Constipation

Question 1

Criteria for diagnosis of functional constipation

Answer 1

2 of the following for 3 months and symptom onset at least 6 months prior

Lumpy or hard stools in 1/4 of defecations
Straining in 1/4 of defecations
<3 spontaneous bowel movements weekly
Sensation of incomplete evacuation in 1/4 of defecations
Manual maneuvers to defecate 1/4 of the time

Question 2

Red flag signs in constipation

Answer 2

GI bleeding
Unexplained iron-deficiency anemia
Unintentional weight loss
Palpable abdominal mass
Family history of colon cancer
Symptom onset >50 years of age
Sudden/acute onset of change in bowel habits

Question 3

When to consider endoscopy

Answer 3

Recent onset of symptoms in patients >50 years of age.
Severe symptoms
Alarm/red flags (weight loss, anemia, rectal bleeding)
Family history of colorectal cancer

Question 4

Drugs with constipating effects

Answer 4

Antacids w/ aluminum or calcium
Bismuth
Opioids
Anticonvulsants 
Diuretics that can cause hypokalemia
Antiparkenson agents
Resins
Anticholinergic drugs
Serotonin receptor antagonists (ondansetron)
Antipsychotic agents
Iron products 
Verapamil

Question 5

Non pharm options for constipation

Answer 5

Dietary fiber intake (25-38 g/day)
Fluid intake of 2.2-3L per day
Regular schedule for movements
Physical exercise
Physical manipulation might benefit spinal injury patients

Question 6

Fiber sources

Answer 6

Grains, veg, fruit, psyllium, unprocessed bran

Question 7

Use of neloxegol

Answer 7

Opioid induced constipation

Mu-opioid receptor antagonist

Question 8

Highest dose of neloxegol

Answer 8

25mg daily

Question 9

Adverse effects of neloxegol

Answer 9

Diarrhea, abdominal pain, flatulence

Question 10

Methylnaltrexone moa

Answer 10

Mu opioid antagonist

Question 11

Methylnaltrexone place in therapy

Answer 11

Opioid induced constipation in palliative patients