylene glycol3350 (PEG3350) 12-72 up to 96 (oral) -Glycerin 15-30 min(rectal l&s)
(Colon) Large poorly absorbed ions or molecules draw water into the colon or rectum through osmosis to stimulate a bowel movement
Emollients 12-72 hrs -Docusate Salts
(Small and large intestines) PREVENTATIVE for patients with anorectal disorders. "stool softeners" are anionic surfactants that, increase wetting efficiency of intestinal fluid as well as facilitate a mixture of aqueous and fatty substance to soften the fecal mass
Stimulant -Anthraquinolones (Senna) 2YO 6-10hr up to 24hr oral -Diphenylmethanes (Bisacodyl) 6YO 15-60min rectal
(colon) -Increase intestinal motility by local irritation of the mucosa or by a more selective action on the intramural nerve plexus of intestinal smooth muscle. -also increase secretion of water and electrolytes in the intestine
Bulk-forming 12-24 hrs up to 72 hrs -methylcellulose -polycarbophil -psyllium
(small & large intestines) Dissolve or swell in intestinal fluid, forming emollient gels that facilitate passage of intestinal contents and stimulate peristalsis
Constipation Laxatives
Bulk-forming (small intestine) Hyperosmotic (colon) Emollients (small intestine) Lubricants (colon) Saline (intestines &colon) Stimulant (colon)
Saline Laxative 0.5-3 hrs (oral) 2-15min (rectal) -Mg hydroxide 0.5-6 hrs (oral) -Mg citrate -dibasic sodium phosphate -monobasic sodium phosphate *Mg sulfate (see pcp 1st)
Small intestine (orally) Colon (rectally) The ions draw water into the intestine, increasing intraluminal pressure (increased pressure exerts mechanical stimulus that increases intestinal motility)
Caffeine 100-200mg PO Q3-4hr MDD 600mg Pregnancy: 300mg
USE: Fatique and drowsiness MOA: Inhibition of A1 and A2A receptors SE: cardiovascular (BP/HR), CNS (HA, anxiety, insomnia, tremors), heart palpitations DDI: warfarin increase risk of bleeding
Bismuth Subsalicylate (Pepto-Bismol) 262-525mg PO Q 0.5-1H PRN
USE: Heart burns and dyspepsia 18YO
Proton Pump Inhibitors (PPI) Omeprazole(prilosec) 20mg Lansoprazole(Prevacid) Esomeprazole(Nexium) NTE 14 days
USE: Heart burns and dyspepsia 18YO ONSET: 2-3 hrs DURATION: 12-24 hrs MOA: Irreversibly bind to gastric ATPase pump on parietal cells
Diphenhydramine Benadryl 25mg Unisom 50mg PO QHS 3d, 1d-off, NTE 7-10 or 14 days.
USE: Insomnia 12-65 YO CLASS: Antihistamine MOA: Inhibition of histamine-1 and muscarinic receptors SE: anticholinergic SE: dry mouth, constipation, urinary retention, blurred vision, tinnitus Anticholinergic toxicity: anxious, excitability, dilated pupils, flushed skin, hot/dry mucous membranes, elevated body temperature
Antacid MgOH AlOH Ca Carbonate Na Bicarbonate
USE: heart burns and dyspepsia 12YO ONSET: <5 min DURATION: 20-30 min before meal/ 1-3 hr after meal MOA: Neutralize gastric acid by increase pH on central cells when pH >5, inhibits conversion of pepsinogen to pepsin MgOH: Diarrhea AlOH: Constipation Ca Carbonate: belching, constipation, hypercalcemia, renal calculi Na Bicarbonate: belching, flatulence
Histamine2-receptor antagonists (H2RA) Cimetidine(Tagamet HB) - 200mg MDD: 2 tab Ranitidine(Zantac) - 75-150mg MDD: 2 tab Famotidine(Pepcid) - 10-20mg MDD: 2 tab Nizatidine(Axid) - 75mg MDD: 2 tab NTE 14 days
Use: Heart burns and dyspepsia 12YO ONSET: 30-45 min DURATION: 4-10 hrs MOA: reversibly inhibit histamine 2 receptor on parietal cells SE: headache, diarrhea, constipation, dizziness, drowsiness