Constipation Flashcards
What is constipation?
<3 bowel movements/week characterized by difficulty passage
How long does ingested food retain in stomach?
3hrs
Forceful increase in intra-abdominal pressure, initiated w/ an exhalation attempt against a closed glottis is also know as…
Valsalva maneuver
What are some nonpharmacological Tx?
- Fiber
- 2L/day + 300ml for pregnant
- Bowel training
- Gastrocolic reflexes first thing in the morning and 30 min after meals
Exclusions?
- <2yrs old
2. Laxative use >7days
What is the first line treatment?
Bulk-forming
Psllium, methylcellulose, and calcium polycarbophil are considered…?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Bulk-forming
MOA = dissolves and swells in intestinal fluids leading to peristalsis
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Bulk-forming
AE = flatulence, cramping, esophageal obstruction, acute bronchospasm
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Bulk-forming
Polyethylene glycol and glycerin are considered…?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Hyperosmotic
MOA of Miralax (polyethylene)?
Draws water into rectum/bowel
MOA of glycerin?
Evacuates lower bowel only
Onset of Miralax?
1 to 3 days
Onset of glycerin?
15 to 30 min
Indication of Miralax?
Short term Tx for age ≥17
Indication of glycerin?
Intermittent basis for all age groups
AE of Miralax?
Bloating, cramping, flatulence
AE of glycerin?
Rectal irritation w/ overdose
Docusate sodium and Docusate calcium are considered…?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Emollients aka stool softeners
MOA = facilitate mixing of aqueous and fatty substances to soften fecal matter
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Emollient
Indication = prevent straining and painful defecation
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Emollient & Lubricant
AE = diarrhea, mild abdominal cramp
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Emollient
Patient counseling = dont use longer than a week + often used with senna for opioid induced constipation
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Emollient
Mineral oil is considered…?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
MOA = coats stool and prevents colonic absorption of fecal water
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
Avoid use with docusate
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
Impairs absorption of Vit. A, D, E, K, and oral contraceptives
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
AE = lipid pneumonia from aspiration + anal pruritis
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
Patient counseling = dont use longer than a week + take on an empty stomach + dont use on children <6 yrs old + no use in pregnant women + no use in adults with difficulty swallowing
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Lubricant
Magnesium citrate, magnesium sulfate, magnesium hydroxide are considered….?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Saline
MOA = draws water into intestine to increase intraluminal pressure and intestinal motility
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Saline
Indication = acute bowel evacuation
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Saline
Patient counseling = only for occasional use and quick onset of action
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Saline
What saline formulation should you avoid?
Magnesium sulfate aka Epsom salt
What is the FDA MedWatch AE of sodium phosphate (in saline)?
Acute phosphate nephropathy
MOA of Senna?
Increase intestinal motility
MOA of Bisacodyl?
Acts on mucosal nerve plexus + causes contraction of entire colon
Indication of use for Senna & Bisacodyl
Bowel prep & used with docusate for opioid induced constipation
AE of Senna?
Urine discoloration
Patient counseling of Senna?
Dont use longer than a week + take with water
Patient counseling of Bisacodyl?
Do not crush, do not take within 1 hr of ingesting dairy, antacids, H2RAs, or PPIs
Pregnant women should avoid which one?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Stimulants + saline
No enemas to be given at what age?
<2yrs old
Children should avoid…?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Stimulants
Elderly should have caution against which kind..?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Stimulants
When is opioid induced constipation used?
In noncancer and cancer pain
MOA of opioid induced constipation?
Opioids bind to bowel and CNS receptors + decrease GI motility + drying stool
What should you avoid when during an opioid induced constipation?
Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant
Bulk-forming
