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OTC + Legal/Ethics > Constipation > Flashcards

Constipation Flashcards

1
Q

What are 4 symptoms of constipation?

A
  1. Pain/difficulty passing stools
  2. Feeling of incomplete evacuation
  3. Abdominal discomfort
  4. Bloating
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2
Q

Does constipation require a counselling room?

A

Yes

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3
Q

What are 10 red flags for referral with constipation?

A
  1. Blood or mucous in stool to particularly tarry, red or black stools.
  2. Constipation alternating with diarrhoea
  3. Tenesmus - a continuous feeling of the need to defecate
  4. Severe or persistent abdominal pain
  5. Unexplained weight loss
  6. A sudden change in bowel habits > 2 weeks
  7. Constipation persisting after 1 week or laxative use or 2 weeks of dietary modification
  8. Laxative misuse suspected
  9. Constipation presenting as a new symptom that is not attributable to changes in diet, lifestyle, medication or medical condition.
  10. Constipation in infants < 3 months, to exclude organic causes such as Hirschsprung’s disease.
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4
Q

Does constipation have a PSA self-care card?

A

Yes (Constipation)

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5
Q

What is the preferred over-the-counter treatment option for constipation in children and non-pregnant adults?

A

Osmotic Laxatives (such as macrogol)

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6
Q

What are the directions for Movicol (macrogol) for adults and children over 12 years in constipation?

A

Use 1 to 3 sachets of Movicol Original daily

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7
Q

What are the directions for Movicol (macrogol) for children aged 6 - 11 years?

A

Use 2 sachets of Movicol Junior daily (up to a maximum of 4 sachets daily)

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8
Q

What are the directions for Movicol (macrogol) for children aged 2 - 5 years?

A

Use 1 sachet of Movicol Junior daily (up to a maximum of 4 sachets daily)

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9
Q

What are 6 non-preferred over-the-counter options for constipation in children and non-pregnant adults and why?

A
  1. Lactulose: less likely to be tolerable
  2. Glycerol suppositories: less likely to be tolerable
  3. Saline enema (Microlax): only necessary in advanced constipation
  4. Stimulant laxatives (senna): can cause “laziness” of the bowel
  5. Coloxyl (docusate 50 mg): Unsafe in children under 3
  6. Poloxamer: unlikely to be of significant effect
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10
Q

Are osmotic laxatives (such as macrogol) safe in pregnancy?

A

Yes (in occasional doses)

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11
Q

Are osmotic Laxatives (such as macrogol) safe in breastfeeding?

A

Yes

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12
Q

What is the age range for Osmotic Laxatives (such as macrogol)?

A

Safe in children over 2 years

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13
Q

What is the preferred over-the-counter treatment option for constipation in pregnant women?

A

Stool softeners (such as Coloxyl [docusate 50 mg])

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14
Q

What are the directions for Coloxyl (docusate 50 mg) in constipation in patients over 12 years?

A

1-3 tablets once to twice daily. Maximum of 10 tablets daily in divided doses

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15
Q

What are the directions for Coloxyl (docusate 50 mg) in constipation in children aged 6 to 12 years?

A

1-3 tablets once daily

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16
Q

What are the directions for Coloxyl (docusate 50 mg) in constipation in children aged 3 to 6 years?

A

1 tablet once daily

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17
Q

What are 6 non-preferred over-the-counter options for constipation in pregnant women and why?

A
  1. Macrogol: limited safety in pregnancy
  2. Lactulose: less likely to be tolerable
  3. Glycerol suppositories: less likely to be tolerable
  4. Saline enemas: only necessary in advanced constipation
  5. Stimulant laxatives (senna): unsafe in pregnancy
  6. Poloxamer: unknown safety in pregnancy and unlikely to be of significant effect
18
Q

Are stool softeners (such as Coloxyl [docusate 50 mg]) safe in pregnancy?

A

Yes

19
Q

Are stool softeners (such as Coloxyl [docusate 50 mg]) safe in breastfeeding?

A

Yes

20
Q

What is the age range for stool softeners (such as Coloxyl [docusate 50 mg]))?

A

Safe in children over 3

21
Q

What is the preferred over-the-counter treatment option for constipation in children under 3?

A

Poloxamer 100mg/mL (Coloxyl Oral Drops)

22
Q

What are the directions for Poloxamer 100mg/mL (Coloxyl Oral Drops) for constipation in children aged 18 months to 3 years?

A

0.8 mL (80 mg) three times daily

23
Q

What are the directions for Poloxamer 100mg/mL (Coloxyl Oral Drops) for constipation in children aged 6 to 17 months?

A

0.5mL (50 mg) three times daily

24
Q

What are the directions for Poloxamer 100mg/mL (Coloxyl Oral Drops) for constipation in children under 6 months?

A

0.3mL (30 mg) three times daily

25
Q

What are 5 non-preferred over-the-counter options for constipation in children under 3 and why?

A
  1. Macrogol: unsafe in children under 2, less likely to be accepted by child
  2. Lactulose: less likely to be accepted by child
  3. Glycerol suppositories: less likely to be accepted by child
  4. Saline enema (Microlax): less likely to be accepted by child, only required in advanced constipation
  5. Stimulant laxatives (senna): unsafe in children under 2, can lead to “lazy” bowel
26
Q

Is Poloxamer 100mg/mL (Coloxyl Oral Drops) safe in pregnancy?

A

No (unknown)

27
Q

Is Poloxamer 100mg/mL (Coloxyl Oral Drops) safe in breastfeeding?

A

No (unknown)

28
Q

What is the age range for Poloxamer 100mg/mL (Coloxyl Oral Drops)?

A

Safe from birth

29
Q

What are 7 pieces of non-pharmacological advice for constipation?

A
  1. Increase fluids
  2. Increase fibre
  3. Increase exercise
  4. Do not suppress the urge to defecate
  5. Recommended adult daily fibre intake is 25-30 grams.
  6. Insoluble and soluble fibre are effective in preventing or alleviating constipation.
  7. Regular toileting and positive encouragement should be the first step in the management of constipation in children.
30
Q

What are 5 Sources of insoluble fibre?

A
  1. Legumes
  2. Skin of fruit and vegetables
  3. Nuts
  4. Wholegrain foods
  5. Seeds
31
Q

What are 6 Sources of soluble fibre?

A
  1. Oats
  2. Barley
  3. Ispaghula
  4. Rye
  5. Fruits
  6. Vegetables
32
Q

What is the time to onset of bulk-forming laxatives (psyllium husk, ispaghula husk)?

A

48 to 72 hours

33
Q

What is the time to onset of oral stimulant laxatives?

A

6 to 12 hours

34
Q

What is the time to onset of suppository stimulant laxatives?

A

15 to 60 minutes

35
Q

What is the time to onset of stimulant laxative enemas?

A

5 to 15 minutes

36
Q

What is the time to onset of oral osmotic laxatives?

A

2 to 48 hours

37
Q

What is the time to onset of rectal osmotic laxatives?

A

5 to 30 minutes

38
Q

What is the time to onset of oral stool softeners?

A

24 to 72 hours

39
Q

What is a contraindication of lactulose?

A

Galactosaemia (inability to digest galactose)

40
Q

What is a precaution of macrogol?

A

Macrogol should be used with caution when there is electrolyte disturbances, sodium restriction, or heart failure

41
Q

Describe the role of stool softeners in constipation

A

Evidence of effectiveness of stool softeners as a single agent is lacking. However, they can be used in combination treatment, children, and pregnancy

42
Q

Why is blood in stools a red flag?

A

This could indicate a gastrointestinal perforation or colon cancer

OTC + Legal/Ethics (66 decks)

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