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OTC Exam 3 > Constipation > Flashcards

Constipation Flashcards

(56 cards)

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1
Q

Who is affected?

A
  • Affects 2-27% of American pop (underestimated)

* Women, elderly, and children = highest risk

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2
Q

Definition

A

3 or less stools/week

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3
Q

May lead to?

A

Hypertension, Arrhythmias, Rectal Prolapse, Hemarrhoids

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4
Q

Caused by which medical conditions?

A
  • IBS
  • Anal ulcers
  • Anal fissures
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5
Q

Caused by which meds?

A
  • Ca or Al antacids
  • Narcotic analgesics
  • Anticholinergics
  • Tricylclics
  • Some Ca channel blockers
  • Antispasmodics
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6
Q

Caused by which psych/physiologic conditions?

A

• Depression Slows GI movement

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7
Q

Caused by which lifestyle characteristics?

A
  • Menopause
  • Intake of fluids/Dehydration
  • Diet
  • Avoiding the Urge
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8
Q

Why in Advanced Age

A
  • Physiologic changes
  • Mult. med conditions
  • Mult. meds
  • lifestyle
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9
Q

Why in Pedes

A
  • Unavialable toilet facilites
  • Change in daily routine or environment
  • Decrease in fiber
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10
Q

Why in Women

A

*Medical conditions
*Hormonal changes
Slower transit time
*Pregnancy

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11
Q

Treatment Goals

A
  • Relieve constipation and reestablish normal bowel function
  • Establish dietary/exercise habits
  • Promote safe, effective use of laxatives
  • Avoid overuse of laxative products
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12
Q

General Treatment Approach

A
  • Lifestyle modifications
  • Do not ignore the urge
  • Laxatives
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13
Q

Lifestyle Modifications

A
  • High Fiber Diet (20-30gm/day)
  • increased water/fluids (32-128oz/day)
  • Exercise
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14
Q

Types of laxatives

A
  • Bulk Forming
  • Emollient
  • Lubricant
  • Saline (Osmotic)
  • Hyperosmotic
  • Stimulants
  • Miscellaneous
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15
Q

Exclusions to Self-treatment

A
  • Marked abdominal pain/cramping
  • Marked/unexplained flatulence
  • Fever
  • Nausea/vomiting
  • Paraplegia/Quadriplegia
  • Daily laxative use
  • Unexplained changes in bowel habits, especially if accompanied by wt. loss
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16
Q

Exclusions to Self-treatment cont.

A
  • Bloody/Black/Tarry stool
  • Change in caliber of stool
  • Any bowel sx that persist >2wks or recur >over 3 months
  • Any bowel sx that recur after dietary or lifestyle changes
  • Any bowel sx that recur after laxative use
  • History of IBD
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17
Q

Combo Products

A

Often a stimulant and stool softener

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18
Q

Visicol Function and dose

A

Sodium phosphate  take the evening before a coloscopy and repeat day of:
• 3 tabs with 8oz of clear liquids q15min for 20 tabs (last dose will be 2 tabs)

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19
Q

Visicol SE

A

Caution with acute phosphate nephropathy
Watery BM occurs an hour of starting
18 years and up
Need to be hydrated

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20
Q

Bulk-forming types

A
  • Methylcellulose
  • Carboxymethylcellulose sodium
  • Psyllium
  • Partially hydrolyzed gaur gum
  • Polycarbophil
  • Plantago seeds
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21
Q

Bulf-forming MOA and onset

A

Stool is bulked > Water rushes to the intestines and is retained > swelling occurs > peristalsis is stimulated
Onset: 12-24 hours, up 72 hours

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22
Q

Bulk-forming AE

A
  • Abdominal cramping
  • Flatulence
  • Esophageal obstruction

*if not mixed thoroughly with enough water, clumps may form in the esophagus

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23
Q

Bulk-forming recommendations

Study These Flashcards
A

• Initial therapy
• Geriatrics
• Pregnant women
*mimics normal physiologic mechanism for evacuation

24
Q

Bulk-forming interactions

Study These Flashcards
A

• Cellulose
> Oral anticoagulants
> Digitalis
> Salicylates

• Ca Polycarbophil
>Tetracyclines

25
Bulk-forming Contraindications
``` • narrowing or intestinal ulcerations > fecal impaction or intestinal obstruction • fluid restrictions >CHF >Kidney Failure • Phenylkeouria > neurologic changes ```
26
Bulk-forming cautions
* < 6 years old (cannot drink that much fluid) | * Diabetics (dextrose content)
27
Emollient Types
* Docusate Sodium (Colace®) * Docusate Calcium (Kaopectate®) *need to drink a lot of water
28
Emollient MOA and onset
Softens the fecal mass  pts do not strain Onset: 24-72 hours, up to 5 days
29
Emollient recommendations
* Geriatrics * Pts that do not have long-term constipation * Pre and post-operative pts where straining is undesirable
30
Emollient Contraindications
* <6 years old | * PTS with long standing constipation
31
Lubricant Types
• Mineral Oil (liquid petroleum)
32
Lubricant MOA and onset
Coats fecal matter Onset: 6-8 hr (oral) 5-15 min (rectal)
33
Emollient AE
• Lipid pneumonia • Oily stools   in accidents *seen with repeated/prolonged use
34
Emollient Interactions
* Fat-soluble vitamins | * Emollients ( lubricant’s absorption)
35
Emollient Contras
* <6 years old * Bedridden  lipid pneumonia * Pregnant women in Vit. K for fetus (needed for clotting)
36
Emollients Cautions
• Elderly  lipid pneumonia
37
Saline Laxatives (Osmotics) Types
* Mg citrate (Citroma) * Mg hydroxide (Phillips) * Mg Sulfate (Epsom Salt) * Dibasic Na phosphate (Phosphosoda) * Monobasic Na Phosphate (Fleet Enema) * Na Biphosphate (Fleet Enema)
38
SL MOA and onset
Ions draw water into intestine  intraluminal pressure Imotility Onset: 30min-3hrs (oral) 2-5min (rectal)
39
SL AE
* 20% of Na and H2O comes back into vasculature Na overload | * Acute phosphate nephropathy from oral Na phosphates
40
SL recommended
• PTS constipated >7 days • Acute evacuation is required endoscopy suspected poisoning
41
SL contras
* < 5 years old (oral) * <2 years old (rectal) * Pregnancy * Ileostomy or colostomy * Renal impairment * CHF
42
SL Cautions
* Na restricted diet | * Elderly (Na overload)
43
Hyperosmotic Types
• Glycerin • Polyethylene glycol (MiraLax) *mix in 4-8 oz of any beverage once daily for a max of 7 days
44
HO MOA and Onset
``` Draws H2O into the rectum/bowel Local irritant effect when given rectally Onset: 1-3 days (oral) 30 min (rectally) ```
45
HO recommended
* Glycerin in infants (cut in half length wise) * Polyethylene glycol used in 16 and older * PTS who do not like to drink water * PTS who do not want cramps or gas
46
Stimulants types and onset
``` • Sennosides and senna 6-12 hours (oral), up to 24 hours • Bisacodyl 6-10 hours (oral) 15-60 min (rectally) • Castor oil 2-6 hours (oral) ```
47
Stimulants MOA
Local irritation of the mucosa Sennosides and senna  inhibit H2O and electrolyte absorption from large intestine  intestinal pressure  motility Bisocoydal  acts on mucosal nerve plexus and causes contraction of the entire colon Castor oil  unknown
48
Stimulants AE
* Cathartic colon * Cramping * Loss Fluid
49
Stimulant Recommended
* Before radiologic or endoscopic exam * Before GI surgery * Tx of opiate induced chronic constipation * Bisacoydal – OK with Colostomy
50
Stimualnts Contras
• Pregnancy (3rd Trimester)
51
Stimulants Cautions
• Use sparingly in geriatrics
52
GG: Caution in
* Renal Failure – Mg * Cardiovascular Disease – Na * Diabetes – Dextrose
53
GG: Children
* < 2 yr old – no enemas * Avoid stimulants * Most effective may be diet and education about not holding it
54
GG: Advanced Age
* Bulk-forming preferred * Glycerin suppositories * Saline enemas for acute episodes * Caution with products that shift fluid and electrolytes (saline) * Caution about chronic use of stimulants (malabsorption/fluid loss)
55
GG: Pregnancy
* Diet modification * Bulk-forming preferred * Avoid stimulants and saline cathartics (Mg sulfate)
56
GG: Breastfeeding
* Stimulants OK | * Avoid saline cathartics  diarrhea and respiratory distress

OTC Exam 3 (6 decks)

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