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Gastrointestinal > Constipation > Flashcards

Constipation Flashcards

1
Q

Causes of constipation

A

Lack of fibre
Lack of fluids
Meds
Medical conditions
Pregnancy

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2
Q

What drugs cause constipation

A

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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3
Q

What conditions cause constipation

A

IBS, diverticular, hypothyroidism, anaemia

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4
Q

Why Does pregnancy cause constipation

A

Yes
Hormonal changes and baby getting bigger

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5
Q

Constipation red flags

A

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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6
Q

Constipation treatment

A

BOSS

  1. Lifestyle
  2. Bulk forming ( stericulia, isphagula,methyl cellulose, bran)
  3. Osmotic ( macrogol, lactulose)
  4. Stimulant ( senna, bisacodyl, sodium picosulfate, glycerol suppository, co -danthramer)
  5. Softeners (liquid paraffin)
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7
Q

Whats ‘other drugs’ used in chronic constipation in adults

A

Linactolide
Prucalopride
Docusate

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8
Q

Which laxative is both a bulk forming and softener

A

Methyl cellulose

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9
Q

Which laxative is a stimulant and softener

A

Docusate

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10
Q

Bulk forming laxatives MOA

A

increases bulk of stool

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11
Q

Onset of bulk forming laxatives

A

2-3 days

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12
Q

Whys it important to maintain adequate fluids with bulk forming laxatives

A

To prevent intestinal or oesophageal obstruction

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13
Q

Stimulant laxatives MOA

A

Increases intestinal motility

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14
Q

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

A

Co-danthramer
Co- danthrusate

Colour urine red
And its carcinogenicity

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15
Q

Which laxatives colour urine red

A

Co danthramer
Co danthrusate

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16
Q

Which laxative colours urine red/brown

A

Senna

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17
Q

Which laxatives need to be avoided in intestinal obstruction

A

Stimulants and bulk forming

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18
Q

Stimulant laxatives SE

A

Abdominal discomfort, flatulence

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19
Q

Onset of stimulant laxatives

A

6 - 12 hours

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20
Q

Stimulant suppository onset

A

20-60 minutes

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21
Q

Abuse of laxatives can cause which electrolyte imbalance

A

Hypokalaemia

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22
Q

Senna age OTC

A

18+ yrs

Can be sold to 12-17 under pharmacist supervision

23
Q

Can you sell senna to < 12 years

A

No
Needs an RX

24
Q

Whats the max u can sell SENNA OTC

A

Max 2 short treatment courses

25
Q

MHRA updates: AVOID senna in ______

A

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

26
Q

Can you give senna in pregnancy

A

In stable pregnancy if GP allows

27
Q

Faecal softner MOA

A

Softens and wets faeces

28
Q

Faecal softener examples

A

Liquid paraffin

29
Q

Which laxative can cause anal seepage

A

Faecal softener
Mostly docusate

30
Q

What are the 2 types of osmotic laxatives

A

Macrogol 3350

Lactulose

31
Q

Osmotic laxatives MOA

A

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

32
Q

Osmotic laxatives onset

A

2 days for max effect

33
Q

Which osmotic laxative acts faster

A

Macrogol 3350

34
Q

SE of osmotic laxatives

A

Bloating, electrolyte imbalance, abdominal pain

35
Q

Which laxative is also used to treat hepatic encephalopathy

A

Lactulose

36
Q

Management of short duration constipation

A

BOS

  1. Bulk
  2. Osmotic
  3. Stimulant
37
Q

Management of constipation in pregnancy and breastfeeding

A

BOS

  1. Bulk
  2. Osmotic
  3. Stimulant
38
Q

Management of chronic constipation

A

BOS

  1. Bulk
  2. Osmotic
  3. Stimulant
39
Q

Management in faecal impaction

A

OS

  1. Osmotic then add or switch to stimulant
40
Q

Management of constipation in children

A
  1. Osmotic (macrogol 1st)
  2. Stimulant

Lifestyle and macrogol 1st otherwise add or switch to stimulant.
Otherwise switch to lactulose or softener

41
Q

Management of opioid induced constipation

A
  1. Osmotic or docusate + stimulant
  2. Naloxegol or methylnaltrexone bromide (use these in adjunct to existing laxatives in palliative care pts)
42
Q

In chronic constipation which osmotic laxative is preferred

A

Macrogol 3350

43
Q

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

A

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

2-3 hrs before bed

44
Q

Laxative abuse may lead to which electrolyte imbalance

A

Hypokalaemia

45
Q

Arachis oil is an example of which laxative?

What would you ask the patient before giving it them?

A

Softener

Peanut allergy

46
Q

Sodium sulphate and magnesium sulphate are examples of which laxative

A

Osmotic

47
Q

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

A

Osmotic - lactulose, macrogol

48
Q

Which laxative causes malabsorption of vitamins ADEK

A

Faecal softner

49
Q

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

A

Softeners
- docusate
- methyl cellulose
- liquid paraffin

50
Q

Lactulose dose 1-11months

A

2.5ml BD

51
Q

Lactulose dose 1-4 years

A

2.5-10ml BD

52
Q

Lactulose dose 5-17 years

A

5-20ml BD

53
Q

Lactulose dose for adult (18+)

A

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

54
Q

Which electrolyte causes constipation

A

Aluminium

Gastrointestinal (10 decks)

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