1. Teaching Points
1.1. Retain suppository for no less that 60 minutes
1.2. May cause visual disturbances
1.3. Indicated for acute pain only and not for long-term use
1.4. Increased risk of MI, stroke, GI perforation and bleeding
2. Side Effects
2.1. Dizziness
2.1.1. meclilzine
2.1.1.1. Classification
2.1.1.1.1. Second generation antihistamine
2.1.1.2. Mechanism of Action
2.1.1.2.1. Management of vertigo due to vestibular system dysfunction
2.1.1.3. Normal Dosage
2.1.1.3.1. 25-100 mg/day in divided doses
2.1.1.4. Contraindications
2.1.1.4.1. Use with caution in the elderly, in patients taking anticholinergic medications, patients with pyloric/duodenal obstruction, hepatic impairment, or renal impairment. Patients taking meclizine should not drive or operate heavy machinery due to CNS depression.
2.2. Constipation
2.2.1. Milk of Magnesia
2.2.1.1. Classification
2.2.1.1.1. Saline laxative
2.2.1.2. Mechanism of Action
2.2.1.2.1. Increases the osmotic effect by drawing water into the intestinal tract
2.2.1.3. Normal Dosage
2.2.1.3.1. 400 mg/5mL: 15-60 mL at bedtime or in divided doses
2.2.1.4. Contraindications
2.2.1.4.1. Use with caution in patients with renal impairment, with myasthenia gravis or other neuromuscular diseases, and in the elderly.
2.3. Diarrhea
2.3.1. loperamide
2.3.1.1. Classification
2.3.1.1.1. Antidiarrheal
2.3.1.2. Mechanism of Action
2.3.1.2.1. Binds to the opiate receptor in the gut wall, inhibiting the release of acetylcholine and prostaglandins, thereby reducing propulsive peristalsis, and increasing intestinal transit time. Increases the tone of the anal sphincter, thereby reducing incontinence and urgency.
2.3.1.3. Normal Dosage
2.3.1.3.1. 4 mg initially, then 2 mg after each loose stool; not to exceed 16 mg/day
2.3.1.4. Contraindications
2.3.1.4.1. Contraindicated in patients with abdominal pain in the absence of diarrhea; not recommended in infants below 24 months of age.