Constipation and Diarrhoea

Question 1

TX for acute diarrhoea

Answer 1

ORT to correct dehydration

Question 2

TX for travelers diarrhoea/ if rapid control is needed?

Answer 2

Loperamide

Question 3

TX for faecal incontinence

Answer 3

Loperamide

Question 4

What is the licensing age for loperamide?

Answer 4

OTC: 12 years+
Prescription: 4 years+

Question 5

What is the OTC dosing for loperamide?

Answer 5

Take 1-2 doses (2-4mg) at first, then one with every loose stool, MAX 8 doses (16mg) per day

Question 6

what is the MHRA warning for loperamide?

Answer 6

QT prolongation with high doses

Question 7

Loperamide overdose treatment

Answer 7

Naloxone

Question 8

Constipation red flags

Answer 8

Blood in stool
Anaemia
Abnormal pain
Weight loss
New onset of constipation if over 50

Question 9

First line non-drug treatment for constipation

Answer 9

1. Increase fibre
2. Increase water
3. Increase exercise
   + review meds that may be causing it
   - opioids (codeine), clozapine

Question 10

Bulk forming laxatives examples

Answer 10

Methylcellulose
Ispaghula husk
Sterculia

Question 11

Bulk forming laxatives
- MOA
- Onset of action
- Counselling point

Answer 11

MOA: increases faecal mass to stimulate peristalsis
Onset of action: 2-3 days
Always take with plenty of WATER to prevent intestinal blockage

Question 12

Stimulant laxative examples

Answer 12

Bisacodyl
Sennna

Question 13

Stimulant laxatives
- MOA
- Onset of action
- Avoid in…

Answer 13

MOA: Stimulate colonic nerves causing peristalsis
Onset of action: 6-12 hours
Avoid in intestinal obstruction

Question 14

What type of laxatives are Co-Danthramer and Co-danthrusate?
- What colour do they turn urine?

Answer 14

Stimulant laxatives reserved for terminal illness only
- they are carcinogenic
Turn urine RED

Question 15

What are the two effects of docusate and glycerol?

Answer 15

They both have a dual mechanism of action being
- stimulant
- stool softeners

Question 16

Examples of osmotic laxatives

Answer 16

Lactulose and macrogol

Question 17

Osmotic laxative
- MOA
- Onset of action
- Counselling point

Answer 17

MOA: increases amount of fluid in the large bowel to stimulate peristalsis
Takes 2-3 days to work
They also have stool softening properties

Question 18

TX short duration constipation

Answer 18

Bulk forming + good hydration
- osmotic if not cleared

Question 19

TX for chronic constipation

Answer 19

1. Bulk-forming + hydration
   - If stool remains hard -> add or change to macrogol (or lactulose)
   - if no change in 6 months for WOMEN -> prucalopride (CAN BE USED IN MEN AS OF 21/01/25)
   - withdraw lactulose slowly when patient improves