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David's lecture > Constipation > Flashcards

Constipation Flashcards

1
Q

What are some of the functions of the small intestine?

A
  • Reabsorbs water and compact material into feces
  • Absorbs vitamins produced by bacteria
  • Store fecal matter prior to defecation
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2
Q

List the areas of the colon and what each are involved in?

A
  • Ascending , Tranverse, descending - ivolved in the reabsorption of water and vitamins
  • Sigmoid, rectum, anal canal - Involved in packaging of the remaining material into feaces
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3
Q

The ransit of small labeled markers through the large intestine occurs in 36-48hrs. TRUE OR FALSE?

A

TRUE

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4
Q

What does haustrations and mass movement do and what do they aid in?

A
  • Haustrations (mixing movement) : aids in reabsorption and packaging
  • Mass movement (Propulsive movements) : Keeps material moving though the colon
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5
Q

List some of the Rome criteria for the diagnosis of constipation?

A
  • Two stools or less per week
  • A feeling of incomplete evacuation at least 25% of the time
  • A feeling of anal blockage
  • Straining at stool at least 25% of the time
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6
Q

What are the pathophysiological components of chronic constipation?

A
  • abnormal intrinsic motility
  • Lack of luminal factors
  • Medications (can cause abnormal motility)
  • Impaired defecation
  • Lack of extrinisic innervation in paraplegia
  • Hormones
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7
Q

What is latrogenic constipation?

A

-When symptoms are caused by medication

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8
Q

What type of medications cause constipation?

A

-Pain medications, iron, calcium, blood pressure medications

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9
Q

Opiods induced constipation in palliative care is common. TRUE OR FALSE?

A

TRUE

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10
Q

How do opiods cause constipation?

A
  • They increase smooth muscle tone which supresses forward peristalsis, increases tone in anal sphincters, Increases transit time and water absorption
  • They reduce sensitivity to anal distention which reduces urge to defecate
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11
Q

What is the most common cause of constipation?

A

-Through the misuse of laxatives

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12
Q

How do the misuse of laxatives cause constipation?

A
  • Longer interval needed to refill colon is misinterpreted as constipation which leads to further laxative use
  • Causes eneteral loss of water and salts leads to release of aldosterone which stimulates reabsorption in intestine, but increaseenal excretion of potassium ions
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13
Q

What does the dobule loss of potassiu ions from renal excretion lead to and what does this do the rate of peristalsis?

A

Hypokalemia which reduces peristalsis

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14
Q

What is the role of aldosterone?

A

Stimulates the kidneys to absorb and retain water

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15
Q

What is impaired defecation?

A

-The loss of feedback between components of the fecal reflex

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16
Q

Constipation is a disease. TRUE OR FALSE?

A

FALSE

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17
Q

List the therapy classes for constipation?

A
  1. Bulk forming laxatives
  2. Osmotic laxatives
  3. Stimulant laxatives
  4. Stool softeners
  5. Other agents
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18
Q

what is the mechanim of action for each of the therapy classes for constipation?

A
  1. Bulk forming laxatives : Fiber increases bulk of the stool which activates stretch receptors in the wall of the colon which acts to increase colonic activity
  2. Osmotic laxatives : Increases fluid content of stools which activates stretch receptors which increases fecal activity.
  3. Stimulant laxatives : They increase peristalsis by increasing the activity of muscles in the colon
  4. Stool softeners : These lubricates the stool and helps them pass through the colon easily
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19
Q

What are some of the general contraindication for use of laxatives?

A
  • Laxatives should not be used in the presence of undiagnosed abdominal pain
  • The drug may cause cause an inflamed organ to rupture and spill in GI
  • Oral drugs are also contranindicated when a diagnosed GI disturbance is likely to be worsened by increased motility
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20
Q

Bulk laxatives are insoluble, non digestible and non absorbable. TRUE OR FALSE?

A

TRUE

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21
Q

How long do bulk laxatives take to act?

A

-Takes several days (2 weeks)

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22
Q

List three bulk laxatives?

A
  • Isphagula
  • Methylcellulose
  • Sterculia
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23
Q

What are some fo the ADRs of bulk laxatives?

A

-Bloating and flatulence, GI obstruction and impaction

24
Q

What are the cautions for taking bulk laxatives?

A

-Adequate fluid intake should be maintained to avoid obstruction

25
Q

What are the contranindications for bulk laxtaives?

A
  • Colonic atony - colon will not be stimulated by actiavtion of stretch receptors
  • Faecal impaction and instestinal obstruction - increased motility will not lead to defecation
26
Q

How long does it take for osmotic laxtaives to work and when is this used?

A

1-3 hours

Used prior to surgery or in poisoning

27
Q

What are osmotic laxatives made up of?

A
  • Non digestible sugars and alcohols
  • Macrogol (which is a polymer of ethylene glycol
  • Salts (Magnesium hydorxide (milk of magnesia), sodium phosphate
28
Q

How does lactulose cause the omsotic effect?

A

-It is broken down by bacteria to acetic and lactic acid

29
Q

What are the tow main issues associated with osmotic laxative?

A
  • Increased GI activity

- Electrolyte and osmotic imbalances - danger may cause dehydration

30
Q

What are the ADRs for osmotic laxatives?

A

-Abdominal discomfort and diarrhoea

31
Q

What cautions need to be taken when using osmotic laxatives?

A
  • Danger of dehydration (The elderly and debilitated)

- Those at risk of electrolyte imbalance - Cardiac diseases

32
Q

What are the CIs for osmotic laxatives?

A

-Acute GI conditions , intestinal obstruction and inflammation

33
Q

Stimulant laxative are indicated for severe constipation where more rapid effect is required (6-8hrs). TRUE OR FALSE?

A

TRUE

34
Q

Name some of stimulant laxatives?

A
  • BIsacodyl
  • Anthraquinones - senna
  • Castor oil, cascara
35
Q

Bisacodyl and sodium picosulfate end with the same ingredient and Bisacodyl is activated by hydrolyzes found in the gut wall. TRUE OR FALSE?

A

TRUE

36
Q

Senna and sodium picosulfate are activated by colonic flora. TRUE OR FALSE?

A

TRUE

37
Q

What are the two main issues with Stimulant laxatives?

A
  • Increased GI activity

- Electrolyte and osmotic imbalances

38
Q

What are some of the cautions that have to be taken when prescibing stimulant laxatives?

A

-Those at risk of dehydration or hypokaleamia

39
Q

What are the CIs for stimulant laxatives?

A
  • Inflamed and obstructed intestines

- Undiagnosed abdominal pain

40
Q

Co-danthrusate and co-danthramer show evidence of carcinogenicity and genotoxicity in animal studies. TRUE OR FALSE?

A

TRUE

41
Q

Provide examples of stool softners?

A
  • Docusate sodium
  • Arachis oil (enema)
  • Liquid paraffin (oral solution)
42
Q

Docusate sodium is a surfactant and a bulking agent. TRUE OR FALSE?

A

TRUE

43
Q

How long does docusate sodium take to work?

A
  • 1-2 days
44
Q

What are the ADRs and cautions for docusate sodium?

A
  • Abdominal pain, diarrhoea, hypokaleamia

- Cautions : Patients where hypokalaemia to be avoided, rectal preparation not indicated with haemorrhoids

45
Q

What are the CIs for docusate sodium?

A

-Intestinal blockage

46
Q

Methylnatrexone is a peripherally acting opioid antagonist. TRUE OR FALSE?

A

TRUE

47
Q

What is the half life and the maximum Tmax of Methylnatrexone?

A
  • Half life 8hrs

- Tmax is 0.5 hrs

48
Q

What are the ADRs and cautions for Methylnatrexone?

A
  • Abdominal pain, diarrhoea, flactulence

- Cautions : Patients with damaged GI tract

49
Q

What are the CIs for Methylnatrexone?

A

-Acute surgical abdominal conditions, intestinal blockage

50
Q

Prucalopride is a selective 5HT-4 agonist with prokinetic properties. TRUE OR FALSE?

A

TRUE

51
Q

What are the ADRs and cautions of Prucalopride?

A
  • ADRs: Wide range of abdominal side effects associated with action
  • Cautions : Arrythmias and ischaemic heart disease (hERG)
52
Q

What are the CIs for Prucalopride?

A

-Crohn’s disease, abdominal obstruction and other serious GI conditions

53
Q

What is Lubiprostone (Amitiza) and how does it work?

A

-A chloride channel blocker - acts locally to increase fluid secretion and motility

54
Q

Lubiprostone (Amitiza) has low bioavailability. TRUE OR FALSE?

A

TRUE

55
Q

What are the ADRs and the contraindications for Lubiprostone (Amitiza)?

A
  • ADRs : Wide range of abdominal side effects associated with action
  • Contranindications - Gi obstruction

David's lecture (13 decks)

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