Constipation Flashcards
Constipation is defined as having…
fewer than 3 bowel movements per week
Patients describe constipation as…
- straining to have bowel movement
- passing hard, dry stools
- passing small stools
- feeling as though evacuation is incomplete
- decreased stool frequency
Causes of constipation:
- medical conditions
- psychological conditions
- lifestyle characteristics
- medication induced
- age related changes in gut motility
Medical conditions that cause constipation:
- multiple sclerosis
- parkinsonism
- stroke
- dementia
- irritable bowl syndrome
- diabetes
Psychological conditions that cause constipation:
- depression
- eating disorders
- stress
Lifestyle characteristics that cause constipation:
- immobility
- no exercise
- poor nutrition
- reduced fluid intake
Medication that induces constipation:
- Ca2+ channel blockers (verapamil)
- opiates
- NSAIDs
- antacids (aluminum/calcium)
- tricyclic antidepressants
- diuretics
- anticholinergics
- antihistamines
What is the initial management of constipation?
adjust diet
- foods in high fiber
- increase fluid intake
- engage in exercise
Self-care laxatives should not be taken for more than…
7 days
Exclusions to OTC:
- < 2 YO
- marked abdominal pain or significant distention
- fever
- nausea, vomiting
- sudden change in bowel movements for 2 weeks
- dark, tarry stool or presence of blood
- history of inflammatory bowel disease, chron’s disease, ulcerative colitis, paraplegia
Non-pharmacological therapy:
- balanced diet
- drink 2 L of water QD
- obtain regular aerobic exercise
- fiber
A balanced diet includes…
- increase in fruits and veggies
- consume half of all grains as whole grains
- limit intake of cheese, meat, and processed foods
Why does dietary fiber work for constipation?
- dissolves or swells in intestinal fluid
- increases bulk of fecal mass
- stimulates peristalsis and eliminates stools
Dosage for dietary fiber:
- females: 25 g
- males: 38 g
Fiber supplements are not the same as…
bulk-forming laxatives
Pharmacologic therapies:
- bulk-forming laxatives
- hyperosmotics
- emollients
- lubricants
- saline agents
- stimulants
Examples of bulk-forming laxatives:
- methylcellulose (citrucel)
- polycarbophil (fibercon)
- psyllium (metamucil)
Which pharmacologic therapy is the recommended initial therapy?
bulk-forming laxatives, because it closely mimics the physiological evacuation process
Does the 7 day use limitation apply to bulk-forming laxatives?
No because they are often used for preventative purposes
Onset of action for bulk-forming laxatives:
72 H
- not systemically absorbed
Bulk-forming laxatives are not appropriate for patients…
who have to restrict their fluid intake
- like patients who have heart failure
Adverse effects of bulk-forming laxatives:
- abdominal cramping
- flatulence
Counseling points of bulk-forming laxatives:
- not for < 6 YO
- choose sugar-free agents if diabetic or carb/calorie restricted diet
Examples of hyperosmotics:
- polyethylene glycol 3350 (PEG 3350/miralax)
- glycerin
Polyethylene glycol 3350 (PEG 3350/miralax) dosage:
17 g per capful in 4-8 oz of beverage daily for adults > 17 YO
Onset of polyethylene glycol 3350 (PEG 3350/miralax):
produces bowel movement within 12-72 H
Glycerin is available as…
rectal suppositories to produce bowel movements within 15-30 minutes
Glycerin is safe for occasional use in…
all age groups
Examples of emollients:
- docusate sodium (colace)
- docusate calcium
Onset of action for emollients:
12-72 H
Emollients should be used in people older than…
2 YO
Emollients is frequently used with _____ for long term treatment for opiate induced constipation
a stimulant like senna or bisacody
- tolerance doesn’t develop
Example of lubricants:
mineral oil
Lubricants are strongly…
discouraged due to other safer options
Excessive dosage of lubricants increases the possibility of…
- loss of fat-soluble nutrients (ADEK) from GI tract
- enhances likelihood of product aspriation
Lubricants should be avoided in patients taking…
- anticoagulants
- bedridden patients
- individuals with swallowing difficulties
Examples of saline agents:
- magnesium hydroxide (Phillips Milk of Magnesia)
- magnesium citrate
- sodium phosphate (Fleet-phospho-soda)
Saline agents are also used for…
acute bowel evacuation before procedures like colonoscopy
Onset of action for saline agents:
- 30 min to 6 H for oral doses
- 2 to 15 min for rectal doses
Saline agents can cause…
serious electrolyte imbalances if used long term or at higher than recommended doses
Adverse effects of saline agents:
- abdominal cramping
- nausea/vomiting
- dehydration
You should take saline agents doses with…
water to prevent dehydration
Examples of stimulants:
- senna or sennosides (ex-lax, senokot)
- bisacodyl (dulcolax)
- castor oil
Onset of action for stimulants:
6-10 H but might need 24 H
Suppository stimulants take effect in…
15-60 min
Adverse effects of stimulants:
- severe cramping
- electrolyte/fluid deficiencies
- hypokalemia
Stimulants are subjected to…
overuse
Which product has the strongest support for efficacy and safety?
PEG 3350
- if it doesn’t work, then should use stimulant
Counseling points for laxatives:
- take at bedtime
- avoid taking them within 2 H of other medications
Mild constipation for children should be relieved with…
dietary or behavioral modifications
- increase intake of fluids and fruit juices
- increase high fiber cereals or grains, veggies, or fruits (age+5g/day)
For ages 2-6, they should take…
- docusate sodium or magnesium hydroxide
- faster relief: pediatric glycerin suppositories
- oral senna when everything else fails
For ages 6-12, they should take…
- bulk-forming agents
- docusate sodium
- magnesium hydroxide
- when all fails: glycerin suppositories/oral stimulants
Elderly have a greater risk of constipation due to…
- reduced caloric, fiber, and/or fluid intake
- decreased physical activity
- have comorbidities
- increased use of meds
1st step medical therapy for elderly:
- bulk-forming
- PEG 3350
What should elderly people avoid?
- mineral oil
- saline laxatives
- stimulants
What should be the initial measure for pregnant women?
dietary measures
Common first-line choice for pregnant women:
bulk-forming laxatives
If needed, short term use of _______ is okay for pregnant women
senna or bisacodyl
