Constipation Flashcards
Treatment for constipation begins with
examine patient’s lifestyle & medication regimen (determine the cause)
Meds that can cause constipation
- opiates
- anticholinergics (eg. tricyclic antidepressant (amitryptiline, diphenhydramine, benztropine, etc).
- NDHP-CCB (verapamil)
- oral iron preparations
- calcium or aluminum antacids
- NSAIDs
- clonidine
- diuretics
Constipation +
How do you start the treatment (tx)?
Non-pharmacological interventions first
- diet (fiber)
- exercise
-fluids
-probiotics * limited data
Name drug classes used for constipation tx
- bulk-forming agents/osmotics
- emollients
- lubricant laxative
- hyperosmotic
- saline laxatives
- stimulant laxatives
bulk-forming agents
methylcellulose (Citrucel)
fiber supplements
-act by swelling in intestinal fluid, forming a gel that aids in fecal elimination and promoting peristalsis
-administer 240mL of h20 w/ each dose to prevent esophageal/GI obstruction and worsening symptom
-physical binding of other substances, including meds
emollients
docusate (Colace)
stool softeners: facilitate mixing of aqueous and fatty materials in the intestinal tract (onset: up to 72hrs)
used for prevention, NOT treatment
Which drug class is commonly prescribed with medications known to cause constipation (chronic opiate use, iron supplements)?
emollients (docusate [Colace])
lubricant laxatives
mineral oil/castor oil
-coat the stool, allowing it to be expelled more easily; oily film prevents the stool from losing water to the intestinal reabsorption process
-systemic absorption (can generate immune response)
-aspiration (may lead to lipoid pneumonia)
-decreases absorption of fat-soluble vitamins
which laxatives are unsafe during pregnancy?
Lubricant laxatives
Castor oil is category X (associated with uterine contractions & rupture)
hyperosmotics (recaps) aka osmotics (textbook)
polyethylene glycol aka PEG (MiraLax)
draws water into the intestines
saline laxatives
Magnesium citrate
composed of relatively poorly absorbed ions (Mg+ sulfate, -phosphate, - citrate) (eg. MOM*
-osmotic effects to retain fluid in GI tract
-may be used occasionally to treat constipation in otherwise healthy adults
what ADRs in saline laxatives
fluid and electrolyte imbalance:
Mg (renal dysfunction)
Na (CHF) accumulation
stimulant laxatives
senna glycoside (Senokot) & bisacodyl (Dulcoolox)
increases intestines movement thus enhancing motility
-only recommended in intermittent use
for slow transit constipation, rx?
-bulk-forming (methylcellulose [Citrucel)
-hyperosmotic laxatives (PEG [MiraLax])
-stimulant laxatives (senna, bisacodyl) and other stimulants are the second line
for pts who should avoid straining (hernia, hemorrhoids, MI), rx?
stool softeners (docusate (Colace)
or
hyperosmotics (polyethylene glycol aka PEG (MiraLax)
recommendation for children?
- diet, fluid, & exercise
- avoid under 6 years without evaluation
-glycerin suppository, docusate
agents that cause softening of feces in 1-3 days
bulk-forming agents
&
emollients
agents that result in soft or semifluid stool in 6-12 hrs
stimulant laxatives (bisacodyl & senna)
agents that cause watery evacuation in 1-6 hrs or less
magnesium citrate
magnesium hydroxide
magnesium sulface
bisacodyl (rectal)
osmotics
lactulose, sorbitol, and glycerine
-cause water to enter the lumen of the colon and may stimulate peristalsis
lactulose
acidifies colonic contents, increases water content of the gut, and softens the stool
glycerin
causes local irritation and possess hyperosmotic action
sorbitol
causes intestinal irritation and may affect blood glucose levels in diabetic patients
PEG 3350 (MiraLax)
tx occasional constipation
poop in 1-3 days
kidney disease pts: can take it under physician supervision*
