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OTC II > Constipation > Flashcards

Constipation Flashcards

1
Q

Exclusion from Self-treatment

A

-marked abdominal pain, flatulence
-N/V/D, fever
-chronic condition precluding laxatives (tetraplegia, inflammatory bowel disease, colostomy)
-blood in stool
-anorexia
-under 2 y
-bowel symptoms for more than 2 weeks or recurring in a period of 3 months
-inflammatory bowel disease

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2
Q

Potential cause of Constipation

A

-inability to relax the sphincter
-no signal to relax the sphincter
-swollen rectum

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3
Q

Where does stool emptying occur under normal conditions?

A

-Sigmoid colon
-with medication also emptying of the descending and transversal colon

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4
Q

How is the defecation process initiated?

A

-Peristaltic movement -> signal to the defecation center in the spinal cord

-sphincter relaxes, abdominal pressure incerases

-voluntary relaxation of the external anal sphincter

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5
Q

Signs of constipation

A

-frequency of bowel movement has changed
-hard stool
-lassitude, anorexia, low back pain
-abdominal discomfort, distention (Dehnung)

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6
Q

What is the “normal” frequency range of bowel movement?

A

3x a day to 3x a week
number of BM is not enough to define constipation

-IMPORTANT: know the normal frequency of the patient

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7
Q

Sequelaes of Constipation

A

-Hemorrhoids
-Cardiovascular problems
-Cardiac rhythm disturbance
-Blood presseure surges
-rectal prolapse

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8
Q

What is the recommended daily intake of fluids and fiber?

A

-2L of fluid
-14 g per 1000 calories of fiber
Fiber: vegetables, fruits

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9
Q

Fiber vs. Pre-biotic

A

-Pre-biotic: is the Fiber provided to Pro-biotics
f.e. Fiber supplement with Probiotics

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10
Q

How should a patient increase their amount in fiber intake?

A

Slowly over a period of weeks, too much fiber may cause other side effects

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11
Q

What is Encopresis?

A

-often in children -> spots in the underwear
-overstretched rectum -> loss of urge to poo

-first BM is stuck and dries out, the feces behind is liquid and leaks

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12
Q

What is the first line medication to treat constipation?

A

-Bulk-forming laxative
-FiberCon

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13
Q

MOA Bulk-forming laxatives

A

-dissolves in the intestinal fluid -> increases bulk in the stool, needs sufficient fluid -> facilitates the passage of intestinal content

-Stimulate peristalsis

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14
Q

What type of patients are appropriate to use FibCon Bulkf-forming laxatives?

A

-patients who cannot add fiber to the die
-postpartum women (after childbirth)
-older patients
-patients with colostomy (created passage for BM), IBS, diverticular (digestive) disease

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15
Q

Onset of Bulk-forming laxatives

A

12 to 24 hours ->may take as long as 72 hours

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16
Q

What are the side effects of Bulkf-forming laxatives?

A

-Abdominal cramping and flatulence
-Esophageal obstruction
-Acute bronchospasm (inhalation of hydrophilic material)

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17
Q

What patient population would not be appropriate to treat with bulk-forming laxatives?

A

-Heart failure patients are restricted to increased fluid intake to preserve the heart

-children (there are better options)

-DDI: oral tetracyclines - separate by 2 hours

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18
Q

Precautions Bulk-forming laxatives

A

-Patients at risk for hypercalcemia (HIV, elderly, malignancy, or renal disease -> avoid calcium polycarbophil

-Diabetic patients - some products contain dextrose
-Phenylketonurics - avoid sugar-free agents, bc they contain aspartame

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19
Q

MOA of Emollients

A

Anionic surfactant -> increases wetting efficiency of intestinal fluid
-> facilitates mixing of aqueous and fatty contents to soften the stool

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20
Q

Onset of Emollients

A

24 to 72 hours (can take up to 3-5 days)

needs to be taken every day for chronic patients, PRN will not be efficient

21
Q

When is Emollients appropriate to use?

A

-For prevention rather than treatment
-prevents painful defecation and straining

-for colostomy patients with constipation

22
Q

Side Effects and Precautions

A

-diarrhea and cramping
-Overdoses can cause weakness, sweating, muscle cramps, and irregular heartbeat

Precaution:
-increases the absorption of mineral oil -> toxicity
-Do not use if nausea, vomiting, signs of appendicitis, or undetermined abdominal pain

23
Q

MOA Lubricant agents

A

-Mineral Oil
-Oral or rectal
-coating the fecal and preventing the absorption of water in the colon

24
Q

Onset Lubricant agents

A

Oral: 6-8 hours
Rectal: 5-15 minutes

25
Q

Precautions of Lubricant agents

A

-should be avoided - bc of side effects
-not in children under 6y
-can cause loss of fat-soluble nutrients (Vit A, D, E, K?)
-can be aspirated -> lipid pneumonia
-reduces the absorption of coagulants, contraceptives, and digitalis (treats heart failure)

26
Q

MOA Saline laxatives

A

-Non-absorbalbe cations and anions
-draws water into the intestine -> increases intraluminal pressure
-exerts mechanical stimulus

27
Q

Which patient population is NOT appropriate for Saline laxatives?

A

-Patients with chronic constipation
-great for relief, not prevention

-pt under 2y
-pt with renal impairment -> frequent intake of magnesium products leads to hypermagnesemia -> hypotension, muscle weakness

28
Q

Onset of Saline laxatives

A

Oral: 30 minutes to 3 hours
Rectal: 2-5 minutes (ER room)

-for acute evacuation

29
Q

DDI of Saline laxatives

A

-anticoagulants, digitalis, phenothiazines, tetracyclines

30
Q

Contraindication of Saline laxatives

A

-patients with ileostomy or colostomy, dehydration
syndromes, renal impairment, and CHF

-patients on sodium restrictions and patients that
cannot tolerate fluid loss

-(Fleet’s Phospho-soda: without adequate hydration -> acute kidney injury when used as a bowel
prep

31
Q

Hyperosmotic Agents

A

-Glycerin
-MiraLAX: PEG (Polyethylene glycol) 3350 w/o electrolytes

32
Q

Glycerin

A

-Osmotic irritant effects, drawing water into the rectum to stimulate a bowel movement
(Saline laxatives also draw water into the intestine)

Adults can use suppositories, children should use liquids

caution in pt with previous rectal irritation

-Onset: 15 minutes

33
Q

Onset of PEG 3350

A

-poorly absorbed ethylene glycol molecules create an osmotic effect
-17 grams mixed in 4-8 ounces of clear liquid
-produce a bowel movement in up to 3 days

34
Q

Side effects PEG 3350

A

-bloating, abdominal discomfort, cramping and flatulence
-high doses cause diarrhea

35
Q

Stimulant laxatives drugs

A

Anthraquinones and diphenylmethanes

36
Q

MOA Stimulant

A

-action on the intramural nerve plexus of the
smooth muscle -> local irritation of the
mucosa
-> increases propulsive peristalsis

37
Q

Which side effect is especially associated with stimulants?

A

Crampings throughout the whole large intestine

38
Q

Why do Anthraquinones mostly work in the colon?

A

-minimally absorbed -> limited to the colon
-Aloe, casanthranol, senna, rhubarb
-> Only Senna is recommended

39
Q

Onset and MOA of Anthraquinones

A

-Onset: 6-12 hours
-Inhibit water and electrolyte absorption from the large intestine
-> Increases intestine volume and pressure to colonic motility

40
Q

Diphenylmethanes MOA

A

-Bisacodyl
Tablets: hours; Rectal: Minutes
-contact with the mucosal nerve plexus on the colon
->Producing segmental and axonal contractions of the entire colon

-Onset 15 minutes

41
Q

Castor oil

A

-Classified as a stimulant or anionic surfactant (Emollient)

-prolonged use -> excessive loss of fluid, electrolytes, and nutrients

42
Q

Why can prolonged use of Castor oil cause excessive loss of nutrients?

A

-Because its site of action is the small intestine (absorption of nutrients)

43
Q

Side effects of Stimulants

A

-Severe cramping
-Electrolyte and fluid deficiencies
-Enteric loss of protein
-Malabsorption (excessive hypermotility)
-Hypokalemia
-Colic
-Increased mucous secretions

44
Q

Council on patients about Stimulative laxatives

A

-reversible pigmentation of the colonic mucosa
-can change the color of the urine
metabolic acidosis or alkalosis, hypocalcemia, tetany, loss of enteric protein, and malabsorption

45
Q

Combination of products

A

-When indicated: senna and docusate
-other combis are NOT recommended unless they are part of colon prep

46
Q

Which patient population might use combinations of laxatives?

A

-Patients with chronic diseases
-patients taking opioids

47
Q

Product selection

A

First line: bulk-forming laxatives
Second line: PEG 3350
Third line: stimulant (Cations, anions - Mg citrate; Senna)

48
Q

How to treat patients who seek fast relief?

A

Lubricant agents: 5-15 min
Saline laxatives (rectal): 2-5 min
Diphenylmethanes (Bisacodyl -rectal): minutes

In the next hours:
Saline Laxatives - Oral: 30 minutes to 3 hours
Lubricant agents - Oral: 6-8 hours
Anthraquinones (Stimulant): 6-12 hours

49
Q

Laxatives with relief in days

A

Bulk-forming laxatives: 12-72 hours (up to 3 days)
Emollients: 24-72 hours (1-3 days)

OTC II (17 decks)

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