Term
|
Definition
MoA – increase stool bulk and fluid retention – reduce constipation
Advantages
Non-toxic
OTC
Inexpensive
Disadvantages and AEs
Increased gas/bloating and long onset
NEJM2008 - mayer - too much pain/problems - finds them unuseful
Patient Education
Increase water intake - otherwise get constipation worse |
|
|
Term
|
Definition
polyethylene glycol and lactulose (sm doses)
MoA – increase fluid in GI tract – reduce constipation
Advantages
Minimal cramping (smaller amounts)
Not absorbed
Miralax is now OTC
Disadvantages and AEs
Long onset (up to 3 days)
Said something about patient maybe needing to be "scoped"????
Patient Education
qs to effect - start at a tbsp
Longer onset |
|
|
Term
|
Definition
MoA- Cl- channel activator that ↑ Cl- rich fluid secretion
Advantages
Approved for men and women
2 fold increase in % of patients reporting significant or moderate relief of symptoms
Disadvantages and AE
Cost
Nausea (17-29%)
diarrhea
Patient Education
Take with food to decrease nausea
Swallow whole |
|
|
Term
Serotonin-4 receptor agonist
Tegaserod (Zelnorm) |
|
Definition
MoA - Targets and modulates 5-HT4 receptor, increases GI motility
Advantages
Effective in select patients
Disadvantages and AEs
Severe diarrhea
Increase in MI, stroke, acute coronary syndrome versus placebo (0.1% versus 0.01%)
Cannot just get it - must get okay from FDA to use it!
Patient Education
n/a because you won't dispense it! |
|
|
Term
|
Definition
Can be used in diarrhea prominent too
many types available in health food stores, also in yogurts
Activia Yogurt - Bifidus Regularis (aka bifidus animalis and bifidus lactis)
Stoneyfield Yogurt - L. acidophilus, Bifidus, L. casei, and L. rhamnosus
MoA
Normalize/Improve intestinal flora
Advantages
Can be used for diarrhea or constipation
No reports that any of these ever being pathogenic - fairly safe
Disadvantages and AEs
Supplements - not FDA regulated
Not on USP lists of approved supplements
No efficacy results from large RCT
Patient Education
Be sure to inform MD of use |
|
|
Term
|
Definition
Advantages
Cheap, effective
Disadvantages and AEs
Sedation, possible constipation |
|
|
Term
|
Definition
Advantages
Cheap, safe
Lowers cholesterol
Disadvantages and AEs
Taste
Increased gas/cramping
Rx only
Drug interaction |
|
|
Term
| Antidepressants – TCA and SSRIs - doses lower than that for depression |
|
Definition
MoA - Independent analgesic properties and anticholinergic effects
Advantages
Cheap
Both may help underlying depression (but note lower doses!)
Disadvantages and AE
No benefit in global symptoms (per mayer article)
Decrease in abdominal pain is more w/ TCA than with SSRIs |
|
|
Term
Anticholinergics/antispasmodics
(dicyclomine, hyoscyamine, probantheline, mepenzolate, methscopolamine) |
|
Definition
MoA – Reduces stimulated colonic activity via smooth muscle relaxation
Advantages
cheap
Disadvantages and AE
Sedation
Constipation
Anticholinergic effects |
|
|
Term
Serotonin-3 receptor agonist
Alosetron (Lotronex) |
|
Definition
WOMEN ONLY with SEVERE DIARRHEA
MoA- 5-HT3 receptor antagonist, DECREASES GI motility
Advantages
Best efficacy data for decreasing s/sx
Disadvantages and AE
Only for WOMEN
Increased risk of ischemic colitis secondary to constipation
Restricted - only certain MDs can write for it
Patient Education
n/a - won't dispense - comes from MD/mfr. |
|
|
