Constipation
Charles Theisler in Adjuvant Medical Care, 2023
Osmotic Agents: Osmotic laxatives help fluids move through the colon. Examples include prescription strength polyethylene glycol (Golytely, Nulytely)8 or over-the-counter products such as lactulose (Kristalose, 10–20 gm/day) and polyethylene glycol (Miralax). Magnesium oxide is a useful supplement in treating constipation.9 Typically, to relieve constipation, doses range from 1,000–2,000 mg/day. Magnesium citrate (citrate of magnesia, Citroma, 240 ml orally one time) is effective and has a number of health benefits, including improved calcium absorption, increased gastrointestinal motility, stool softening, and others.9 Magnesium hydroxide (2.4–4.8 gm) in the form of milk of magnesia can also be effective.10 Magnesium sulfate (10–30 gm) in the form of salts should only be used for occasional treatment of constipation, and doses should be taken with a full 8 oz. glass of water.10,11
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Transient sedation is common, and usually resolves in a few days. Excessive sedation several days into treatment with methadone, however, should be addressed with dose adjustment. Nausea is less common in children than in adults, but should be anticipated and treated, usually with agents such as ondansetron or metoclopramide. The use of promethazine and other phenothiazines is discouraged as they are central nervous depressants. Pruritus may respond to antihistamines; some patients may be managed with small subcutaneous or intravenous doses of nalbuphine. Constipation should be expected in most children requiring opioid therapy and is best managed with an agent that will stimulate the bowel and soften the stool such as a senna associated with docusate, which is ineffective when used alone. Lactulose can be used in ambulatory patients but may produce significant bowel distention and discomfort in patients who are bedridden. Milk of magnesia may be tried in some patients. Suppositories or enemas may be necessary in some cases. Subcutaneous methylnaltrexone is devoid of systemic effects but may cause severe cramping and should never be used if structural obstruction is a possibility. Urinary retention is less common than it is in adults but may respond to rotation.
Dietary treatment of overweight and obesity
G. Michael Steelman, Eric C. Westman in Obesity, 2016
Although some mild symptoms of fatigue may occur during the keto-adaptation phase, if your patients are taking medications, these symptoms can also occur due to overmedication by antihypertensive or hypoglycemic (Table 5.6). Instruct your patient to call the clinic if he or she experienced symptoms such as dizziness, lightheadedness, or muscle cramping. Home monitoring of glucose and/or blood pressure is recommended. Home glucose monitoring is highly recommended if the patient is taking insulin or taking multiple hypoglycemic agents. If fatigue or muscle cramping occurs, recommend one bouillon cube dissolved in hot water every 4 hours as needed. If symptoms persist, then bring the patient back to the clinic for measurement of serum electrolytes. Potassium or magnesium supplementation can be added if serum measurements are abnormally low. Because potassium and magnesium are intracellular electrolytes, serum levels are a poor indicator of total body depletion. For example, a history of muscle cramps and hyperreflexia on physical exam is highly suggestive of magnesium deficiency. As a preventive treatment for muscle cramping and constipation, a slow-release magnesium preparation like Slow-Mag or 1 teaspoon of milk of magnesia at bedtime is helpful. For patients who are taking insulin or other injectable hypoglycemic agents, we instruct patients to call the doctor on call when the glucoses go below 100 mg/dL.
Slime molds response to carbon nanotubes exposure: from internalization to behavior
Published in Nanotoxicology, 2021
Manon Ternois, Maxence Mougon, Emmanuel Flahaut, Audrey Dussutour
We used the CCVD (catalytic chemical vapor deposition) technique to synthesize the DWCNTs. Magnesia (MgO) was used as support material for in situ generated catalytic nanoparticles of cobalt and molybdenum (Flahaut et al. 2003). CCVD is a widely used method due to its capacity to produce CNTs with a high yield and possibly also a high purity with easily controllable reaction conditions to tune the desired type of carbon nanotubes (Yeoh et al. 2009). First, the catalytic powder was placed in a ceramic container which was positioned in a tube furnace. The synthesis was performed with dihydrogen (H2) and a methane (CH4) mixture flow. Methane served as the source of carbon by catalytic decomposition on the cobalt and molybdenum nanoparticles, leading to the formation of carbon nanotubes. The obtained black nanocomposite powder was composed of DWCNTs and the catalytic support, which was dissolved by addition of a concentrated aqueous solution of hydrochloric acid (3.5 mL of deionized water and 15 mL of 37% HCl for 1 g of powder) and left overnight. Then, a vacuum filtration was carried out using a nitrocellulose membrane (0.45 µm pore size). Successive filtrations were performed to remove the excess of HCl and the solution of Mg, Co and Mo salts. Finally, the last washing was carried out using tap water.
Combination of a hot-melt subcoating and an enteric coating for moisture protection of hygroscopic Sennae fructus tablets
Published in Pharmaceutical Development and Technology, 2019
Kira-Isabel Zier, Wulf Schultze, Claudia S. Leopold
Aqueous spray-dried Sennae fructus extracts were obtained from roha arzneimittel (Bremen, Germany). The subcoating materials were medium chain triglyceride (MCT), purchased from Henry Lamotte Oils (Bremen, Germany), stearic acid (StA; Palmac 98-18) from Berg + Schmidt (Hamburg, Germany), Precirol® ATO 5 (Pr), and Compritol® 888 ATO (Cp) both from Gattefossé (Bad Krozingen, Germany). The outer enteric coating Eudragit® L 30D-55 (EuL55) was received from Evonik (Darmstadt, Germany) and talcum from CSC Jäklechemie (Hamburg, Germany). Triethyl citrate, sodium chloride, magnesium chloride, Combi Titrant 5, Combi Methanol for volumetric Karl-Fischer titration, and potassium carbonate were obtained from Merck (Darmstadt, Germany). Magnesium stearate was bought from Magnesia (Lüneburg, Germany). Fumed silica and microcrystalline cellulose were obtained from NRC (Hamburg, Germany). Sudan red 7B was purchased from Merck (Darmstadt, Germany). Methanol was bought from Honeywell (Erkrath, Germany), acetonitrile for HPLC from VWR International (Hannover, Germany), and anhydrous formic acid was purchased from Sigma-Aldrich (Schnelldorf, Germany). Sennoside B was obtained from Carl Roth (Karlsruhe, Germany).
An overview of the efficacy and safety of prucalopride for the treatment of chronic idiopathic constipation
Published in Expert Opinion on Pharmacotherapy, 2019
Marzieh Daniali, Shekoufeh Nikfar, Mohammad Abdollahi
The general approach to treat constipation totally depends on the reason of constipation and initially is limited to lifestyle modifications such as dietary changes (fiber: 20 to 35 g/day) and daily exercise. Additionally, in the second step different types of laxatives such as bulk-forming (psyllium and methylcellulose), osmotic laxatives (PEG and lactulose) or saline laxatives (milk of magnesia) are recommended [53–55]. A randomized clinical trial was performed to compare the efficacy of bulk-forming laxatives like psyllium and prunes (dried plums), and evaluated that both laxatives are well tolerated but prunes are more efficient [56]. The next pharmacotherapy line concludes guanylate cyclase-C (GCC) agonists like linaclotide or plecanatide (mechanism: stimulation of intestinal secretion fluid [55] and amelioration of abdominal discomfort [53]) or prokinetics such as prucalopride [9,57].
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