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Hemorrhoids & Const
Hemorrhoids and constipation
| Question | Answer |
|---|---|
| When do you refer for hemorrhoids? | severe pain, bleeding, seepage, change in bowel pattern, prolapse, thrombosis |
| nonpharm treatment: what are some methods | avoid heavy lifting, foods that aggravate symptoms, NSAIDS or aspirin, only sit on toilet for 10 minutes, increase fiber and fluid intake |
| Local antihistamines: what are these drugs | benzocaine, lidocaine, pramoxine, tetracaine |
| Local antihistamines: druf reactions | allergen reaction, CNS and CV effects |
| Local antihistamines: special notes about where to apply? | DONT USE INTERNALLY |
| Vasoconstrictors: what are meds in this class | ephedrine, epinephrine, phenylephrine |
| Vasoconstrictors: which of the three can be used internally? | phenylephrine and epherine |
| Vasoconstrictors: which of the three can be used only externally? | epinephrine |
| Vasoconstrictors: what are some adverse effects of all three drugs | nervousness, tremors, sleeplessness, nausea, no desire to eat |
| Vasoconstrictors: what are some adverse effects of only ephedrine and phenylephrine | increased cardiac contractility, increased heart rate, bronchodilation |
| Protectants: what meds are in this class | al hydroxide, glycerin, mineral oil, white petrolatum |
| Protectants: what are some adverse drug reactions? | may cause an allergic reaction, |
| Astringents: what are some meds in this class | calamine, zinc oxide, witch hazel-external use only |
| Astringents: adverse effects | witch hazel: stinging, CD. Calamine and zinc: dont use chronically, may cause zinc toxicity, NV, lethargy, severe pain |
| Keratolytics: what are some meds in this class | alcoxa and recoursinol |
| Keratolytics: what are some adverse effects in this class | death in infants, tinnitis, unconsiousness, convulsions |
| Analgesics/anesthetics/antipruretics: what are some meds in this class | menthol, jupiter jar, camphor |
| Analgesics/anesthetics/antipruretics: cautions in this class | all externally used, menthol allergic reaction, jupiter jar contains phenol and if ingested can cause organ failure, camphor may cause convulsions |
| Corticosteroids: what meds are in this class? | hydrocortisone |
| Corticosteroids: adverse effects | skin atrophy, bacterial and fungal infections |
| special pop: pregnant and lactation | external products only, internal products ok |
| special pop: children under 12 | refer |
| special pop: elderly | more prone to hemorrhoids, treatment similar to younger patients |
| What are some nonpharm solutions to constipation? | adequate fluid intake, exercise, dont keep yourself from pooping, balanced diet, behavior modifications, increase fiber intake |
| Exclusions for self treatment for constipation | abdominal pain, NV, sudden change in bowel movements that last over 2 weeks, using lax for 7+ days no relief, rectal bleeding |
| What are some causes for constipation | being sedentary, disorders in the structure of the bowel, electrlyte abnormalities, diabetes or thyroid stuff, dimentia, parkinsons, depression, ED |
| Bulk-forming: what meds are in this class | methylcellulose, calcium polycarbophil, psyllium |
| Bulk-forming: methylcellulose come in what types of dosage forms | capsule and powder |
| Bulk-forming: calcium polycarbophil comes in what dosage form | capsule |
| Bulk-forming: psillium comes in what dosage form | capsule and powder |
| Bulk-forming: whats the MOA | swell up in int fluid forming an emollient gels that soften stools and stimulate peristalsis |
| Bulk-forming: onset | 12-24h up to 72 |
| Bulk-forming: warning/precautions | children under 6, separate bulk forming and other meds by 2 hours, hypercalcemia, diabetics, CHF or CRF |
| Hyperosmotic: MOA | draws water into the colonand rectum through osmosis to stimulate a BM |
| Hyperosmotic: onset | PEG 3350: 12-72 hours up to 96, Glycerin: 15-30mins |
| Hyperosmotic: dosage forms for PEG 3350 and glycerin | PEG 3350: powder. Glycerin: rectal solid supp and rectal liquid supp |
| Hyperosmotic: SE of PEG 3350 | minimal, bloating, abdominal discomfort, cramping, farting |
| Hyperosmotic: SE of Glycerin | minimal, rectal irritation, hypokalemia, dont use if you have a hemorrhoid |
| Hyperosmotic: warnings for PEG and glycerin | PEG 3350: IBS, renal disease, children under 6. Glycerin: previous issues with anal irritation |
| Emollient: MOA | increase wetting of int fluid and make a mix of fat and watery stuff to soften stools |
| Emollient: onset | 12-72 h up to 5days |
| Emollient: what dosage form does Docusate sodium come in | capsule and syrup |
| Emollient: what dosage form does docusate calcium come in. | capsule |
| Emollient: side effects | minimal diarrhea, abdoninal cramping |
| Emollient: drug interactions | dont use with mineral oil |
| Lubricant: MOA | softens stool by coating teh stool and preventing absorption of fecal water |
| Lubricant: onset | 6-8 hours for oral, 5-15 mins for rectal |
| Lubricant: what meds are in this class | mineral oil |
| Lubricant: what dosage forms does mineral oil come in? | oral liquid, oral liquid emulsion, oral liquid enema |
| Lubricant: side effects | anal leakage, anal puss |
| Lubricant: precautions | aspiration into lungs, children under 6yo, pregnant, bedridden, older, diff swallowing |
| Lubricant: drug interactions | BC, digoxen, blood thinners, docusate |
| Saline: MOA | osmosis to draw in water and increasing interluminal pressure |
| Saline: onset Mg hydroxide | 30mins-6h |
| Saline: onset mg citrate and Na2+ phosphate preps | oral: 30mins-3h Rectal: 2-15mins |
| Saline: what druga are in this class | Mg citrate, mg hydroxide, monobasic na phosphate, mg sulfate |
| Saline: what DF does mg citrate come in | liquid |
| Saline: what DF does mg hydroxide come in | liquid |
| Saline: what DF does monobasic NA phosphate and dibasic na phosphate come in | rectal liquid enema |
| Saline: what DF does mg sulfate come in | solid |
| Saline: side effects | minimal, abdominal cramping, NV, dehydration, electrolyte imbalance |
| Saline: warnings precautions | renal impairment, newborns, older adults, Naphosphate contraindicated in CHF |
| Saline: drug interactions | oral anticoagulants, digoxin, chlorpromazine, tetracycline, other products with mg |
| Stimulant: MOA | stimulate muscle in GI to contract and move stool, soften stool, increase of electrolytes |
| Stimulant: onset | oral: 6-10h up to 24 rectal: 15-60mins |
| Stimulant: what are some drugs in this class | senna, bisacodyl, castor oil |
| Stimulant: what DF does senna come in | tab |
| Stimulant: what DF does bisacodyl come in | tab and rectal solid supp |
| Stimulant: what DF does castor oil come in | liquid |
| Stimulant: what are some SE | cramp, electrolyte deficiencies, malabsorption, increased mucous secretion Senna makes the pee pink/brown |
| Stimulant: drug interactions | bisacodyl: antacids, H2RA, PPI, Milk |
| docusate increases what | mush |
| bisacodyl and senna increase what | push |
| Children 2-6 recommendation | 1st: oral docusate or mg hydroxide, quicker: glycerin syrup |
| children 6-12 recommendation | 1st: bulk forming, docusate, mg hydroxide, quicker relief: glycerin or bisacodyl supp |
| opioid induced recommendation | stim+emolient (senna and bisacodyl+ docusate) |
| ocassional constipation | bulk forming or PEG 3350, mg hydroxide |
| prevent straining recommedation | emoliant like docusate |
| colonoscopy recommendation | peg 3350 w or wo stimulant mg citrate |
| hemorrhoids recomendation | emollient docusate |
| advanced age recomendation | oral bulk orming, peg 3350 and docusate |
| pregnancy/lactation recommendation | 1st: oral bulk forming, docusate 2nd: senna, bisacodyl, peg 3350 |
Created by:
carlypentland
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