Constipation

Question 1

List some factor that contribute to constipation

Answer 1

PNS - stimulate motility
SNS - stops motility
GI hormons
Serotonin (IBS)
CNS (emotions)
gastro-colic reflex

Question 2

List some concerns

Answer 2

medication induced
DB
colon cancer
IBS
blood
anal fissure
can’t pass gas
3 days w/o anything

Question 3

Red flags of constipation

Answer 3

> 7 days w/o BM
change in texture
blood
weight loss
decreased habit
change in BM
fever
pain
narrow stools
unresponsive to treatment

Question 4

When to get help?

Answer 4

if stomach pain
blood loss
losing weight w/o trying

Question 5

Non drug measures for C

Answer 5

fluid
exercise
fiber (25 g for women, 38 g for men)
look at diet overall

Question 6

What medications are preventive?

Answer 6

bulk
docusate
PEG350

Question 7

What meds are acute use?

Answer 7

senna
bisacodyl

Question 8

What are worrying signs in elderly?

Answer 8

unexplained weight loss
blood in stool
fever
N, V
family history of colorectal cancer

Question 9

What meds for C can be used in pregnancy?

Answer 9

docusate
PEG350

Question 10

What meds are CI in pregnancy?

Answer 10

senna
bisacodyl
MOM (milk of Mg)

Question 11

What are some meds that can cause C?

Answer 11

opioids
antihistamine (1st gen)
tricyclic antidepressants

Question 12

Example of bulk forming agents

Answer 12

PEG350
psyllium
poly carbophil

Question 13

MOA of bulk forming agents

Answer 13

swell intestinal
create gel to help push it thru
takes a few days
make sure to have with fluids

Question 14

Example of stool softener

Answer 14

docusate

Question 15

MOA of stool softener

Answer 15

anionic surfactant
softens the fecal mass

Question 16

CI with stool softener

Answer 16

mineral oil

Question 17

Examples of lubricant

Answer 17

mineral oil

Question 18

MOA of mineral oil

Answer 18

softens by coating it

Question 19

main problems with mineral oil

Answer 19

anal leakage
lipid penumonia

Question 20

MOA of saline

Answer 20

osmotic
-non-absorbable ions
-remains in the gut
higher osmotic
draws water in

Question 21

Examples of non-saline osmotic

Answer 21

glycerin suppositories

Question 22

MOA of glycerin suppositories

Answer 22

osmotic-local irritant
used with young
within 30 mins

Question 23

MOA of lactulose syrup

Answer 23

colon –> bacteria –> lactic acid –> osmotic pressure –> increase stool volume
works within 1-2 days

Question 24

S/E of Lactulose syrup

Answer 24

gas/bloating

Question 25

MOA of PEG350

Answer 25

preventative therapy
takes a few days (17g)

Question 26

Examples of Stimulants

Answer 26

bisacodyl

Question 27

MOA of stimulants

Answer 27

irrritant to gut lining
onset ~6-12 hrs

Question 28

S/E of bisacodyl

Answer 28

minimally absorbed
diarrhea if too much

Question 29

Microlax enemas

Answer 29

physically and chemically works
mainly used in nursing homes