Constipation

Question 1

Symptoms

Answer 1

Infrequent stools, difficulty passing stools, incomplete emptying

Question 2

What do nice say on constipation

Answer 2

Less 3 times a week

Question 3

Extended symptoms

Answer 3

Lower abd pain
Bloating
Excess straining

Question 4

Lifestyle

Answer 4

No alcohol, increase fibre, exercise, water toilet routine. Feet on stool

Question 5

ALARM symptoms (new)

Answer 5

New symptoms Age over 50 , blood in stools, anaemia , weight loss ,abdominal pain, fever

Question 6

1st line constipation

Answer 6

Non pharmacological measures

Question 7

2nd line + example +MOA +S/e

Answer 7

Bulk (ispaghula, sterculia, methylcellulose)
MOA= increase faecal mass stimulate peristalsis work fully in 2-3 days (72hrs)

S/e bloating, Cramps, flatulence, gut obstruction - avoided by drinking plenty water

Question 8

Counselling bulk

Answer 8

• adequate amount of water avoid gut oBstructuon
• swallow plenty of wa term and avoid at night

Question 9

Warning in ispaghula husk

Answer 9

potent allergen = hypersensitivity

Question 10

Osmotic laxative example, MOA , S/E

Answer 10

Macrogol 3350, llactulose, MGOH
3rd line - can add to bulk to soften stool or just alone

MOA increase water in colon by drawing water from body or from the water it’s drank
Macrogol - sequesters fluid
Lactulose - cause osmotic diarrhoea off low faecal ph
Works in 2-3 days 72hr, 48hrs for lactulose

S/e discomfort, flatulence, nausea When start lactulose so tske with orange juice, water or meals

Question 11

MOA/ side effect stimulant

Answer 11

Works by increase gut motility by irritating the gut lining
Glycerol works 15-30 mins
Others take 6-12hrs

S/e cramps, colours urine yellow -ubrown, Excessive use = diarrhoea, lazy bowel , hypokalaemiaty

Question 12

Osmotic lax macrogol PEG and starch thickened foodds

Answer 12

Don’t use as increases risk of aspiration by dysphagia

Question 13

Stimulant laxative how long can use and why used

Answer 13

Short term use 1 week - 4th line and used to help stools pass that are already soft

Question 14

Examples of stimulant

Answer 14

Senna , bisacodyl, glycerol , docusste, sodium picosulfate

Question 15

Counselling point stumulant

Answer 15

Take at night so first pass in morning
Wet glycerol suppository before use

Question 16

Co-dantramer or co-dantrusate

Answer 16

These are stimulant laxative that are genotoxic and carcinogenic

Question 17

S/e of co-danthramer and danthrusate

Answer 17

1)carcinogenic used in terminally ill agent
2) colours urine red
3) local irritation and excoriation avoid prolonged skin contact

Question 18

Other laxatives with faecal softening properties

Answer 18

1) methylcellulose= bulk
2)docusate (weak stimulant)
3)glycerol Rectal stimukant)

Question 19

Example of faecal softener main and why not reccmoned

Answer 19

Liquid paraffin
S/e anal seepage, lipoid pneumonia, granulamtous of gi

2) causes malabsorption of fat soluble fits ADEK

Question 20

5HT4 antagonists example and when to use

Answer 20

If 2 diff classes of laxative have been tried at highest tolerated doses for at least 6 months = 5ht receptor antagonists

Prucalopride (women only)
Lubiprostone