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Constipation Flashcards

1
Q

Constipation is defined as having…

A

fewer than 3 bowel movements per week

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2
Q

Patients describe constipation as…

A
  • straining to have bowel movement
  • passing hard, dry stools
  • passing small stools
  • feeling as though evacuation is incomplete
  • decreased stool frequency
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3
Q

Causes of constipation:

A
  • medical conditions
  • psychological conditions
  • lifestyle characteristics
  • medication induced
  • age related changes in gut motility
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4
Q

Medical conditions that cause constipation:

A
  • multiple sclerosis
  • parkinsonism
  • stroke
  • dementia
  • irritable bowl syndrome
  • diabetes
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5
Q

Psychological conditions that cause constipation:

A
  • depression
  • eating disorders
  • stress
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6
Q

Lifestyle characteristics that cause constipation:

A
  • immobility
  • no exercise
  • poor nutrition
  • reduced fluid intake
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7
Q

Medication that induces constipation:

A
  • Ca2+ channel blockers (verapamil)
  • opiates
  • NSAIDs
  • antacids (aluminum/calcium)
  • tricyclic antidepressants
  • diuretics
  • anticholinergics
  • antihistamines
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8
Q

What is the initial management of constipation?

A

adjust diet

  • foods in high fiber
  • increase fluid intake
  • engage in exercise
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9
Q

Self-care laxatives should not be taken for more than…

A

7 days

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10
Q

Exclusions to OTC:

A
  • < 2 YO
  • marked abdominal pain or significant distention
  • fever
  • nausea, vomiting
  • sudden change in bowel movements for 2 weeks
  • dark, tarry stool or presence of blood
  • history of inflammatory bowel disease, chron’s disease, ulcerative colitis, paraplegia
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11
Q

Non-pharmacological therapy:

A
  • balanced diet
  • drink 2 L of water QD
  • obtain regular aerobic exercise
  • fiber
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12
Q

A balanced diet includes…

A
  • increase in fruits and veggies
  • consume half of all grains as whole grains
  • limit intake of cheese, meat, and processed foods
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13
Q

Why does dietary fiber work for constipation?

A
  • dissolves or swells in intestinal fluid
  • increases bulk of fecal mass
  • stimulates peristalsis and eliminates stools
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14
Q

Dosage for dietary fiber:

A
  • females: 25 g

- males: 38 g

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15
Q

Fiber supplements are not the same as…

A

bulk-forming laxatives

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16
Q

Pharmacologic therapies:

A
  • bulk-forming laxatives
  • hyperosmotics
  • emollients
  • lubricants
  • saline agents
  • stimulants
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17
Q

Examples of bulk-forming laxatives:

A
  • methylcellulose (citrucel)
  • polycarbophil (fibercon)
  • psyllium (metamucil)
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18
Q

Which pharmacologic therapy is the recommended initial therapy?

A

bulk-forming laxatives, because it closely mimics the physiological evacuation process

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19
Q

Does the 7 day use limitation apply to bulk-forming laxatives?

A

No because they are often used for preventative purposes

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20
Q

Onset of action for bulk-forming laxatives:

A

72 H

- not systemically absorbed

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21
Q

Bulk-forming laxatives are not appropriate for patients…

A

who have to restrict their fluid intake

- like patients who have heart failure

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22
Q

Adverse effects of bulk-forming laxatives:

A
  • abdominal cramping

- flatulence

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23
Q

Counseling points of bulk-forming laxatives:

A
  • not for < 6 YO

- choose sugar-free agents if diabetic or carb/calorie restricted diet

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24
Q

Examples of hyperosmotics:

A
  • polyethylene glycol 3350 (PEG 3350/miralax)

- glycerin

25
Polyethylene glycol 3350 (PEG 3350/miralax) dosage:
17 g per capful in 4-8 oz of beverage daily for adults > 17 YO
26
Onset of polyethylene glycol 3350 (PEG 3350/miralax):
produces bowel movement within 12-72 H
27
Glycerin is available as...
rectal suppositories to produce bowel movements within 15-30 minutes
28
Glycerin is safe for occasional use in...
all age groups
29
Examples of emollients:
- docusate sodium (colace) | - docusate calcium
30
Onset of action for emollients:
12-72 H
31
Emollients should be used in people older than...
2 YO
32
Emollients is frequently used with _____ for long term treatment for opiate induced constipation
a stimulant like senna or bisacody | - tolerance doesn't develop
33
Example of lubricants:
mineral oil
34
Lubricants are strongly...
discouraged due to other safer options
35
Excessive dosage of lubricants increases the possibility of...
- loss of fat-soluble nutrients (ADEK) from GI tract | - enhances likelihood of product aspriation
36
Lubricants should be avoided in patients taking...
- anticoagulants - bedridden patients - individuals with swallowing difficulties
37
Examples of saline agents:
- magnesium hydroxide (Phillips Milk of Magnesia) - magnesium citrate - sodium phosphate (Fleet-phospho-soda)
38
Saline agents are also used for...
acute bowel evacuation before procedures like colonoscopy
39
Onset of action for saline agents:
- 30 min to 6 H for oral doses | - 2 to 15 min for rectal doses
40
Saline agents can cause...
serious electrolyte imbalances if used long term or at higher than recommended doses
41
Adverse effects of saline agents:
- abdominal cramping - nausea/vomiting - dehydration
42
You should take saline agents doses with...
water to prevent dehydration
43
Examples of stimulants:
- senna or sennosides (ex-lax, senokot) - bisacodyl (dulcolax) - castor oil
44
Onset of action for stimulants:
6-10 H but might need 24 H
45
Suppository stimulants take effect in...
15-60 min
46
Adverse effects of stimulants:
- severe cramping - electrolyte/fluid deficiencies - hypokalemia
47
Stimulants are subjected to...
overuse
48
Which product has the strongest support for efficacy and safety?
PEG 3350 | - if it doesn't work, then should use stimulant
49
Counseling points for laxatives:
- take at bedtime | - avoid taking them within 2 H of other medications
50
Mild constipation for children should be relieved with...
dietary or behavioral modifications - increase intake of fluids and fruit juices - increase high fiber cereals or grains, veggies, or fruits (age+5g/day)
51
For ages 2-6, they should take...
- docusate sodium or magnesium hydroxide - faster relief: pediatric glycerin suppositories - oral senna when everything else fails
52
For ages 6-12, they should take...
- bulk-forming agents - docusate sodium - magnesium hydroxide - when all fails: glycerin suppositories/oral stimulants
53
Elderly have a greater risk of constipation due to...
- reduced caloric, fiber, and/or fluid intake - decreased physical activity - have comorbidities - increased use of meds
54
1st step medical therapy for elderly:
- bulk-forming | - PEG 3350
55
What should elderly people avoid?
- mineral oil - saline laxatives - stimulants
56
What should be the initial measure for pregnant women?
dietary measures
57
Common first-line choice for pregnant women:
bulk-forming laxatives
58
If needed, short term use of _______ is okay for pregnant women
senna or bisacodyl

OTC (23 decks)

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