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NHG > constipation > Flashcards

constipation Flashcards

1
Q

symptoms of constipation

A 
decreased frequency of BO 
hard, dry stools 
straining 
abdominal bloating 
feeling of incomplete bowel movement 
feeling like having to pass a bowel movement but not able to
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2
Q

causes of constipation

A

lifestyle:
travel, inadequate dietary fibre and or fluid intake
physical inactivity, parent child interactions, holding back urge to defecate

medical causes:
drug induced (opioids, anticholinergic drugs, CCB, calcium and iron supplements etc) 
neurogenic causes, mechanical obstruction, metabolic conditions, psychogenic causes, pregnancy, pain, age
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3
Q

things to ask

A

age and other demographic factors
onset/duration and history
associated symptoms: abdominal discomfort, bloating, straining
specific symptoms: stool quality, exact location of discomfort, severity of symptoms
usual stool habits
medication/medical history
changes in lifestyle associated with onset
what has been tried? how long?

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4
Q

when to refer

A 
<2yo
marked abdominal pain/discomfort 
n/v
bloody/black or tarry stools 
fever 
unexplained changes in bowel habits esp if accompanied by weight loss 
change in stool caliber 
symptoms > 1 week with laxatives or >2 weeks if self treat 
suspect medication
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5
Q

types of fibre/bulk forming laxatives (2)

A 
isphaghula husk (fybogel) 
sterculia
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6
Q

MOA of bulk forming

A

reduced stool consistency by increasing retention of water in stool
increased stool volume
improves passage of feral material

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7
Q

onset of bulk forming

A

up to 72 hours

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8
Q

how to administer bulk forming

A

taken with food

stir contents into glass of cold/room temperature water and drink immediately

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9
Q

contraindications for bulk forming

A

intestinal obstruction

fecal impaction

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10
Q

SE for bulk forming

A

flatulence/bloating
esophageal/colonic obstruction
interfere absorption of drugs
psyllium may cause allergic reaction

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11
Q

lubricant laxative example

A

liquid paraffin

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12
Q

lubricant laxative moa

A

coat decal matter with oil –> prevents water from leaving faces

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13
Q

lubricant laxative onset of action

A

6-8h

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14
Q

lubricant laxative administration

A

avoid taking within 2h of meals

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15
Q

contraindication for lubricant laxative

A 
abdominal pain 
n/v present 
gerd 
bed-ridden 
dysphagia
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16
Q

precaution for lubricant laxative

A

do not recommend for elderly, preggo or <6yo

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17
Q

SE of lubricant laxative

A 
may impede absorption of fat solution vitamins 
interfere absorption of drugs 
unpleasant taste 
anal seepage 
lipid pneumonia
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18
Q

stimulant laxatives (2)

A

Senna

bisacodyl

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19
Q

Senna dose

A

7.5mg (2 tabs on)

max 70-100mg/day, divided bd

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20
Q

Senna moa

A

stimulates nerve plexus of intestinal smooth muscle
increase peristalsis
decrease reabsorption of water and electrolytes from colon

21
Q

Senna onset

A

6-12 hours PO

22
Q

Senna contraindications

A

acute inflammation (eg churns)
bowel obstruction/fecal impaction
n&v
<12yo

23
Q

Senna SE

A

abdominal cramps, n&v
diarrhoea
hypokalemia, dehydration
melanosis coli, discolours urine

24
Q

bisacodyl onset

A

PO: 6-12h
Supp: 15-60min

25
Q

bisacodyl dosage

A

enteric coated: 5-15mg single dose. max 30mg for bowel evacuation
suppository: 10mg single dose

26
Q

bisacodyl administration

A

space from milk, antacids, avoid with cimetidine

27
Q

bisacodyl SE

A

abdominal cramps, n&v, diarrhoea
hypokalaemia, dehydration
cathartic colon with chronic use?

28
Q

osmotic laxatives (5)

A 
lactulose
polyethylene glycol 
magnesium sulfate 
sodium phosphate 
glycerin
29
Q

lactulose MOA

A

non-absorbed disaccharides are metabolised by colonic back into organic acids
increase osmotic pressure (draws fluid into GI lumen –> softens stool, distends lumen and promotes peristalsis)
prebiotic: strengthens growth of some bacteria while suppressing potentially pathogenic bacteria
lowers pH

30
Q

lactulose onset

A

24-48h

31
Q

lactulose SE

A

abdominal cramping, flatulence, bloating, diarrhoea

32
Q

polyethylene glycol MOA

A

retains water in intestinal lumen by creating an osmotic gradient

33
Q

polyethylene glycol SE

A

bitter taste, incontinence, diarrhoea

34
Q

magnesium sulfate dose

A

5-15g in a glass of water + another glass of water

35
Q

magnesium sulfate MOA

A

retains water in the intestinal lumen by creating an osmotic gradient

36
Q

magnesium sulfate onset

A

30min-3h

37
Q

magnesium sulfate indication

A

bowel cleansing before medical procedures

38
Q

magnesium sulfate contraindication

A

severe renal impairment
congestive cardiac failure
GI obstruction
N&V

39
Q

magnesium sulfate precaution

A

drink as much fluids as possible

minimum 9 glasses to prevent dehydration

40
Q

glycerin suppository dosage

A

<6yo: 1-1.5g

>6yo: 3g

41
Q

glycerin suppository onset

A

15-60min

42
Q

glycerin suppository precaution

A

avoid in conditions involving rectal irritation (eg piles)

43
Q

glycerin SE

A

rectal irritation

44
Q

phosphate enema adult dose

A

133ml

45
Q

phosphate enema paediatrics dose

A

66.6ml

46
Q

phosphate enema moa

A

mechanical lavage

47
Q

phosphate enema onset

A

5-15min

48
Q

phosphate enema administration

A

not more than 1 in 24h

49
Q

phosphate enema precaution

A

risk of colonic peforation, rectal gangrene, hyperphosphatemia, hypocalcemic tetany
chronic use can lead to loss of rectal tone and focal incontinence
avoid in renal impairment and CHF

NHG (9 decks)

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