Constipation

Question 1

What is constipation?

Answer 1

<3 bowel movements/week characterized by difficulty passage

Question 2

How long does ingested food retain in stomach?

Answer 2

3hrs

Question 3

Forceful increase in intra-abdominal pressure, initiated w/ an exhalation attempt against a closed glottis is also know as…

Answer 3

Valsalva maneuver

Question 4

What are some nonpharmacological Tx?

Answer 4

1. Fiber
2. 2L/day + 300ml for pregnant
3. Bowel training
4. Gastrocolic reflexes first thing in the morning and 30 min after meals

Question 5

Exclusions?

Answer 5

1. <2yrs old

2. Laxative use >7days

Question 6

What is the first line treatment?

Answer 6

Bulk-forming

Question 7

Psllium, methylcellulose, and calcium polycarbophil are considered…?

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 7

Bulk-forming

Question 8

MOA = dissolves and swells in intestinal fluids leading to peristalsis

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 8

Bulk-forming

Question 9

AE = flatulence, cramping, esophageal obstruction, acute bronchospasm

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 9

Bulk-forming

Question 10

Polyethylene glycol and glycerin are considered…?

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 10

Hyperosmotic

Question 11

MOA of Miralax (polyethylene)?

Answer 11

Draws water into rectum/bowel

Question 12

MOA of glycerin?

Answer 12

Evacuates lower bowel only

Question 13

Onset of Miralax?

Answer 13

1 to 3 days

Question 14

Onset of glycerin?

Answer 14

15 to 30 min

Question 15

Indication of Miralax?

Answer 15

Short term Tx for age ≥17

Question 16

Indication of glycerin?

Answer 16

Intermittent basis for all age groups

Question 17

AE of Miralax?

Answer 17

Bloating, cramping, flatulence

Question 18

AE of glycerin?

Answer 18

Rectal irritation w/ overdose

Question 19

Docusate sodium and Docusate calcium are considered…?

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 19

Emollients aka stool softeners

Question 20

MOA = facilitate mixing of aqueous and fatty substances to soften fecal matter

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 20

Emollient

Question 21

Indication = prevent straining and painful defecation

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 21

Emollient & Lubricant

Question 22

AE = diarrhea, mild abdominal cramp

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 22

Emollient

Question 23

Patient counseling = dont use longer than a week + often used with senna for opioid induced constipation

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 23

Emollient

Question 24

Mineral oil is considered…?

Bulk-forming
Hyperosmotic
Emollient
Lubricant
Saline
Stimulant

Answer 24

Lubricant

Question 25

MOA = coats stool and prevents colonic absorption of fecal water ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 25

Lubricant

Question 26

Avoid use with docusate ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 26

Lubricant

Question 27

Impairs absorption of Vit. A, D, E, K, and oral contraceptives ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 27

Lubricant

Question 28

AE = lipid pneumonia from aspiration + anal pruritis ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 28

Lubricant

Question 29

Patient counseling = dont use longer than a week + take on an empty stomach + dont use on children <6 yrs old + no use in pregnant women + no use in adults with difficulty swallowing ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 29

Lubricant

Question 30

Magnesium citrate, magnesium sulfate, magnesium hydroxide are considered....? ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 30

Saline

Question 31

MOA = draws water into intestine to increase intraluminal pressure and intestinal motility ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 31

Saline

Question 32

Indication = acute bowel evacuation ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 32

Saline

Question 33

Patient counseling = only for occasional use and quick onset of action ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 33

Saline

Question 34

What saline formulation should you avoid?

Answer 34

Magnesium sulfate aka Epsom salt

Question 35

What is the FDA MedWatch AE of sodium phosphate (in saline)?

Answer 35

Acute phosphate nephropathy

Question 36

MOA of Senna?

Answer 36

Increase intestinal motility

Question 37

MOA of Bisacodyl?

Answer 37

Acts on mucosal nerve plexus + causes contraction of entire colon

Question 38

Indication of use for Senna & Bisacodyl

Answer 38

Bowel prep & used with docusate for opioid induced constipation

Question 39

AE of Senna?

Answer 39

Urine discoloration

Question 40

Patient counseling of Senna?

Answer 40

Dont use longer than a week + take with water

Question 41

Patient counseling of Bisacodyl?

Answer 41

Do not crush, do not take within 1 hr of ingesting dairy, antacids, H2RAs, or PPIs

Question 42

Pregnant women should avoid which one? ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 42

Stimulants + saline

Question 43

No enemas to be given at what age?

Answer 43

<2yrs old

Question 44

Children should avoid...? ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 44

Stimulants

Question 45

Elderly should have caution against which kind..? ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 45

Stimulants

Question 46

When is opioid induced constipation used?

Answer 46

In noncancer and cancer pain

Question 47

MOA of opioid induced constipation?

Answer 47

Opioids bind to bowel and CNS receptors + decrease GI motility + drying stool

Question 48

What should you avoid when during an opioid induced constipation? ``` Bulk-forming Hyperosmotic Emollient Lubricant Saline Stimulant ```

Answer 48

Bulk-forming