Constipation Flashcards
mouth to anus transit time is normally ___ hours
* up to ___ may still be considered normal
30-40 hours
* 72 hours
acute constipation:
less than ___ bowel movements/week
3
chronic constipation:
symptoms lasting longer than ___ weeks
* may respond to laxatives but returns after they are stopped
6 weeks
disease states that slow down GI motility
- diabetes
- Parkinson’s
- CNS injury or disease
- MS
Common Drug Causes of Constipation
- opioids - __ receptor agonist in GI tract, slows everything down
- NSAIDs - inhibition of prostaglandins. ___ series play a significant role in ___ and fluid ___
- antacids containing ___ and ___.
- drugs with strong ___ properties
- Verapamil, clonidine, Ca channel blockers
- ___ preparations
- dramatic dose increase in ___
- mu
- E, motility, movement
- Ca, Al
- anticholinergic
- Iron
- diuretics
T or F: as much fiber as possible should be added to the diet quickly
False; want to add fiber slowly ober 7-10 days to minimize gas
Prunes have a high [ ] of simple sugars like ___ , ___ g of fiber, and a natural laxative called ___
sorbitol, 12 g, dihydrophenylsatin
T or F: kiwi is a good alternative to prunes bc you wont toot as much
True;
when is colonic activity the greatest
- first thing in the morning
- within 30 minutes after meals
Bulk laxatives
psyllium - ___
methylcellulose - ___
calcium polycarbophil - ___
MOA: forms gels which retain ___, swells, and stimulates a BM
- Metamucil
- Cirucel
- Fibercon
water
T or F: bulk laxatives soften stool better than docusate
True
Disadvantage of Bulk Laxatives
* __ formation
* impacts drug ___
- gas
- absorption
use cold water to decrease gas
Surfactant/Emollient
Docusate
* Dose: 100 mg once or twice daily
* MOA: decreases fecal ___ (stool softener)
* not effective for ___ constipation, mostly preventitive
- surface tension
- active
Lubricant
mineral oil
MOA: lubricates lumen of the ___
* only effective for ___
* may decrease absorption of ___ vitamins
colon
* prevention
* fat soluble
Saline Laxatives
Examples: Milk of Magnesia, Fleet, and Mg citrate
MOA: draws fluid into the colon to stimulate motility
* ___ onset
* used for ___ management
* avoid in ___ patients
- quick
- acute
- renal
Hyperosmotic agents
- excellent for ___ constipation
- softens while stimulating BM
chronic
Hyperosmotic agents
glycerin suppositories
* ___ onset
quick
Hyperosmotic agents
PEG 3350 - ____
* onset: ___
MiraLAX
1-3 days
Stimulant Laxatives
Senna: 2 tabs 1-2x daily
Bisacodyl: 1-2 tabs daily
* ___ coated
* MOA: locally stimates ___ nerves to produce __ and mobility; also increased fluid and Na secretion into the lumen
- enteric
- enteric, contractions
Stimulant Laxatives
Advantages:
* ___ hr onset
* works for patients with ___ disorders
* drug of choice for ___
Disadvantages:
* avoid ___ term continuous use in patients with normal GI motility
- 6-12 hr
- motility
- opioid induced constipation
Stimulant Laxatives
Bisacodyl ___
10 mg PR
___ onset
suppositories
quick
Chloride Channel Acitvators
- activates chloride channels in ___ resulting in ___ influx which increases fluid movement into intestinal lumen
- negative goes through channel, positive follows to balance, brings its BFF water with it
- Small intestine
- Na
Chloride Channel Activator
Lubiprostone ( ___ )
Indicaions: chronic ___ consitpation IBS-C, ___ with chronic, non-cancer pain
* Dose: 24 mcg ___ with food + water
* avoid in ___
* reserved for patients who do not respond or tolerate other laxatives
Amitiza
* idiopathic, OIC
* BID
* pregnancy
Guanylate Cyclase-C receptor activator
Linaclotide ( ___ )
* increases chloride and ___ secretions into the lumen and inhibits ___ absorption
* indicated for ___
* Dose: ___ mcg once daily
* take 30 min before 1st meal of the day
* 72 mcg appears as effective with less diarrhea
* $$$
Linzess
* bicarbonate
* sodium
* CIC
* 145 mcg
Guanylate Cyclase-C receptor activator
Plecanatide ( ___ )
Dose: ___ mg once daily
may be administered at any time of day, with or without food
Trulance
3 mg
Chronic constipation treatment tiers
- relieve acute constipation with ___ modifications
- ___ forming laxatives and fluids
- PEG, lactulose, sorbitol
- short term use of ___
- lubiprostone, linaclotide, prucalopride, plecanatide
- dietary
- bulk
- stimulants
Special Populations
spinal cord injury pts:
* routine use of ___
* usually ___ form
- stimulants
- suppository
Special Populations
pregnancy
* diet, fiber, ___
* ___ in more severe cases
- docusate
- senna
Special Populations
diabetics
* prokinetic agents: ___ and ___
* stimulants
metoclopramide
prucalopride
patients on opioids
* stimulants
* then add __, lactulose, or ___ prn
* avoid ___ laxatives
* opioid receptor ___ when other treatment doesnt work
- docusate, PEG
- bulk
- antagonists
T or F: bulk laxatives are first line therapy for patients on opioids
FALSE; avoid bulk laxatives
Special Populations
patients on opioids
* methylnaltrexone ( ___ )
* mu opioids receptor ___
* dose based on ___
* 8-12 mg ___ every ___ day
* expect a BM within ___ minutes
* $$$
- Relistor
- antagonist
- weight
- SC, other
- 30 min
Special Populations
patients on opioids
* Naloxegol ( ___ )
* mu opioid receptor ___
* 25 mg __ once daily
* 1 hr prior to first ___ or 2 hrs after
* needs to be taken on a ___ stomach
* high ___ meal increases rate of ___
* tablet can be ___
* $$$
- Movantik
- antagonist
- PO
- meal
- empty
- fat, absorption
- crushed
Prep for colonoscopy
PEG
* 2-4 L
* drink 8 oz q ___
* refrigerate
10 minutes
Prep for colonoscopy
prior day to procedure, “enjoy ___ all day”
* mix 1 bottle of ___ into 2 bottles of gatorade (cannot do red flavor)
* drink extra 8 oz of clear fluid every hour
* take ___ 5 mg bisacodyl tabs at noon
* at 2 pm, begin drinking gatorade solution, 8 oz q 10-20 minutes over an ___.
* Wait ___ minutes, then drink 2nd bottle
clear liquids
* Miralax
* 4 x
* hour
* 30 minutes
