Constipation

Question 1

Constipation
Less than 3 bowel movements/ week characterized by strain, passage of hard, dry stools
2-28% of population

Question 2

Constipation

Usually results from abnormally slow movement of feces through colon & accumulates in descending colon

Untreated may lead to hemorrhoids, anal fissures, rectal prolapse, fecal impaction

Question 3

Treatment of Constipation
Relieve constipation & reestablish normal bowel fxn
Establish dietary & exercise habits that aid in preventing recurrences
Promote safe & effective use of lax
How long? ______________

Answer 3

less than 7 days

Question 4

Pharmacologic Therapy for Constipation
Classified by MOA
Bulk forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Question 5

Clinical presentation of constipation: difficulty passing the stool…bowel movement frequency will be different than there normal so again its their baseline and whats happening now and may complain of anorexia where they don’t want to eat anything,dull headache, low back pain, abdominal discomfort, bloating,gas, they may have psychosocial distress because its stressful when somebody is not regular and complaints of constipation

Question 6

Bulk-Forming Agents
Methylcellulose, polycarbophil, psyllium
Most closely approximate physiologic mech on promoting
evacuation
Dissolve or swell in intestinal fluid of intestines- stim
peristalsis
Not absorbed systemically & do not interfere with
absorption of nutrients
Onset?_______________________
* CHOKING!
Separate meds by ? ________hours

Answer 6

onset is 12 to 24 hours so half a day to a day up to 72 hours so up to 3 days

2 hours

Question 7

Metamucil

Start with 1 serving per day
Two rounded teaspoons in 8oz of water with meals up to 3 times; used to make you feel less hungry

Question 8

Hyperosmotic Agents

Draw water into colon/ rectum thru osmosis to stimulate BM
PEG 3350: 17 grams in 4-8 oz water
Onset 12-72 hours up to 96 hours
First-line option

This can used regularly especially someone on opioids

Only recommended for what age?

Answer 8

17 years and older

Question 9

Hyperosmotic agents
Glycerin
15-30 minutes
**SUPP safe in all groups
Side Effects: min w/ glycerin

Question 10

Side effects are minimal with glycerin or miralax

Question 11

Miralax

Measure cap at ____grams of powder

Use once a day no more than 7 days

Question 12

___________________

Stool softeners

Anionic surfactants act in intestines to increase wetting
efficacy of intestinal fluid as well as facilitate a mix of aq
and fatty substances to soften fecal matter=______________

Prevent straining & painful defecation
Combo w/ stimulant for long term tx
Onset: 12-72 hours up to 3-5 days
_________+: 1-3 caps daily

Answer 12

Emollient Agents

Slippery

12years+

Question 13

Colace aka Docusate sodium

Another product docusate calcium aka SURFAK

Safe to use everyday somebody who is on iron is a good candidate for emollient agent because iron can cause constipation or someone who is post surgery

Take with plenty of ___________

Answer 13

water

Question 14

Colace (an emollient agent) is NOT a stimulant agent

Question 15

Lubricant Agent

Question 16

_____________ might be 30 minutes which is quick…used before a colonoscopy test

Answer 16

Magnesium citrate

Question 17

Philips Milk of Mag at 3 to 6 hours

Question 18

Fleet enema onset is 2 to 15 minutes to produce a bowel movement…we worry about electrolyte imbalances so we might see hypomagnesemia which results in hypotension, muscle weakness and fatigue

Question 19

First line treatment will be ____________ for most simple constipation cases then a second choice would be Dulcolax

Answer 19

miralax

Question 20

(Senna can cause cramping in pts so we won’t always recommend this one first)

Question 21

We want to make sure pt uses stimulants for least amount of time…smallest dose for the least amount of time because your bowels can get use to stimulant laxatives and then they would loose their own ability to have a sense of needing to go and having the ability to go and sometimes these are abused

Question 22

A bisacodyl suppository takes 15 to 60 minutes to work…it’s a quick option for pts however pts prefer an oral agent

Question 23

Always start with 1 tablet first 😊

What is active ingredient in Dulcolax? 600mg ______________ (saline laxative)
30 minutes to 6 hours

Answer 23

magnesium hydroxide

Question 24

Saline Laxative Agents
Mag citrate, mag hydroxide, mono-&dibasic sodium
phosphate, mag sulfate
Ions retained in intestinal wall & draw water in by osmosis
increase intraluminal pressure & intestinal motility
Oral onset: 30 min-3 hrs- 6 hrs
Rectal: 2-15 min

Electrolyte imbalances: hypermagnesemia (hypotension,
muscle weakness, fatigue)
& Sodium phosphate- ___________________, hypocalcemia,
hypernatremia

Answer 24

hyperphosphatemia

Question 25

______________

Mineral oil
* Soften fecal contents in colon by coating stool & preventing colonic
absorption of fecal water
* Onset: 6-8 hours after oral (5-15 min rectal)
** DON’T recommend there are safer agents**
Anal leakage of oil, lipid pneumonia
Impair A, D, E, K absorption

Answer 25

Lubricant Agent