constipation Flashcards

1
Q

common in these 3

A

women
pregnancy
elderly

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2
Q

what is it

A

defecation that is unsatisfactory because of infreq stools, difficult stool passage, seemingly incomplete defection

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3
Q

red flags - malignancy? bowel disorder?

A
  • new onset, esp if >50
  • anaemia, abdominal pain, weight loss, blood in stool
  • review drug if caused by drug
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4
Q

advice for all pt with constipation

A
  • increase dietary fibre (whole grains, fruit, veg)
  • do this gradually to minimise flatulence and bloating
  • effects may be seen in a few days, but may take as long as 4 weeks
  • have fruits high in fibre and sorbitol
  • adequate fluid intake will help soften stool and make it easier to pass
  • this can be difficult in frail and elderly
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5
Q

true or false - avoid fruits that are high in sorbitol and fruit juices high in sorbitol if you have constipation

A

FALSE
e.g. apples, apricots, avocados, cherries, peaches, plums, prunes
These can help prevent and treat constipation

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6
Q

laxative abuse can lead to which electrolyte disturbance?

A

hypokalaemia

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7
Q

name 4 bulk forming laxatives

A

bran
isphagula husk
methyl cellulose
sterculia

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8
Q

this bulk forming laxative also acts as a stool softener

A

methylcellulose

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9
Q

onset of action for bulk forming laxatives

A

up to 72 hours

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10
Q

bulk forming laxatives can exacerbate the following symptoms

A

flatulence, bloating, cramping

(hence why when you counsel pt to increase fibre intake, you advice them to do this gradually)

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11
Q

is it important to advice pt to drink enough water when theyre on bulk forming laxatives because…

A

avoids intestinal obstruction

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12
Q

name 5 stimulant laxatives

A
  • bisacodyl
  • sodium picosulfate
  • senna
  • co-danthramer
  • co-danthrusate
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13
Q

co-danthramer and co-danthrusate are what kind of laxatives?

A

stimulant

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14
Q

how to stimulant laxatives work and what is a common SE

A

increase intestinal motility
often cause abdominal cramps

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15
Q

avoid stimulant laxatives if …

A

intestinal obstruction

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16
Q

use of co-danthamer and co-danthrusate

A

only used in palliative care/terminally ill because of the potential carcinogenecity and genotoxicity

17
Q

this laxative is believed to act as a stimulant and faecal softener

A

docusate

18
Q

glycerol suppositories act as ..

A

lubricant and rectal stimulant due to its mild irritant action

19
Q

how do faecal softeners work

A

decreasing surface tension and increasing penetration of intestinal fluid into faecal mass

20
Q

these two laxatives have faecal softening properties

A

docusate (stimulant and softener)
glycerol (lubricant and rectal stimulant)

21
Q

what laxative class would enemas containing arachnis oil fall into and why?

A

faecal softeners
they lubricate and soften impacted faeces to promote bowel movement

22
Q

Liquid paraffin has been used as a lubricant. However, use with caution because of adverse effects e.g.

A

anal seepage
risk of granulomatous disease of GIY
lipid pnuemonia on aspiration

23
Q

how do osmotic laxatives work

A

increase amount of water in large bowel by draining fluid from body into bowel or retaining the fluid they were adminsitered with

24
Q

explain why lactulose is useful in hepatic encephalopathy

A
  • not absorbed from the GIT
  • produces osmotic diarrhoea of low faecal pH and discourages proliferation of ammonia producing organisms
25
Q

name 2 osmotic laxatives

A

macrogol
lactulose

26
Q

ensure macrogol is taken with sufficient fluid to ..

A

reduce dehydration

27
Q

name two other drugs that are used in constipation

A

linaclotide
prucalopride

28
Q

MOA lincalotide and when is it used

A

guanylate cyclase-C receptor agonist
licensed for treatment of moderate to severe IBS associated with constipation
increases intestinal fluid secretion and transit
decreases visceral pain

29
Q

prucalopride MOA and use

A

selective 5HT3 receptor agonist
has pro kinetic properties (promotes movement in GIT)
licensed for chronic constipation in adults when other laxatives have failed to provide adequate response

30
Q

are bowel cleansing preparations used for constipation

A

no

31
Q

when are bowel cleansing preparations used

A

before colonic surgery, colonoscopy or radiological examination to ensure bowel is free of solid contents