NURS215 Study Guide - Final Guide: Laxative, Lorazepam, Prochlorperazine
8 May 2018
School
Department
Course
Professor
GI
Pathophysiology
Medications
Symptoms
M of Ac + Kinetics
Side effects + Contra-indication
Alimentary canal: mouth to rectum
Accessory organs: Salivary glands, liver, gall bladder,
pancreas
Digestion fx:
1. Transport (peristalsis in stomach / intestines)
2. Absorb = villi in SI + water absorption in LI
o Meds cross villi and go into capillaries
3. Enzymes for digestion: gastric & pancreatic juice +
bile
SI
3 parts:
duodenum, jejunum, ileum (longest)
Major fx is absorption
LI
4 parts:
ascending colon, transverse colon, descending
colon, sigmoid colon
Major fx is re-absorb water and host flora for Vit. B /
K synthesis
Slow = re-absorption of water
Constipation / obstruction disorder
o mobility, elder, dehydration, fibre, drug s/e
1. Bulk forming
Pull water into stool, add size
o Metamucil (psyllium)
Prophylactic, 1-2 to effect
Long-term, H20 INTAKE!
o Fruit fibres
2. Softeners
Pull water and fat into stool, decrease straining
o Colace (docusate sodium)
Prophylactic
Short term post-MI (contains Na+) or surgery
Renal fx dependent
3. Saline and Osmotics
Pull water into stool
Prophylactic
o Milk of Magnesia
Renal excretion
FAST- ACTING! 1-3 hours
o Lactulose
Contra-indicated for those lactose intolerant
8-12 hrs
4. Stimulants
Irritants, increase peristalsis
o Dulcolax, Senna (Exlax, Senokot), Castor oil
Potent and uncomfortable
NOT 1ST LINE!
Fast-acting, maybe even diarrhea
5. Miscellaneous
Lubricating
o Mineral oil, glycerine (PR)
Adjunct tx for constipating
May block mineral reabsorption! Monitor levels
Mostly PO and OTC
Abdominal distension
Flatulence
N&V
Cramping
Hard / infrequent stools
1. Bulk forming
Pull water into stool, add size
2. Softeners
Pull water and fat into stool
Decrease straining
Renal fx dependent
3. Saline and Osmotics
Pull water into stool
Lactulose
Not absorbed in SI nor broken
down by human enzymes,
stays in the digestive bolus,
causing retention of water
through osmosis leading to
softer, easier to pass stool.
Has a secondary laxative
effect in the colon, where it
is fermented by the gut flora,
producing metabolites which
have osmotic powers
and peristalsis-stimulating
effects (such as acetate), but
also methane associated
with flatulence.
4. Stimulants
Pull water into stool
5. Miscellaneous
Pull water into stool
Softeners
Saline / osmotics
Milk of Magnesia
renal fx dependent
Lactulose not for those who
are lactose intolerant
s/e:
abdominal bloating
cramps
Flatulence
Stimulants not good for
pediatrics
s/e:
abdominal pain
may cause perforation if
there is an obstruction
Cathartics = enema
- Fast evacuation of stool
o Expand bowel
o Lubrication and dilution
- If there is a big stool, colonoscopy . . BUT RARE!
Fast = absorption of nutrients/water and removal
of waste products
Diarrhea
o Dangerous if associated with a fever
o Can cause: Electrolyte imbalance
Dehydration
Malabsorption
1. Opioids
mu receptor in GI decreases peristalsis
• Lomotil (diphenoxylate + atropine)
• Imodium (Loperamide HCl’meperidine + atropine)
Atropine is an anti-muscarinic (blocks PS system and
stimulates sympathetic drive HR)
C. difficile causes severe diarrhea (elderly, hospitals,
long antibiotics tx)
• Clostridium difficile
Gram+ bacteria destroys intestinal lining
→ 1st Flagyl, 2nd Vancomycin
→ FMT
INFECTIOUS!
Traveler’s diarrhea
Mostly bacterial, INFECTIOUS!
• Ciproflaxin PO / IV
High bioavailability, renal/biliary excretion
• Probiotics
Lactobacillus acidophilus
Destroy other bacteria by secreting toxic
hydrogen peroxide (restore & protect normal
flora)
BioK+
Schedule II
Added to foods/yogurt
o REHYDRATION !!!!
At home:
Schedule 1 solutions: Gastrolyte, Pedialyte
Hospital:
Isotonic IV (NS, D5.2NaCl)
5% dextrose and 0.2% NS
No-mans-land:
1L water, 80mL glucose, 7mL NaCl
S&S:
• Severe diarrhea
• Blood or pus in stools
• Fever
• Abdominal pain
Opioid as antidiarrheals:
s/e: CNS depression in high
doses, slow systems
Opioids s/e:
Dry mouth
Dizziness
N&V
Abdominal pain
Ciproflaxin s/e:
N&V
Headache/dizziness
Abdominal pain
Blurred vision
Anxiety
Document Summary
Accessory organs: salivary glands, liver, gall bladder, pancreas. Digestion fx: transport (peristalsis in stomach / intestines, absorb = villi in si + water absorption in li, meds cross villi and go into capillaries, enzymes for digestion: gastric & pancreatic juice + bile. 4 parts: ascending colon, transverse colon, descending colon, sigmoid colon. Major fx is re-absorb water and host flora for vit. Constipation / obstruction disorder: mobility, elder, dehydration, fibre, drug s/e, bulk forming. Pull water into stool, add size: metamucil (psyllium) Pull water and fat into stool, decrease straining: colace (docusate sodium) Irritants, increase peristalsis: dulcolax, senna (exlax, senokot), castor oil. Fast evacuation of stool: expand bowel, lubrication and dilution. If there is a big stool, colonoscopy . Pull water into stool, add size: softeners. Not absorbed in si nor broken down by human enzymes, stays in the digestive bolus, causing retention of water through osmosis leading to softer, easier to pass stool.
