Constipation

Question 1

Treatment for constipation begins with

Answer 1

examine patient’s lifestyle & medication regimen (determine the cause)

Question 2

Meds that can cause constipation

Answer 2

1. opiates
2. anticholinergics (eg. tricyclic antidepressant (amitryptiline, diphenhydramine, benztropine, etc).
3. NDHP-CCB (verapamil)
4. oral iron preparations
5. calcium or aluminum antacids
6. NSAIDs
7. clonidine
8. diuretics

Question 3

Constipation +
How do you start the treatment (tx)?

Answer 3

Non-pharmacological interventions first
- diet (fiber)
- exercise
-fluids
-probiotics * limited data

Question 4

Name drug classes used for constipation tx

Answer 4

• bulk-forming agents/osmotics
• emollients
• lubricant laxative
• hyperosmotic
• saline laxatives
• stimulant laxatives

Question 5

bulk-forming agents

Answer 5

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

Question 6

emollients

Answer 6

docusate (Colace)

stool softeners: facilitate mixing of aqueous and fatty materials in the intestinal tract (onset: up to 72hrs)

used for prevention, NOT treatment

Question 7

Which drug class is commonly prescribed with medications known to cause constipation (chronic opiate use, iron supplements)?

Answer 7

emollients (docusate [Colace])

Question 8

lubricant laxatives

Answer 8

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

Question 9

which laxatives are unsafe during pregnancy?

Answer 9

Lubricant laxatives

Castor oil is category X (associated with uterine contractions & rupture)

Question 10

hyperosmotics (recaps) aka osmotics (textbook)

Answer 10

polyethylene glycol aka PEG (MiraLax)

draws water into the intestines

Question 11

saline laxatives

Answer 11

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

Question 12

what ADRs in saline laxatives

Answer 12

fluid and electrolyte imbalance:

Mg (renal dysfunction)
Na (CHF) accumulation

Question 13

stimulant laxatives

Answer 13

senna glycoside (Senokot) & bisacodyl (Dulcoolox)

increases intestines movement thus enhancing motility

-only recommended in intermittent use

Question 14

for slow transit constipation, rx?

Answer 14

-bulk-forming (methylcellulose [Citrucel)
-hyperosmotic laxatives (PEG [MiraLax])
-stimulant laxatives (senna, bisacodyl) and other stimulants are the second line

Question 15

for pts who should avoid straining (hernia, hemorrhoids, MI), rx?

Answer 15

stool softeners (docusate (Colace)
or
hyperosmotics (polyethylene glycol aka PEG (MiraLax)

Question 16

recommendation for children?

Answer 16

• diet, fluid, & exercise
• avoid under 6 years without evaluation

-glycerin suppository, docusate

Question 17

agents that cause softening of feces in 1-3 days

Answer 17

bulk-forming agents
&
emollients

Question 18

agents that result in soft or semifluid stool in 6-12 hrs

Answer 18

stimulant laxatives (bisacodyl & senna)

Question 19

agents that cause watery evacuation in 1-6 hrs or less

Answer 19

magnesium citrate
magnesium hydroxide
magnesium sulface

bisacodyl (rectal)

Question 20

osmotics

Answer 20

lactulose, sorbitol, and glycerine

-cause water to enter the lumen of the colon and may stimulate peristalsis

Question 21

lactulose

Answer 21

acidifies colonic contents, increases water content of the gut, and softens the stool

Question 22

glycerin

Answer 22

causes local irritation and possess hyperosmotic action

Question 23

sorbitol

Answer 23

causes intestinal irritation and may affect blood glucose levels in diabetic patients

Question 24

PEG 3350 (MiraLax)

Answer 24

tx occasional constipation
poop in 1-3 days

kidney disease pts: can take it under physician supervision*

Question 25

PEG 3350 with electrolytes (GoLYTELY, Colyte)

Answer 25

for acute complete bowel evacuation before GI examination

Question 26

when Rx’ing stimulant laxative, which drug class should be avoided & time frame?

Answer 26

antacids (h2-receptor antagonists & PPIs, & milk)

1-2 hours

Question 27

OIC abbr

Answer 27

opioid-induced constipation

Question 28

define constipation

Answer 28

<3 stools per week
or
difficult passage of stools, hard stools, or a feeling of incomplete evacuation

Question 29

for pregnancy?

Answer 29

-diet modification (regular, balanced meals), whole grains, & h20 intake
-bulk-forming laxatives
-emollients
-polyethylene glycol 3350