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OTC Exam 3 > Constipation > Flashcards

Constipation Flashcards

1
Q

Who is affected?

A
  • Affects 2-27% of American pop (underestimated)

* Women, elderly, and children = highest risk

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2
Q

Definition

A

3 or less stools/week

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3
Q

May lead to?

A

Hypertension, Arrhythmias, Rectal Prolapse, Hemarrhoids

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4
Q

Caused by which medical conditions?

A
  • IBS
  • Anal ulcers
  • Anal fissures
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5
Q

Caused by which meds?

A
  • Ca or Al antacids
  • Narcotic analgesics
  • Anticholinergics
  • Tricylclics
  • Some Ca channel blockers
  • Antispasmodics
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6
Q

Caused by which psych/physiologic conditions?

A

• Depression Slows GI movement

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7
Q

Caused by which lifestyle characteristics?

A
  • Menopause
  • Intake of fluids/Dehydration
  • Diet
  • Avoiding the Urge
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8
Q

Why in Advanced Age

A
  • Physiologic changes
  • Mult. med conditions
  • Mult. meds
  • lifestyle
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9
Q

Why in Pedes

A
  • Unavialable toilet facilites
  • Change in daily routine or environment
  • Decrease in fiber
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10
Q

Why in Women

A

*Medical conditions
*Hormonal changes
Slower transit time
*Pregnancy

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11
Q

Treatment Goals

A
  • Relieve constipation and reestablish normal bowel function
  • Establish dietary/exercise habits
  • Promote safe, effective use of laxatives
  • Avoid overuse of laxative products
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12
Q

General Treatment Approach

A
  • Lifestyle modifications
  • Do not ignore the urge
  • Laxatives
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13
Q

Lifestyle Modifications

A
  • High Fiber Diet (20-30gm/day)
  • increased water/fluids (32-128oz/day)
  • Exercise
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14
Q

Types of laxatives

A
  • Bulk Forming
  • Emollient
  • Lubricant
  • Saline (Osmotic)
  • Hyperosmotic
  • Stimulants
  • Miscellaneous
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15
Q

Exclusions to Self-treatment

A
  • Marked abdominal pain/cramping
  • Marked/unexplained flatulence
  • Fever
  • Nausea/vomiting
  • Paraplegia/Quadriplegia
  • Daily laxative use
  • Unexplained changes in bowel habits, especially if accompanied by wt. loss
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16
Q

Exclusions to Self-treatment cont.

A
  • Bloody/Black/Tarry stool
  • Change in caliber of stool
  • Any bowel sx that persist >2wks or recur >over 3 months
  • Any bowel sx that recur after dietary or lifestyle changes
  • Any bowel sx that recur after laxative use
  • History of IBD
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17
Q

Combo Products

A

Often a stimulant and stool softener

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18
Q

Visicol Function and dose

A

Sodium phosphate  take the evening before a coloscopy and repeat day of:
• 3 tabs with 8oz of clear liquids q15min for 20 tabs (last dose will be 2 tabs)

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19
Q

Visicol SE

A

Caution with acute phosphate nephropathy
Watery BM occurs an hour of starting
18 years and up
Need to be hydrated

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20
Q

Bulk-forming types

A
  • Methylcellulose
  • Carboxymethylcellulose sodium
  • Psyllium
  • Partially hydrolyzed gaur gum
  • Polycarbophil
  • Plantago seeds
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21
Q

Bulf-forming MOA and onset

A

Stool is bulked > Water rushes to the intestines and is retained > swelling occurs > peristalsis is stimulated
Onset: 12-24 hours, up 72 hours

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22
Q

Bulk-forming AE

A
  • Abdominal cramping
  • Flatulence
  • Esophageal obstruction

*if not mixed thoroughly with enough water, clumps may form in the esophagus

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23
Q

Bulk-forming recommendations

A

• Initial therapy
• Geriatrics
• Pregnant women
*mimics normal physiologic mechanism for evacuation

24
Q

Bulk-forming interactions

A

• Cellulose
> Oral anticoagulants
> Digitalis
> Salicylates

• Ca Polycarbophil
>Tetracyclines

25
Q

Bulk-forming Contraindications

A 
•	narrowing or intestinal ulcerations > fecal impaction or intestinal obstruction
•	fluid restrictions 
>CHF
>Kidney Failure
•	Phenylkeouria > neurologic changes
26
Q

Bulk-forming cautions

A
  • < 6 years old (cannot drink that much fluid)

* Diabetics (dextrose content)

27
Q

Emollient Types

A
  • Docusate Sodium (Colace®)
  • Docusate Calcium (Kaopectate®)

*need to drink a lot of water

28
Q

Emollient MOA and onset

A

Softens the fecal mass  pts do not strain

Onset: 24-72 hours, up to 5 days

29
Q

Emollient recommendations

A
  • Geriatrics
  • Pts that do not have long-term constipation
  • Pre and post-operative pts where straining is undesirable
30
Q

Emollient Contraindications

A
  • <6 years old

* PTS with long standing constipation

31
Q

Lubricant Types

A

• Mineral Oil (liquid petroleum)

32
Q

Lubricant MOA and onset

A

Coats fecal matter
Onset:
6-8 hr (oral)
5-15 min (rectal)

33
Q

Emollient AE

A

• Lipid pneumonia
• Oily stools   in accidents
*seen with repeated/prolonged use

34
Q

Emollient Interactions

A
  • Fat-soluble vitamins

* Emollients ( lubricant’s absorption)

35
Q

Emollient Contras

A
  • <6 years old
  • Bedridden  lipid pneumonia
  • Pregnant women in Vit. K for fetus (needed for clotting)
36
Q

Emollients Cautions

A

• Elderly  lipid pneumonia

37
Q

Saline Laxatives (Osmotics) Types

A
  • Mg citrate (Citroma)
  • Mg hydroxide (Phillips)
  • Mg Sulfate (Epsom Salt)
  • Dibasic Na phosphate (Phosphosoda)
  • Monobasic Na Phosphate (Fleet Enema)
  • Na Biphosphate (Fleet Enema)
38
Q

SL MOA and onset

A

Ions draw water into intestine  intraluminal pressure Imotility
Onset:
30min-3hrs (oral)
2-5min (rectal)

39
Q

SL AE

A
  • 20% of Na and H2O comes back into vasculature Na overload

* Acute phosphate nephropathy from oral Na phosphates

40
Q

SL recommended

A

• PTS constipated >7 days
• Acute evacuation is required
endoscopy
suspected poisoning

41
Q

SL contras

A
  • < 5 years old (oral)
  • <2 years old (rectal)
  • Pregnancy
  • Ileostomy or colostomy
  • Renal impairment
  • CHF
42
Q

SL Cautions

A
  • Na restricted diet

* Elderly (Na overload)

43
Q

Hyperosmotic Types

A

• Glycerin
• Polyethylene glycol (MiraLax)
*mix in 4-8 oz of any beverage once daily for a max of 7 days

44
Q

HO MOA and Onset

A 
Draws H2O into the rectum/bowel
Local irritant effect when given rectally
Onset: 
1-3 days (oral)
30 min (rectally)
45
Q

HO recommended

A
  • Glycerin in infants (cut in half length wise)
  • Polyethylene glycol used in 16 and older
  • PTS who do not like to drink water
  • PTS who do not want cramps or gas
46
Q

Stimulants types and onset

A 
•	Sennosides and senna
6-12 hours (oral), up to 24 hours
•	Bisacodyl
6-10 hours (oral) 
15-60 min (rectally)
•	Castor oil
2-6 hours (oral)
47
Q

Stimulants MOA

A

Local irritation of the mucosa
Sennosides and senna  inhibit H2O and electrolyte absorption from large intestine  intestinal pressure  motility
Bisocoydal  acts on mucosal nerve plexus and causes contraction of the entire colon
Castor oil  unknown

48
Q

Stimulants AE

A
  • Cathartic colon
  • Cramping
  • Loss Fluid
49
Q

Stimulant Recommended

A
  • Before radiologic or endoscopic exam
  • Before GI surgery
  • Tx of opiate induced chronic constipation
  • Bisacoydal – OK with Colostomy
50
Q

Stimualnts Contras

A

• Pregnancy (3rd Trimester)

51
Q

Stimulants Cautions

A

• Use sparingly in geriatrics

52
Q

GG: Caution in

A
  • Renal Failure – Mg
  • Cardiovascular Disease – Na
  • Diabetes – Dextrose
53
Q

GG: Children

A
  • < 2 yr old – no enemas
  • Avoid stimulants
  • Most effective may be diet and education about not holding it
54
Q

GG: Advanced Age

A
  • Bulk-forming preferred
  • Glycerin suppositories
  • Saline enemas for acute episodes
  • Caution with products that shift fluid and electrolytes (saline)
  • Caution about chronic use of stimulants (malabsorption/fluid loss)
55
Q

GG: Pregnancy

A
  • Diet modification
  • Bulk-forming preferred
  • Avoid stimulants and saline cathartics (Mg sulfate)
56
Q

GG: Breastfeeding

A
  • Stimulants OK

* Avoid saline cathartics  diarrhea and respiratory distress

OTC Exam 3 (6 decks)

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