lower GI- constipation

Question 1

normal BM frequency

Answer 1

=< 3 a week

Question 2

causes of constipation

Answer 2

low activity, low fiber, low carbs, low fluid intake, meds, cheese, putting off urge

Question 3

most constipating antacids

Answer 3

Al, then Ca

Mg loosens stools, Al/Mg usually balance each other out

Question 4

notable constipating meds

Answer 4

opioids, Al/Ca antacids, anti-cholinergics

Question 5

bulk laxatives onset

Answer 5

12-72 hours

Question 6

stimulant laxatives onset

Answer 6

6-12 hours

Question 7

saline laxatives

Answer 7

30 min-3 hours

Question 8

surfactant laxatives

Answer 8

24-72 hours

Question 9

lubricant laxatives

Answer 9

6-8 hours

Question 10

hyperosmotic laxatives

Answer 10

15 min-1 hour

Question 11

bulk laxatives MOA

Answer 11

• Nonabsorbable; expand and take up water; stimulate distension reflex and intestinal motility
• good first choice, safest to use

Question 12

bulk laxatives contraindications

Answer 12

GI obstruction

Question 13

bulk laxatives caution in:

Answer 13

• diabetics (has a lot of sugar)

- GI obstruction

Question 14

bulk laxatives types

Answer 14

polycarbophil, psyllium, methylcellulose

Question 15

stimulant laxatives MOA

Answer 15

• local irritation of intestinal tract, increase peristalsis, increase fluid secretion (usually the colon is an absorptive organ, this makes it secrete fluid instead)
• Generally, not laxative of first choice

Question 16

stimulant laxatives warnings

Answer 16

• casual use discouraged
• overuse damages physiologic neurologic colon function, becomes dependent on it
• “cathartic colon”

Question 17

stimulant laxatives types

Answer 17

senna, sennasides, castor oil, bisacodyl

Question 18

saline laxatives MOA

Answer 18

• High concentration of electrolytes - hypertonic state - osmotic gradient - draws water into colon - increased colonic pressure - stimulates movement
• Single dose or short term use

Question 19

saline laxatives warnings

Answer 19

CHF, HTN, renal failure

Question 20

saline laxatives types

Answer 20

• Phillips Milk of Magnesia
• Fleet Phospho-Soda
• Magnesium Citrate

Question 21

surfactant laxatives are actually

Answer 21

surfactants/emollients

Question 22

surfactant laxatives MOA

Answer 22

• Mild - increase fluid secretion, “wetting” agents; lowers surface tension, allowing water into fecal mass.
• Prevention rather than treatment

Question 23

surfactant laxative types

Answer 23

docusate

Question 24

docusate dose

Answer 24

100 mg is a placebo, use 250 mg

Question 25

lubricant laxatives MOA

Answer 25

• Oil - lubricates colon, rectum, anal canal allowing easier passage of hard stool.
• Limited utility - one time use

Question 26

lubricant laxatives warnings

Answer 26

seepage, fat-soluable vitamin malabsorption (vit A/D/E)

Question 27

lubricant laxatives types

Answer 27

mineral oil

Question 28

hyperosmotic laxatives MOA

Answer 28

Creates hyperosmotic envir- stretches mucosa, causes peristalsis, moves bowels

Question 29

hyperosmotic laxatives, glycerin use

Answer 29

• Short term, episodic use; pediatrics

- Suppositories (Fleet Babylax, Sani-Supp)

Question 30

hyperosmotic laxatives other types

Answer 30

• Sorbitol, lactulose

- Polyethylene glycol (PEG aka Miralax) +/- E-lytes

Question 31

probiotics and constipation

Answer 31

• support for bowel health
• No restrictions on length of use
• Dietary supplement

Question 32

referral

Answer 32

• blood in feces, concern for colorectal cancer
• N/V
• acute abdom pain
• fever
• 7-10 days duration
• unresponsive to adequate laxatives

Question 33

stim laxatives use

Answer 33

opioid induced constipation

bulk laxative isn’t going to do anything in colon is asleep

Question 34

referral, why N/V?

Answer 34

N/V means they have complete obstruction, food won’t go out either direction