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OTC > Constipation > Flashcards

Constipation Flashcards

1
Q

Constipation is defined as having…

A

fewer than 3 bowel movements per week

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2
Q

Patients describe constipation as…

A
  • straining to have bowel movement
  • passing hard, dry stools
  • passing small stools
  • feeling as though evacuation is incomplete
  • decreased stool frequency
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3
Q

Causes of constipation:

A
  • medical conditions
  • psychological conditions
  • lifestyle characteristics
  • medication induced
  • age related changes in gut motility
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4
Q

Medical conditions that cause constipation:

A
  • multiple sclerosis
  • parkinsonism
  • stroke
  • dementia
  • irritable bowl syndrome
  • diabetes
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5
Q

Psychological conditions that cause constipation:

A
  • depression
  • eating disorders
  • stress
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6
Q

Lifestyle characteristics that cause constipation:

A
  • immobility
  • no exercise
  • poor nutrition
  • reduced fluid intake
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7
Q

Medication that induces constipation:

A
  • Ca2+ channel blockers (verapamil)
  • opiates
  • NSAIDs
  • antacids (aluminum/calcium)
  • tricyclic antidepressants
  • diuretics
  • anticholinergics
  • antihistamines
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8
Q

What is the initial management of constipation?

A

adjust diet

  • foods in high fiber
  • increase fluid intake
  • engage in exercise
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9
Q

Self-care laxatives should not be taken for more than…

A

7 days

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10
Q

Exclusions to OTC:

A
  • < 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
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11
Q

Non-pharmacological therapy:

A
  • balanced diet
  • drink 2 L of water QD
  • obtain regular aerobic exercise
  • fiber
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12
Q

A balanced diet includes…

A
  • increase in fruits and veggies
  • consume half of all grains as whole grains
  • limit intake of cheese, meat, and processed foods
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13
Q

Why does dietary fiber work for constipation?

A
  • dissolves or swells in intestinal fluid
  • increases bulk of fecal mass
  • stimulates peristalsis and eliminates stools
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14
Q

Dosage for dietary fiber:

A
  • females: 25 g

- males: 38 g

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15
Q

Fiber supplements are not the same as…

A

bulk-forming laxatives

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16
Q

Pharmacologic therapies:

A
  • bulk-forming laxatives
  • hyperosmotics
  • emollients
  • lubricants
  • saline agents
  • stimulants
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17
Q

Examples of bulk-forming laxatives:

A
  • methylcellulose (citrucel)
  • polycarbophil (fibercon)
  • psyllium (metamucil)
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18
Q

Which pharmacologic therapy is the recommended initial therapy?

A

bulk-forming laxatives, because it closely mimics the physiological evacuation process

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19
Q

Does the 7 day use limitation apply to bulk-forming laxatives?

A

No because they are often used for preventative purposes

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20
Q

Onset of action for bulk-forming laxatives:

A

72 H

- not systemically absorbed

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21
Q

Bulk-forming laxatives are not appropriate for patients…

A

who have to restrict their fluid intake

- like patients who have heart failure

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22
Q

Adverse effects of bulk-forming laxatives:

A
  • abdominal cramping

- flatulence

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23
Q

Counseling points of bulk-forming laxatives:

A
  • not for < 6 YO

- choose sugar-free agents if diabetic or carb/calorie restricted diet

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24
Q

Examples of hyperosmotics:

A
  • polyethylene glycol 3350 (PEG 3350/miralax)

- glycerin

25
Q

Polyethylene glycol 3350 (PEG 3350/miralax) dosage:

A

17 g per capful in 4-8 oz of beverage daily for adults > 17 YO

26
Q

Onset of polyethylene glycol 3350 (PEG 3350/miralax):

A

produces bowel movement within 12-72 H

27
Q

Glycerin is available as…

A

rectal suppositories to produce bowel movements within 15-30 minutes

28
Q

Glycerin is safe for occasional use in…

A

all age groups

29
Q

Examples of emollients:

A
  • docusate sodium (colace)

- docusate calcium

30
Q

Onset of action for emollients:

A

12-72 H

31
Q

Emollients should be used in people older than…

A

2 YO

32
Q

Emollients is frequently used with _____ for long term treatment for opiate induced constipation

A

a stimulant like senna or bisacody

- tolerance doesn’t develop

33
Q

Example of lubricants:

A

mineral oil

34
Q

Lubricants are strongly…

A

discouraged due to other safer options

35
Q

Excessive dosage of lubricants increases the possibility of…

A
  • loss of fat-soluble nutrients (ADEK) from GI tract

- enhances likelihood of product aspriation

36
Q

Lubricants should be avoided in patients taking…

A
  • anticoagulants
  • bedridden patients
  • individuals with swallowing difficulties
37
Q

Examples of saline agents:

A
  • magnesium hydroxide (Phillips Milk of Magnesia)
  • magnesium citrate
  • sodium phosphate (Fleet-phospho-soda)
38
Q

Saline agents are also used for…

A

acute bowel evacuation before procedures like colonoscopy

39
Q

Onset of action for saline agents:

A
  • 30 min to 6 H for oral doses

- 2 to 15 min for rectal doses

40
Q

Saline agents can cause…

A

serious electrolyte imbalances if used long term or at higher than recommended doses

41
Q

Adverse effects of saline agents:

A
  • abdominal cramping
  • nausea/vomiting
  • dehydration
42
Q

You should take saline agents doses with…

A

water to prevent dehydration

43
Q

Examples of stimulants:

A
  • senna or sennosides (ex-lax, senokot)
  • bisacodyl (dulcolax)
  • castor oil
44
Q

Onset of action for stimulants:

A

6-10 H but might need 24 H

45
Q

Suppository stimulants take effect in…

A

15-60 min

46
Q

Adverse effects of stimulants:

A
  • severe cramping
  • electrolyte/fluid deficiencies
  • hypokalemia
47
Q

Stimulants are subjected to…

A

overuse

48
Q

Which product has the strongest support for efficacy and safety?

A

PEG 3350

- if it doesn’t work, then should use stimulant

49
Q

Counseling points for laxatives:

A
  • take at bedtime

- avoid taking them within 2 H of other medications

50
Q

Mild constipation for children should be relieved with…

A

dietary or behavioral modifications

  • increase intake of fluids and fruit juices
  • increase high fiber cereals or grains, veggies, or fruits (age+5g/day)
51
Q

For ages 2-6, they should take…

A
  • docusate sodium or magnesium hydroxide
  • faster relief: pediatric glycerin suppositories
  • oral senna when everything else fails
52
Q

For ages 6-12, they should take…

A
  • bulk-forming agents
  • docusate sodium
  • magnesium hydroxide
  • when all fails: glycerin suppositories/oral stimulants
53
Q

Elderly have a greater risk of constipation due to…

A
  • reduced caloric, fiber, and/or fluid intake
  • decreased physical activity
  • have comorbidities
  • increased use of meds
54
Q

1st step medical therapy for elderly:

A
  • bulk-forming

- PEG 3350

55
Q

What should elderly people avoid?

A
  • mineral oil
  • saline laxatives
  • stimulants
56
Q

What should be the initial measure for pregnant women?

A

dietary measures

57
Q

Common first-line choice for pregnant women:

A

bulk-forming laxatives

58
Q

If needed, short term use of _______ is okay for pregnant women

A

senna or bisacodyl

OTC (23 decks)

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