Constipation

Question 1

What is the normal BM activity?

Answer 1

wide range 2x per week to 3x per day

Question 2

Is constipation a normal part of aging?

Answer 2

NO!

Question 3

What is the causes of constipation?

Answer 3

Disease states
Drug causes
Immobility
Fluids

Question 4

What is a key component of constipation?

Answer 4

Straining

Question 5

What other things should be kept in mind when thinking of constipation?

Answer 5

Medication
Diabetes
Colon cancer
IBS
Depression

Question 6

What are red flags of constipation?

Answer 6

Stool texture change, blood, hemorhoids, weight loss, pain, narrower stools

Question 7

When should someone get help for constipation in terms of time?

Answer 7

Constipation lingers for 3 weeks or changes in bowel habit of more than 2 weeks

Question 8

What does a bowel obstruction usually lead to?

Answer 8

Constipation with very dramatic progression in symptoms

Question 9

Should we increase water in constipation?

Answer 9

no we get lots of water in food

Question 10

What type of fibre should we add?

Answer 10

Soluble and insoluble fibre slowly

5g a day

Question 11

Where is sorbitol located?

Answer 11

In prunes/plums and it has an instant laxative effect

Question 12

What food is a bulk-forming agent non food?

Answer 12

Soluble fibre

Question 13

What is psyllium?

Answer 13

Metamucil

Question 14

What is important with taking psylium

Answer 14

Take it with atleast a cup of water and

if you have diabetes watch for the flavoured agent

Question 15

How does psylium induced obstruction occur?

Answer 15

by not taking the product with enough water

Question 16

What is Senna?

Answer 16

It provides relief of acute constipation with 6-12 hours

Question 17

What does polycarbophil do?

Answer 17

It is a preventative agent for constipation that works in 12-72 hours

Question 18

What in inulin

Answer 18

It is a non thickening agent that can be added to food or fluid

Question 19

When is psylium become effective?

Answer 19

12-72 hours post taking it

Question 20

What is Stool softener?

Answer 20

added to other laxatives and preventative measures

Question 21

What is docusate?

Answer 21

not entirely effective

Question 22

Why is mineral oil not really indicated for constipation?

Answer 22

Can cause anal seepage

Question 23

How long does mineral oil take to work?

Answer 23

6-8 hours, taken very enema works very quick though

Question 24

What does Saline do?

Answer 24

Draws water into the gut

Question 25

What dose of magnesium is required for a laxative effect?

Answer 25

~250mg

Question 26

What are osmotic laxatives use carefully in?

Answer 26

Those with chonic renal or congestive heart failure

Question 27

How fast does Fleet work? (Enema)

Answer 27

2-5 minutes

Question 28

How long does Phillips take to work?

Answer 28

Overnight

Question 29

What are glycerin suppositories especially good in?

Answer 29

infants and young children because it causes a bowel evac within 30 minutes

Question 30

How long does lactulose syrup take to take effect?

Answer 30

1-2 days

Question 31

What is the common side effects of lactulose syrup?

Answer 31

gas/bloating

Question 32

What is PEG 3350?

Answer 32

Miralax or Restoralax

Question 33

What is Peg 3350 used?

Answer 33

Preventative therapy.

Question 34

What is the dosing of Peg 3350?

Answer 34

Capful (17g) then titrate every 2-3 days until mushy stool consistency

Question 35

What are stimulants?

Answer 35

Phenolphthalein (ExLax)

Question 36

How long does stimulants take to work?

Answer 36

6-12 hours

Question 37

What is the MOA of stimulants?

Answer 37

irritant to gut linings

Question 38

What are side effects of bisacodyl and senna?

Answer 38

minimally absorbed, but can lead to diarrhea, Stimulants

Question 39

What are the stimulants Senokat dosing?

Answer 39

Extra strength= 1-2 tabs OD BID at night Normal Strength = 2-4 tabs OD-BID at night

Question 40

What is the dosage of Dulcolax?

Answer 40

Suppository, Once a day Oral = 1-2 tabs daily

Question 41

Onset of senokat?

Answer 41

6-12 hours

Question 42

Onset of dulcolax (bisacodyl)

Answer 42

Supp = 15-60 minutes Oral= 6-12 hours

Question 43

How much senna does one usually start with?

Answer 43

8mg then titrate up

Question 44

How do you take Senna when on T-3?

Answer 44

T3 late in day 8mg first night T3 in AM 16mg first night

Question 45

What is the onset of senna combo with docusate

Answer 45

Senna 6-8 hours, Docusate = 3 days

Question 46

What is the rate of microlax enemas

Answer 46

5ml dose evacuation in 5-20 minutes Used in nursing home commonly

Question 47

What is Colyte

Answer 47

Pre-colonoscopy drink 240ml every 10 minutes to 4L BM in 1 hour

Question 48

What is lubiprostone used for?

Answer 48

IBS-C more so. helps with opioid induced constipation

Question 49

How can we prevent constipation in elderly?

Answer 49

Bulk forming agents, docusate, peg 3350

Question 50

How can we address the acute needs of constipation?

Answer 50

Senna, Bisacodyl

Question 51

What is a key factor to consider with constipation

Answer 51

Is when someone has a significant decrease in frequency of bowel movements

Question 52

What is a normal BM for infants

Answer 52

1bm per each feed to 1 per week

Question 53

Common causes of pediatrics constipation

Answer 53

Starting solid food Low fluids

Question 54

How many BM do breastfed babies have?

Answer 54

once every 7-10 days

Question 55

How often does a formula fed babies have a BM?

Answer 55

2 a day

Question 56

How can we stimulate paediatric BM?

Answer 56

MD Rectal stimulation with Qtip and vaseline Glycerin suppository

Question 57

What are common causes of child constipation?

Answer 57

Too busy to poop Dietary issues Toilet training issues

Question 58

What is the youngest age that we can recommend an enema?

Answer 58

2 yo

Question 59

How much PEG 330 should a child be given?

Answer 59

1/2 capful, but its not for kids unless MD

Question 60

What is very common treatment for pregnancy?

Answer 60

Docusate Peg 3350 Psyllium

Question 61

What is not necessarily first line for pregnancy due to CI

Answer 61

MOM, Senna, Bisacodyl