Pharm Laxatives

Surfactant laxatives are?

*Docusate sodium or Calcium

Glycerin supp can cause evacuation in ___ and are used to what?

30 min Used to re-establish normal bowel function following termination of laxative abuse.

What is the function of the colon?

Absorbs water and electrolytes (1500 mL of fluid enters colon each day and 90% of fluid is absorbed)

What are some AEs of mineral oil?

Aspiration of oil droplets can cause lipid pneumonia Excessive dosing can decrease absorption of fat-soluble vitamins

What are the drugs for stimulant laxatives again?

Bisacodyl (Dulcolax, etc.) Senna (Ex-lax, etc.) Castor oil

Stimulant laxatives are?

Bisacodyl (colon) Senna (colon) Castor oil (small intestine) Stimulate peristalsis and increase secretion of water and electrolytes into the intestines.

Polyethylene glycol (PEG) are known as?

Bowel cleansers (GoLYTELY)

Surfactant laxatives are the true "stool softeners". What are they the DOC for?

Constipatory *medications*

What is a cause for constipation?

Diet deficient in fiber and fluid.

Which drug is for surfactant laxatives again?

Docusate sodium (Colace)

Laxatives are used to?

Ease or stimulate defecation.

Which laxatives produce an immediate response (Stool in 5-30 min)?

Enemas *Glycerin supp*

What does lactulose help with in pts with hepatic disease?

Enhance intestinal excretion of ammonia which helps lower blood ammonia levels in pts with hepatic disease

What is an adverse effect of bulk-forming laxatives?

Esophageal obstruction

PEG allows for what?

Good visualization of the bowel for colonoscopy.

Contraindications for laxative use?

Indvs experiencing abdominal pain, nausea, cramps, or other symptoms of appendicitis Fecal impaction Use with caution in PREGNANCY AND LACTATION

PEG-ELS requires what?

Ingestion of large volume of bad-tasting liquid, but now have others.

Which drug is used for idiopathic constipation in aults and IBS in women > 18 years?

Lubiprostone (Amitiza)

Osmotic laxatives are?

Magnesium (hydroxide, sulfate and citrate) (Milk of Magnesia [MOM]) Sodium phosphate Polyethylene glycol

What are drugs for osmotic laxatives again?

Magnesium salts (Mg hydroxide, -citrate, and -sulfate) Sodium salt (Na phosphate)

Bulk forming laxatives are?

Methylcellulose Psylium Polycarbophil

Which drugs are the bulk-forming laxatives again?

Methylcellulose (Citrucel) Psyllium (Metamucil) Polycabophil (Fibercon, etc.)

What are some misc. laxatives?

Mineral oil Glycerin supp Lactulose PEG solution

Misuse of laxatives comes from?

Misconceptions of what constitutes normal bowel function

Are stimulant laxatives for long term use?

No

Why is PEG-ELS safer than sodium phosphate?

No electrolyte imbalance, no dehydration; safer for pts w/ electrolyte imbalances, heart failure, kidney disease, advanced liver disease.

What should you teach pts about laxative?

Normal bowel fx Ingesting high fiber foods Exercise and establishing regular bowel habits.

When is lactulose used? Why?

Only use if pts do not respond to bulk forming laxative. More expensive Unpleasant side efx (flatulence and cramping)

Stimulant laxatives are most commonly abused by the general public. What are it's two legitimate uses?

Opioid induced constipation TX of slow intestinal transit.

Which laxatives produce a quick response (watery/semifluid stool 2-6 hours)?

Osmotic laxatives (in high doses)

What is a property of lactulose?

Poorly absorbed and cannot be digested by intestinal enzymes but colonic enzymes metabolize it into acids which promote a mild osmotic effect.

There are two kinds of bowel cleansers (both equally effective). What are they?

Sodium phosphate PEG plus electrolytes (ELS)

What should the nurse instruct his/her patients about stimulant laxatives?

Take no sooner than 1 hr p ingesting milk or antacids Swallow intact w/o crushing or chewing

What should you teach patients to do with bulk-forming laxatives?

Take with a full glass of water

What should you teach pts to do with surfactant laxatives?

Take with a full glass of water.

What should pts be taught about osmotic laxatives?

Taught to increase fluid intake

Surfactant laxatives are known as what? Because?

True "stool softeners" because they facilitate penetration of water into feces which softens stools.

Senna (stimulant laxative) can cause urine to have what?

A yellowish-brown or pink color

What are some drugs that cause constipation?

Analgesics Antacids (aluminum hydroxide) Many anti- Diuretics Barium sulfate Muscle relaxants Iron supplements

What are some AEs of osmotic laxatives?

Dehydration Renal decline: Mg toxicity (poorly absorbed, but does) Na retention (exacerbates heart failure, hypertension, edema, acute renal failure)

Proper function of bowel is highly dependent on?

Dietary fiber, which absorbs water which softens feces and increases fecal mass.

What is a cause for laxative abuse?

Bowel replenishment after evacuation can be *2-5 days: often mistaken for constipation (vicious cycle)*

Which laxative is the preferred treatment for temporary treatment of constipation and diarrhea! (BOGO)

Bulk-forming laxatives

What is a laxative effect?

Production of soft, formed stool over a period of 1 or more days. RELATIVELY MILD

What is a catharsis?

Prompt, fluid evacuation of the bowel FAST AND INTENSE