Constipation

Question 1

What is the appropriate treatment for constipation?

Answer 1

Laxatives, propulsives and prokinetics

Question 2

What are the three bulk forming agents?

Answer 2

Ispaghula husk (psylilium), sterculia, methylcellulose

Question 3

What class of laxatives does this MOA describe? absorb fluid from GIT to form soft bulky stool and promote peristalsis

Answer 3

Bulk-forming agents

Question 4

T or F: The indication for bulk forming agents is short term Tx of constipation

Answer 4

False. They are indicated for the long term prophylaxis and Tx of constipation, IBS-C and diverticular disease

Question 5

What are the A/E of bulk-forming agents?

Answer 5

Abd. distension, cramps, flatulence

Question 6

Caution with bulk-forming agents?

Answer 6

other meds should be taken 3 hours before or after; adequate fluid intake advised to avoid intestinal compaction

Question 7

What are the different types of osmotic agents?

Answer 7

MgSO4, Mg(OH)2, lactulose, polyethelene glycol (PEG), glycerine, sodium phosphate, sorbitol

Question 8

What is MOA of osmotic agents?

Answer 8

Draw water and electrolytes into the bowel visa osmotic action to increase water retention in stool and increase stool frequency (stimulate peristalsis)

Question 9

When are osmotic agents Indicated?

Answer 9

acute and chronic constipation, bowel prep

Question 10

Are there specific indications for lactulose?

Answer 10

Acute/chronic constipation, hepatic encephalopathy

Question 11

T or F: the cautions for lactulose are headaches?

Answer 11

False, Cautions are pregnancy and lactation

Question 12

When is lactulose CI?

Answer 12

galactosaemia, warfarin

Question 13

What are the AE of lactulose?

Answer 13

flatulence, abd distention & cramping

Question 14

What are the specific indications of polyethylene glycol (PEG)?

Answer 14

acute constipation, bowel prep

Question 15

T or F: the C of PEG include, pts over 60 and unconcious pts

Answer 15

True

Question 16

When is PEG CI?

Answer 16

GI obstruction, bowel perforation, toxic megacolon

Question 17

What is the onset of action for PEG?

Answer 17

24-96 hrs

Question 18

AE of PEG?

Answer 18

flatulence, abd distension & cramping, ulceration, ischaemic colitis

Question 19

What is the indication for Magnesium salts?

Answer 19

Rapid bowel evacuation

Question 20

Cautions for magnesium salts?

Answer 20

hypermagnessaemia, renal insufficiency

Question 21

When is magnesium salts CI?

Answer 21

intestinal obstruction/perforation, undiagnosed abd pain, existing electrolyte imbalance, myocardial damage

Question 22

T or F: the AE of Magnesium salts include electrolyte imbalance and abd cramps

Answer 22

True

Question 23

T or F: specific indication of Sodium Phosphate include pre operative, radiography and endoscopic bowel evacuation

Answer 23

True

Question 24

What are the cautions associated with sodium phosphate?

Answer 24

risk of phosphate nephropathy, severe dehydration, heart failure

Question 25

The CI for Sodium phosphate is undiagnosed abd distension. T or F?

Answer 25

False. Sodium phosphate is CI in bowel obstruction/perforation

Question 26

What are the AE of sodium phosphate?

Answer 26

electrolyte imbalance, bloating, nausea, abd pain

Question 27

What drugs are stimulant laxatives?

Answer 27

Bisacodyl, Senna, Sodium picosulphate, Castor Oil

Question 28

What is the MOA of Bisacodyl?

Answer 28

direct stimulation of intestinal SM, colonic intramural plexus. They increase peristalsis. They also increase intestinal fluid accumulation by altering water and electrolyte secretion

Question 29

What is the onset of action of Bisacodyl?

Answer 29

6-8hrs

Question 30

Digoxin is the only DI for Bisacodyl. T or F

Answer 30

True

Question 31

CI for Bisacodyl are intestinal obstruction and abd pain. T or F

Answer 31

True

Question 32

What is the I for Bisacordyl?

Answer 32

Tx of short term constipation- cannot be used long term

Question 33

What is the MOA of Senna?

Answer 33

direst stimulation of intestinal SM, increases GI motility and increase accumulation of water and electrolytes in bowel lumen

Question 34

What is the onset of action of Senna?

Answer 34

6-8hrs

Question 35

What are the I for Senna?

Answer 35

acute constipation and bowel prep

Question 36

DI of Senna?

Answer 36

Digoxin

Question 37

The CI of Senna are GI obstruction and IBD. T or F?

Answer 37

True

Question 38

What are the AE of Senna?

Answer 38

abd pain, excessive bowel activity, hypokalemia, dehydration

Question 39

What is the MOA for Sodium picosulfate?

Answer 39

It is the active metabolite of bisacodyl. It is metabolised by colonic bacteriaand will increase GI motility and increase the accumulation of water and electrolytes in the bowel lumen

Question 40

What is the onset of action of sodium picosulfate?

Answer 40

6-12hrs

Question 41

When is sodium picosulfate indicated?

Answer 41

sereve constipation and bowel prep

Question 42

The CI of sodium picosulfate include: GI obstruction, toxic colitis, GI perforation, appemdicitus. T or F?

Answer 42

True

Question 43

What are the AE of sodium picosulfate?

Answer 43

Abd cramps, hypocalcaemia, hypokalemia

Question 44

What is the MOA of castor oil?

Answer 44

It is hydrolysed to ricinoleic acid by lipase enzymes in the GIT. Ricinoleic acid acts as a surfactant and increases water absorption by stools (faecal softening). Rcinoleic acid also stimulates peristalsis

Question 45

T or F: the onset of action of castor oil is 12 hrs?

Answer 45

False. It is 2-6hrs

Question 46

What are the indications for castor oil?

Answer 46

acute constipation, colonic evacuation

Question 47

CI for castor oil are: GI obstruction/perforation, appendicitus and what else?

Answer 47

Ulcerative colitis

Question 48

What are the AE of castor oil?

Answer 48

Abd cramps, electrolyte disturbances, hypotension

Question 49

What are the different lubricant laxatives?

Answer 49

Liquid paraffin, mineral oil, glycerine

Question 50

T or F: the MOA of all lubricant laxatives is: lubricate the intestine by decreasing water absorption from colon to allow for easy passage of stool

Answer 50

True

Question 51

When are lubricant laxatives indicated?

Answer 51

Acute constipation

Question 52

The onset of action for lubricant laxatives is 6-8hrs. T or F?

Answer 52

True

Question 53

When are liquid laxatives CI?

Answer 53

Abd pain, appendicitis, GI obstruction/perforation, UC

Question 54

What are the AE of lubricant laxatives?

Answer 54

Abd cramps, intestinal malabsorption, liquid pneumonitis

Question 55

What class of laxative is Docusate sodium?

Answer 55

It is a stool softener (surfactant laxative)

Question 56

What is the MOA of Ducosate sodium?

Answer 56

lowers surface tension and increase water absorption by stool (stool softening)

Question 57

T or F: Ducosate Sodium is indicated for vomiting?

Answer 57

False. It is indicated for acute/chronic constipation

Question 58

T or F: Ducosate Sodium has a rapid onset of action

Answer 58

False. Onset is 24-72hrs

Question 59

What are the AE of Ducosate Sodium?

Answer 59

Abd cramps, excessive bowel activity, throat irritation

Question 60

What drug class do these drugs belong to? Linaclotide, Prucalopride, Lubiprostone

Answer 60

Propulsives (prokinetics)

Question 61

What is the MOA of Linaclotide?

Answer 61

Increase cGMP concentrations in the gut to increase fluid secretions and intestinal transit

Question 62

When is Linaclotide indicated?

Answer 62

IBS-C, chronic idiopathic constipation

Question 63

Linaclotide is safe for all ages. T or F?

Answer 63

False. CI if <6 yrs and GI obstruction

Question 64

AE of Linaclotide?

Answer 64

Abd pain, severe diarrhoea

Question 65

What is the MOA of Prucalopride?

Answer 65

selective serotonin agonist, elicits GI prokinetic action, colonic peristalsis (increase GI motility

Question 66

When is Prucalopride indicated?

Answer 66

chronic ideopathic constipation

Question 67

When is Prucalopride CI?

Answer 67

GI obstruction, IBD

Question 68

What are the AE of prucalopride?

Answer 68

Abd pain, headache, anxiety

Question 69

What is the MOA of Lubiprostone?

Answer 69

Acts on chloride channels to increase intestinal fluid secretion and motility

Question 70

When is Lubiprostone indicated?

Answer 70

chronic ideopathic constipation, opioid-induced constipation, IBS-C

Question 71

What are the CI of Lubiprostone?

Answer 71

GI obstruction, IBD

Question 72

The AE of Lubiprostone are the same as Prucalopride. T or F?

Answer 72

True. (abd pain, headache, anxiety

Question 73

What are other examples of prokinetics?

Answer 73

Domperidone and metocloprimide. They prevent upward peristalsis and promote downward peristalsis (used as antiemitics)