Laxatives Flashcards
Management chronic constipation
Counselling 1. advice on lifestyle measures
increasing dietary fibre
ensuring adequate fluid intake
ensuring adequate activity levels
Pharmacological
first-line laxative: bulk-forming laxative first-line, such as ispaghula
second-line: osmotic laxative, such as a macrogol
Stimulant laxative eg senna
if frail, consider softner first
when should you stop taking laxatives?
Advise the person to gradually reduce and stop laxatives once the person is producing soft, formed stool without straining at least three times per week.
Management opiod induced constipation
- Osmotic laxative eg lactulose PLUS stimulant laxative eg senna
Management acute constipation eg recent illness, immobility etc
- Senna (stimulant)
Management ibs constipation
- Docusate (softener)
what laxative should you avoid ibs
lactulose
what laxatives should you avoid opioid induced
Do not prescribe bulk-forming laxatives.
specialist management of refractory constipation
prucalopride (specialist prescribed)
consider if at least two laxatives from different classes have been tried at the highest tolerated recommended doses for at least 6 months, and failed to relieve symptoms, where invasive treatment (such as suppositories, enemas, rectal irrigation and/or manual disimpaction) is being considered.
name a bulk forming laxative
ispaghula husk
name a softner laxative
docusate
name 2 stimulant laxative
senna
bisacondyl
name 2 osmotic laxative
macrogol
lactulose
when to not prescribe bulk forming
flatulence and bloating. Excessive doses or inadequate fluid intake may cause intestinal obstruction.
consideration macrogol
Macrogol laxatives can cause medications taken one hour before, during and one hour after to be flushed out of the gastrointestinal tract unabsorbed which includes contraceptive pills.
should you use two laxatives at the same time
NOT of same class
YES of different classes (synergistic
what to consider if diarrhoea on laxatives
impaction and overlfow
second line chronic constipation (after bulk forming)
add macrogol
Management faecal loading
- Macrogol (osmotic)
- Add oral stimulant eg senna
- Enema or suppository
A suppository such as bisacodyl for soft stools; glycerol alone, or glycerol plus bisacodyl for hard stools.
A mini enema such as docusate (softener and weak stimulant) or sodium citrate (osmotic).
