Constipation Flashcards by Shay M

Causes of constipation

Lack of fibre
Lack of fluids
Meds
Medical conditions
Pregnancy

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What drugs cause constipation

Very Old ANTIs get constipation *

Verapamil
Opioids - morphine, codeine

Iron supplements
Aluminium based antacids
Sedating ANTIHISTAMINES- diphenhydramine, promethazine

ANTIMUSCARINICS - trospium, oxybutynin, atropine

Antidepressants
Antiepileptics

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What conditions cause constipation

IBS, diverticular, hypothyroidism, anaemia

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Why Does pregnancy cause constipation

Yes
Hormonal changes and baby getting bigger

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Constipation red flags

Unexplained weight loss - cancer
Continuous fatigue- anaemia
Black, red tarry stools - gastric ulcer
Blood in stool - cancer/ gastric ulcer
Clay like stools- Hepatotoxicity
New onset constipation 50+yrs
Undiagnosed Abdominal pain

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Constipation treatment

BOSS

Lifestyle
Bulk forming ( stericulia, isphagula,methyl cellulose, bran)
Osmotic ( macrogol, lactulose)
Stimulant ( senna, bisacodyl, sodium picosulfate, glycerol suppository, co -danthramer)
Softeners (liquid paraffin)

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Whats ‘other drugs’ used in chronic constipation in adults

Linactolide
Prucalopride
Docusate

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Which laxative is both a bulk forming and softener

Methyl cellulose

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Which laxative is a stimulant and softener

Docusate

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Bulk forming laxatives MOA

increases bulk of stool

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Onset of bulk forming laxatives

2-3 days

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Whys it important to maintain adequate fluids with bulk forming laxatives

To prevent intestinal or oesophageal obstruction

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Stimulant laxatives MOA

Increases intestinal motility

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Which laxatives are used in constipation in terminally ill patients only and why

Co-danthramer
Co- danthrusate

Colour urine red
And its carcinogenicity

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Which laxatives colour urine red

Co danthramer
Co danthrusate

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Which laxative colours urine red/brown

Senna

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Which laxatives need to be avoided in intestinal obstruction

Stimulants and bulk forming

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Stimulant laxatives SE

Abdominal discomfort, flatulence

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Onset of stimulant laxatives

6 - 12 hours

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Stimulant suppository onset

20-60 minutes

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Abuse of laxatives can cause which electrolyte imbalance

Hypokalaemia

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Senna age OTC

18+ yrs

Can be sold to 12-17 under pharmacist supervision

Can you sell senna to < 12 years

No
Needs an RX

Whats the max u can sell SENNA OTC

Max 2 short treatment courses

MHRA updates: AVOID senna in ______

Intestinal obstruction Undiagnosed abdominal pain Unstable pregnancy Atony (muscle weakness)

Can you give senna in pregnancy

In stable pregnancy if GP allows

Faecal softner MOA

Softens and wets faeces

Faecal softener examples

Liquid paraffin

Which laxative can cause anal seepage

Faecal softener Mostly docusate

What are the 2 types of osmotic laxatives

Macrogol 3350 Lactulose

Osmotic laxatives MOA

Increases fluid in large bowel by drawing in fluid or maintaining it

Osmotic laxatives onset

2 days for max effect

Which osmotic laxative acts faster

Macrogol 3350

SE of osmotic laxatives

Bloating, electrolyte imbalance, abdominal pain

Which laxative is also used to treat hepatic encephalopathy

Lactulose

Management of short duration constipation

BOS 1. Bulk 2. Osmotic 3. Stimulant

Management of constipation in pregnancy and breastfeeding

BOS 1. Bulk 2. Osmotic 3. Stimulant

Management of chronic constipation

BOS 1. Bulk 2. Osmotic 3. Stimulant

Management in faecal impaction

OS 1. Osmotic then add or switch to stimulant

Management of constipation in children

1. Osmotic (macrogol 1st) 2. Stimulant Lifestyle and macrogol 1st otherwise add or switch to stimulant. Otherwise switch to lactulose or softener

Management of opioid induced constipation

1. Osmotic or docusate + stimulant 2. Naloxegol or methylnaltrexone bromide (use these in adjunct to existing laxatives in palliative care pts)

In chronic constipation which osmotic laxative is preferred

Macrogol 3350

Patient and carer advice: When would you take bulk forming laxatives

Not immediately before bed because it will swell up and may cause blockage when lying down 2-3 hrs before bed

Laxative abuse may lead to which electrolyte imbalance

Hypokalaemia

Arachis oil is an example of which laxative? What would you ask the patient before giving it them?

Softener Peanut allergy

Sodium sulphate and magnesium sulphate are examples of which laxative

Osmotic

A patient has constipation but also suffers from intestinal obstruction, which laxative would you recommend

Osmotic - lactulose, macrogol

Which laxative causes malabsorption of vitamins ADEK

Faecal softner

Avoid this laxative if a patient has anal seepage or malabsorption of vitamins ADEK

Softeners - docusate - methyl cellulose - liquid paraffin

Lactulose dose 1-11months

2.5ml BD

Lactulose dose 1-4 years

2.5-10ml BD

Lactulose dose 5-17 years

5-20ml BD

Lactulose dose for adult (18+)

Initially 15ml BD According to response 30-50ml TDS

Which electrolyte causes constipation

Aluminium