Constipation

Question 1

3 etiologies of constipation

Answer 1

Low fiber diet
Comorbidities
Drug-induced constipation

Question 2

Comorbidties that can cause constipation

Answer 2

IBS, DM, hypothyroidism, neurologic injuries, pregnancy

Question 3

Drugs that can induce constipation

Answer 3

Opioids**, chronic antihistamines, tricyclic antidepressants, Parkinson’s meds, iron, calcium channel blockers

Question 4

Osmotics drugs

Answer 4

PEG 3350, lactulose, glycerin suppository

Question 5

Onset of action of PEG 3350

Answer 5

12-72 hours

Question 6

Side effect of lactulose

Answer 6

Diarrhea –> have to titrate dose!

Question 7

When to use treatments for chronic idiopathic constipation and IBS-C

Answer 7

When patients have tried OTC products with little to no success

Question 8

Indication for chronic idiopathic constipation meds

Answer 8

For anyone

Question 9

Indication for IBS-C meds

Answer 9

Some are for women only (like lubiprostone)

Question 10

Treatments for chronic idiopathic constipation and IBS-C

Answer 10

Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)

Question 11

Opioid-receptor antagonist medications

Answer 11

Methylnaltrexone (Relistor)
Naloxegol (Movantik)
Naldemedine (Symproic)

Question 12

Lubiprostone (Amitiza) dosing

Answer 12

24mcg PO BID

Question 13

Linaditide (Linzess) dosing

Answer 13

145mcg PO QD, can decrease to 72mcg

Question 14

Plecanatide (Trulance) dosing

Answer 14

3mg PO QD

Question 15

Methylnaltrexone (Relistor) route of administration

Answer 15

SQ

Question 16

Naloxegol (Movantik) route of administration

Answer 16

PO (also has renal dose adjustment)

Question 17

Naldemedine (Symproic) route of administration

Answer 17

PO

Question 18

Nonpharm treatment for constipation

Answer 18

Increase water and fiber intake, exercise, establish a bowel regimen

Question 19

Bulk-forming therapies for constipation

Answer 19

Psyllium seed husks (Metamucil)
Calcium polycarbophil (Fibercon)
Methylcellulose (Citrucel)

Question 20

Who should avoid bulk-forming therapies?

Answer 20

Patients who are fluid-restricted (CHF!)

Question 21

Onset of action for bulk-forming therapies

Answer 21

24-48 hours

Question 22

Side effects of bulk-forming therapies

Answer 22

Abdominal cramping and gas

Question 23

Emollient therapies

Answer 23

Docusate (Colace)

Question 24

Docusate onset of action

Answer 24

12-72 hours

Question 25

Where is docusate useful?

Answer 25

Hard stools, prevent straining in pregnancy, post-partum, post-op surgery

Question 26

Saline laxative therapies

Answer 26

PO magnesium citrate, PO MoM, sodium phosphate (Fleet enema)

Question 27

Onset of action of saline laxatives

Answer 27

PO: 30 mins-3 hours
PR: 2-15 minutes

Question 28

Saline laxative side effects

Answer 28

Abdominal cramping, dehydration, electrolyte imbalances

Question 29

Where should you avoid use of saline laxatives?

Answer 29

Patients who are on sodium, phosphate, and magnesium-restricted diets (CHF and ESRD)

Question 30

Lubricant agent med

Answer 30

Mineral oil (PO and PR)

Question 31

Mineral oil onset of action

Answer 31

PO: 6-8 hours
PR: <15 minutes

Question 32

Stimulant meds

Answer 32

Sennosides, senna (Senokot)- PO

Bisacodyl (Ducolax)- PO and PR

Question 33

Where are stimulants used?

Answer 33

Bowel-prep and opioid-induced constipation

Question 34

Onset of action of stimulants

Answer 34

PO: 6-10 hours
PR: 15-60 minutes

Question 35

Side effects of stimulants

Answer 35

Cramping and abdominal pain