Constipation Flashcards
1
Q
Evaluation of constipation
A
- Check rx meds (opioids, anticholinergics, TCAs, CCBs, Parkinson’s drugs, antipsychotics)
- Check OTC meds (antacids, calcium, iron, etc)
- Check Red Flags
2
Q
Treatment options for “acute/subacute” constipation
A
- Bulk Laxatives (OTC, soluble fiber)
- Stool Softeners (OTC)
- Saline Laxatives (OTC)
- Stimulant Laxatives (OTC)
- Hyperosmolar Laxatives
- Lubricant Laxatives
- Suppositories
- Enemas
- Perineal self-acupressure
3
Q
Bulk Laxatives
A
- Wheat dextrin, psyllium, methylcellulose, polycarbophil
- Speed up colonic transit
- Titrate up, mild to mod constipation** –> make take 3 days to work
- Take w 8 oz water**
- NOT helpful in OIC
- Avoid if obstructive sx, dysphagia, frail/bedbound**
4
Q
Stool Softeners
A
- Docusate
- increase peristalsis
- Not effective when used alone**
5
Q
Saline Laxatives
A
- Magnesium hydroxide
- Hyperosmolar agent that results in increased peristalsis
- Hypermag may occur in CKD
6
Q
Stimulant Laxatives
A
- Bisacodyl*, Senna, Castor Oil
- Alter lyte transport and stimulant myenteric plexus to increase motility
7
Q
Hyperosmolar Laxatives
A
Lactulose
- Hepatic Encephalopathy**: alters ammonia concentration
- Constipation: produced osmotic effect in colon –> distention and peristalsis–> poorly tolerated
Polyethylene Glycol (PEG 3350)
- Crystalline powder
- MOA: induced catharsis by strong lyte and osmotic effects (inc intraluminal fluid)
8
Q
Lubricant Laxatives
A
- Mineral oil
- MOA: eases passage of stool by inhibiting reabsorption of water
- Malabsorption of fat-soluble vitamins possible with prolonged use**
9
Q
Suppositories
A
- Glycerin and Bisacodyl
- Induce evacuation by local rectal stimulation
10
Q
Enemas
A
- Mineral oil, tap water, sodium phosphate, soap suds
- Evacuation induced by distended colon and mechanical lavage
11
Q
Which constipation treatments should you avoid in neutropenic or thrombocytopenic patients?***
A
suppositories and enemas
12
Q
Perineal self-acupressure
A
-2 fingaaaas to areas between anus and scrotum/vagina when the perceive urge to defecate
13
Q
Chronic Idiopathic Constipation (CIC)
A
- More common in elderly and women
- Infrequent BMs (<3x/wk)
- Straining
- Lumpy/hard stool
- Sensation of anal blockage or incomplete evac
- Need for manual maneuvers to aid in defecation
14
Q
Lubiprostone
A
- MOA: PG metabolite that acts locally in GI to open Cl channels on luminal surface of GI–> dec transit time
- Indications: CIC, IBS-C, OIC for non-cancer
- CI: pts with known or suspected mechanical obs and mod/severe gastroparesis**
- ADRs: dose-dependent nausea and diarrhea
15
Q
Linaclotide, Plecanatide
A
- MOA: guanylate cyclase-C receptor agonist
- Indications: CIC, IBS-C
- Pearls: mildly effective**, BBW < 18 (death), CI with obstruction
- ADRs: GI intolerance
