Constipation

Question 1

Constipation is defined as infrequent defecation, < __ / week, along with other symptoms:______, _______, ______ etc

Answer 1

<3 times per week

straining or painful
hard, lumpy stools
incomplete evacuation
bloating and abdominal discomfort
sense of rectal blockage

Question 2

Primary constipation is classified as the following:
1)
2)
3)

Answer 2

1) Normal Transit (Normal frequency but stool is hard and or difficult to pass)
2) Slow transit (Infrequent BM)
3) Pelvic floor dysfunction (Neurological)

Question 3

Secondary constipation is due to ______, _______ or conditions

Answer 3

medications, diseases

Question 4

Some medical conditions that can lead to constipation:
1)
2)
3)

Answer 4

1) CV disease ( stroke )
2) GI (IBS)
3) Neurological (Parkinsons, spinal cord injury)

Diabetes, thyroid disorders, psychiatric (depression, anxiety)

Question 5

Common risk factors:
1)
2)
3)

Answer 5

1) Female Sex
2) Pregnancy
3) >65

Changes in diet, low socioeconomic status, low fluid or caloric intake, living conditions, sedentary lifestyle, ignoring urge to defecate

Question 6

Some examples of medication causes:

Answer 6

Anticholinergics, Antihistamines, Antidiarrheal drugs, Iron, Opioids, NSAIDs, antidepressants etc

Question 7

RED FLAGS
1)
2)
3)

Answer 7

1) CHILDREN <2
2) CONSTIPATED > 2 WEEKS
3) NO BM 7 DAYS

Blood or mucus in stool, systemic symptoms, symptoms of anemia, family hx of colon cancer, constipation and diarrhea (suggestive of IBS), persistent abdominal pain, severe pain during defacation, recent abdominal surgery, weight loss >5%, abdominal or rectal mass, impaction

Question 8

Examples of non-pharm include:

Answer 8

increase fibre intake (25-38g)
increase fluids (2.2-3L)
encourage regular daily bowel routine
avoid straining
increase physical activity

Question 9

First line non-prescription agents are:

Answer 9

1) Bulk forming (psyllium)
2) Osmotic (PEG3350)

Question 10

Psyllium works by _______ stool fluid content

Answer 10

increasing

Question 11

Psyllium onset is __ - __ days

Answer 11

1-3 days

Question 12

Psyllium is contraindicated in _________

Answer 12

fecal impaction

Question 13

Psyllium must be taken with ____ of ____ to prevent fecal impaction

Answer 13

250 ml of water, avoid esophageal obstruction

Question 14

Main side effect of psyllium =

Answer 14

bloating, space by 2 hr from other meds

Question 15

Osmotic laxatives work by drawing fluid into _______ and stimulate peristalsis

Answer 15

the lumen

Question 16

These two non prescription agents are safe for long term use
1)
2)

Answer 16

Psyllium

PEG

Question 17

The onset of PEG is __ - __ days

Answer 17

2-4

Question 18

_____ is more effective and causes less side effects than lactulose

Answer 18

PEG3350

Question 19

These two osmotic are effective in opioid induced constipation:
1)
2)

Answer 19

PEG

Lactulose

Question 20

The onset of lactulose is __ - __ days

Answer 20

1-2 days

Question 21

Common side effects of lactulose include:

Answer 21

Flatulence, cramps, diarrhea, bloating, nausea

Question 22

Main concern with sorbitol 70% solution is:

Answer 22

bowel necrosis

Question 23

The osmotic laxative with the fastest onset of 15 min to 1 hour is

Answer 23

glycerin suppositories

Question 24

Main concern with osmotic saline laxatives like magnesium citrate, magnesium hydroxide, magnesium sulphate, sodium phosphate enema is that they can cause ________

Answer 24

electrolyte imbalances

Question 25

Avoid osmotic saline laxatives (ex magnesium hydroxide) in patients with _____ / _____

Answer 25

renal failure / cardiac disease

Question 26

Stimulant laxatives have an onset of ___ - ___ hours

Answer 26

6-12 hours

Question 27

Drawback to stimulant laxatives is that they have the potential for _____

Answer 27

dependence

Question 28

Stimulant laxatives, like PEG and lactulose, are effective in ________ constipation

Answer 28

opioid-induced

Question 29

Stimulant laxatives are an option if ______ laxatives are not tolerated/fail

Answer 29

osmotic

Question 30

Of the stimulant laxatives (Senna, bisacodyl, cascara sagrada), ______ has less abdominal discomfort

Answer 30

senna

Question 31

Stool softeners/emollients are generally _______

Answer 31

NOT RECOMMENDED

Question 32

Mineral oil should be avoided due to the risk of ______

Answer 32

aspiration

Question 33

These 3 are examples of prescription agents used in constipation:
1)
2)
3)

Answer 33

1) Prucalopride
2) Methylnatrexone/naloxegol
3) Linaclotide

Question 34

Prucaprolide is used in _____ with chronic idiopathic constipation

Answer 34

WOMEN

Question 35

Methylnaltrexone and naloxegol are used in _________ constipation

Answer 35

opioid-induced, reserved for refractory cases and they are $$$

Question 36

Linaclotide is used for _______ ________ constipation in adults when traditional therapies are ineffective

Answer 36

chronic idiopathic

Question 37

First line treatment in pregnancy and breastfeeding:

Answer 37

Non-pharm therapy

Question 38

If non-pharm treatment does not work in pregnancy or breastfeeding the following class of medication can be used:

Answer 38

bulk-forming agents (psyllium) (not systemically absorbed)

Question 39

The following are contraindicated in pregnancy
1.
2.
3.
4.
5.

Answer 39

mineral oil
castor oil
docusate (breast feeding CI)
linaclotide (breast feeding CI)
prucalopride (breast feeding CI)

Question 40

Over use of stimulants can lead to ______ colon

Answer 40

cathartic

Question 41

Second line for breastfeeding

Answer 41

Magnesium hydroxide (Saline laxative)

Question 42

First line treatment in children with constipation:

Answer 42

PEG3350, Lactulose is 2nd because less effective and causes more bloating and abdominal pain

Question 43

____ and ____ can be used in children when other therapies have failed

Answer 43

Senna and bisacodyl (contraindicated in infants)

Question 44

This treatment is safe and effective, and a good option if PO route is refused/immediate relief is needed in children

Answer 44

glycerin suppository