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Clinical part B > Constipation > Flashcards

Constipation Flashcards

1
Q

risk factors for constipation

A 
female
non white
over 65 
fewer years of formal education 
low caloric intake
increased number of meds
lower socioeconomic status 
sedentary lifestyle 
travelling 
toilet training in children 
ignoring the urge to defecate
physical and sexual abuse
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2
Q

diseases causing constipation

A 
IBS
IBD
stroke, MS, parkinsoons
diabetes
chronic renal failure
carcinoma
psychiatric 
anal fissures
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3
Q

meds that cause constipation

A 
antacids
anticholinergics
iron supplements
analgesics
antihypertensive agents
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4
Q

lifestyle causes of constipation

A 
inadequate fibre
inadequate fluids 
lack of exercise
travel 
pregnant 
ignore urge to defecate
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5
Q

signs and symptoms of constipation

A 
infrequent defecation 
abdominal discomfort
nausea 
vomiting
anorexia
early satiety 
small hard stools
incomplete rectal emptying 
rectal bleeding due to hemorrhoids 
weight loss
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6
Q

red flags

A 
symptoms last longer than 2 weeksor no bowel movement in 7 days with laxative use 
blood in stool - dark tarry 
mucus 
rectal bleeding
severe pain 
fever
unexplained weight loss
family history of colon cancer
under 2
unremitting nocturnal symptoms 
recent ab surgery 
anemia 
vomiting
chronic illness associated 
eating disorder
diarrhea alternating with constipation 
rectal or ab mass
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7
Q

goals of therapy

A 
relieve contipation and symptoms 
improve stool consistency
reestablush normal bowel function 
prevent recurrence
avoid complication
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8
Q

preventing constipation

A 
high fibre- popcorn, green pea, avocado
adequate fluid
routine private toilet regimen 
defecate when feel the urge
daily physical activity
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9
Q

non pharms

A 
increase calories 
eat more fruit 
exercise
footstool puts pelvis lower than knees
biofeedback 
try defecate 5-15 min after meal 
juice with sorbitol
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10
Q

agents that cause softening of feces in 12-72 hours

A

bulk forming

emollient

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11
Q

agents that work in 6-12 hours

A

bisacodyl

senna

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12
Q

agents that work in 0.5-3 hours

A

magnesium products

oral sodium phosphates

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13
Q

lactulose onset

A

24-48 hours

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14
Q

glycerin suppository onset

A

15-30min

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15
Q

peg onset

A

2-4 days

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16
Q

enema onset

A

5-15 min

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17
Q

mineral oil, lansoyl onset

A

6-8 hours

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18
Q

use of product for treatment?

prevention?

A

1 week treatment

duration ongoing for prevention

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19
Q

treatment for under 1 year

A

increase fluid

pediatric glycerin suppositories

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20
Q

children over 1 first line agents

A

PEG, lactulose, sorbital

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21
Q

ogents for only over 6 years old

A

bulk formin
mineral oil
lansoyl
senna tablets

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22
Q

agent for only above 12

A

bisacodyl

23
Q

agents for only over 18

A

PEG

24
Q

cause of constipation in pregnancy

A 
elevations in progesterone causign relaxtion in intestinal tract
reduced motilin levels 
intestinal pressure 
decreased exercise ability 
iron and calcium supplements
25
Q

first line treatment in pregnancy

A

bulk forming laxative

glycerin supp

26
Q

treatment in elderly

A

bulk forming agents - must increase fluid but cant if have CHF, renal failure
glycerin supp
PEG
senna, bisacodyl

27
Q

treatment in cancer patients

A

stimulatn laxatives

avoid bulk formin becuase may cause impaction

28
Q

when should laxatives be taken in relation to other drugs

A

2 hours after

29
Q

whats a habitual laxative abuser

A

believes should have a bowel movement everyday

30
Q

signs and symptoms of laxative abuse

A 
diarrhea - severe chronic watery at night 
ab pain, NV
weight loss
muscle weakness
hypokalemia, hypocalemia
31
Q

treatment of laxative abuse

A

referral
weaning off
add high fibre and bulk forming
encourage exercise and fluid intake

32
Q

examples of bulk forming agents

A

psyllium
polycarbophil
inulin
bran

33
Q

MOA bulk forming

A

dissolve in intestinal fluid by attracting water forming a gel and stimulatin peristalsis
increases stool frequency and weight

34
Q

CI bulk forming

A 
partial mechanical obstruction 
fluid restricted patients
partial bowel obstruction 
fecal impaction 
dysphagia 
Gi strictures
throat problems
35
Q

side effects of bulk forming

A

flatulence

bloating

36
Q

examples of stool softeners/emollients

A

docusate sodium

docusate calcium

37
Q

side effects of stool softeners

A

mild transient nausea
gi cramps
rash

38
Q

stool softener MOA

A

surfactant that helps water in the bowel mix with fecal mass

39
Q

use of stool softeners

A

prevention only and even that is lacking evidence

40
Q

lubricant MOA

A

lubricates feces and mucosa

reduce water reabsorption

41
Q

example of lubricant

A

mineral oil

laxative jelly

42
Q

CI lubricants

A 
bedridden 
appendicitis 
rectal bleeding 
dysphagia 
gastric retention 
gerd
MS PD 
children, elderly 
high risk of aspiration
43
Q

stimulant MOA

A

increase peristalsis

44
Q

stimulant examples

A

senna - anthraquinones
cascara sagrada
bisacodyl - diphenylmethane

45
Q

what should you avoid with bisacodyl

A 
milk 
antacids
PPIs
crushing, breaking, chewing
because enteric coatin
46
Q

first line for opiate constipation

A

stimulants

47
Q

side effects of stimulants

A

ab pain
NV
hypokalemia,dehydration, hyponatremia - long term

48
Q

MOA osmotics

A

ions draw water into intestine increasing the intraluminal pressure applying a mechanical stimulus for motility

49
Q

examples of osmotics

A 
glycerin supp 
lactulose
sorbitol 
PEG 
magnesium hydroxide/citrate
sodium phosphate
50
Q

can lactulose be used in diabetes

A

yes

51
Q

safest and most effective product

A

glycerin suppository

52
Q

what is used for bowel cleansing

A

magnesium citrate

53
Q

why should you never use oral sodium phosphate as a purgative

A

serious electrolyte, kidney, cardiovascular, and neurological problems

54
Q

options for enemas

A

mineral oil
phosphate
tap water

Clinical part B (15 decks)

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