Constipation Flashcards
Medical conditions that can cause constipation
IBS, anal disorders (fissures, fistulae, rectal prolapse), MS, PD, spinal cord tumors, DM, hypothyroidism
Constipation is defined as infrequent bowel movements (less than ___ per week)
3 per week
Non-drug tx are preferred for constipation. List them.
Inc fluid intake (64oz daily), limiting caffeine and alcohol intake, inc physical activity
Drugs that can cause constipation
Antacids (aluminum and calcium containing) Clonidine Colesevelam Diphenhydramine Baclofen Amitriptyline Iron Verapamil Sucralfate
If constipation is not improved after ___ days, consult a PCP
7 days
Which OTC to recommend for constipation? Most adults --> Iron-induced --> Opioid-induced --> Preg --> Fast relief -->
Most adults –> fiber
Iron-induced –> decussate (stool softener)
Opioid-induced –> Senna or bisacodyl (Stimulants)
Preg –> fiber
Fast relief –> glycerin suppository (adult/children); bisacodyl (adult)
Psyllium
Metamucil
Calcium polycarbophil
FiberCon
Methylcellulose
Citrucel
Wheat dextrin
Benefiber
First-line tx in most constipation cases and DOC in pregnancy. MOA: absorb water in the intestine, soaking up fluid and adding bulk to the stool=INC perstalsis and DEC stool transit time
Bulk-forming
Contain large ions or molecules that are poorly absorbed. Draw fluid into the bowel lumen through osmosis which distends the colon and INC peristalsis
Osmotics
Directly stimulate neurons in the colon, causing peristaltic activity
stimulants
emollients that reduce the surface tension of the stool oil-water interface allowing more water and fat to mix with the stool (commonly used by those with iron supplements)
Stool softeners
coat the bowel and stool with a waterproof film. keeps moisture in the stool and makes defecation easier (ex: mineral oil)
lubricants
Magnesium hydroxide, PEG, glycerin, lactulose, sodium phosphates, lactitol, sorbitol are examples of
Osmotics
Milk of magnesia
magnesium hydroxide
Miralax
PEG 3350
Fleet liquid glycerin supp, Pedia-Lax
Glycerin