Constipation - Choices

Question 1

Opioid induced constipation

Answer 1

Osmotic OR Docusate + Stimulant

Question 2

Opioid induced constipation (palliative care ONLY)

Answer 2

Co-danthramer
Co-danthrusate

Question 3

Opioid induced constipation - inadequate response

Answer 3

Methylnaltrexone/naloxegol
Opioid reeptor antagonist.
Reverses constipating effects without affecting CNS effects

Question 4

Opioid induced constipation - AVOID

Answer 4

Bulk-forming laxatives
Causes obstruction + painful colic

Question 5

Chronic constipation

Answer 5

Same stepped approach as short duration BUT macrogol is osmotic laxative of choice.

Question 6

Constipation - children

Answer 6

1st line = macrogol
- Add stimulant if inadequate response
- Add lactulose or faecal softener if stools remain hard (docusate)

Question 7

Constipation - pregnancy

Answer 7

1st line = bulk-forming
Hard stools = add osmotic laxative
Soft but difficult to pass = Senna or Bisacodyl
Avoid at term, can stimulate contractions

Question 8

Constipation - breastfeeding

Answer 8

1st line = bulk-forming
Hard stools = add osmotic laxative or macrogol
Alternative = stimulant laxatives