Constipation (Parts 1 & 2 - COMBINED)

Question 1

Constipation - what are the symptoms commonly experienced by patient?

Answer 1

• Abdominal bloating,
• cramping,
• discomfort, or pain,
• feeling of incomplete evacuation of stool

Question 2

According to JAMP (2011), suffering from constipation impacts QoL and has been comparable to serious chronic conditions such as ________ and _______.

Answer 2

Osteoarthritis and diabetes.

Question 3

Aside from symptoms, what are other ways in which healthcare providers will base their definition or diagnosis of constipation?

Answer 3

Based on the number of stools/week.

Question 4

T/F: Caution should be applied to avoid anticholinergic medications in patients at risk for opioid-induced constipation.

Answer 4

True!

Caution should be applied to avoid anticholinergic medications in patients at risk for opioid-induced constipation due to their potential to exacerbate constipation symptoms.

• Especially important to note for those in palliative care, cancer patients, and the elderly.

Question 5

How is Constipation typically defined (in general)?

Answer 5

Less than 3 BM per week accompanied by other symptoms including hard stools; feeling of incomplete evacuation; excessive straining; a sense of rectal blockage; and abdominal discomfort, bloating and distention

Question 6

How is constipation generally defined?

a) Defecation more than 3 times per week

b) Defecation fewer than 3 times per week

c) Defecation exactly 3 times per week

d) Defecation once every 2 days

e) When daily bowel movements (or every other day) is not achieved on a normal basis

Answer 6

b) Defecation fewer than 3 times per week

Some patients incorrectly believe that a daily bowel movement is necessary and that anything less means they are constipated. “Normal” frequencies in BM can range from daily, EOD, to even just 3x per week.

Question 7

T/F: Individuals have a considerable higher risk of constipation with each advancing state of renal failure and should be monitored carefully.

Answer 7

True!

There are many factors that influence this outcome for those affected with kidney diseases, including:

• Fluid and electrolyte imbalances
• Medications (both the kinds of drugs and the number of medications being used)
• Dietary restrictions
• Decreased mobility and/or ability to complete physical activity

Question 8

What are some symptoms commonly associated with constipation?

a) Loose stools
b) Feeling of complete evacuation
c) Excessive straining
d) A sense of rectal openness

Answer 8

c) Excessive straining

Question 9

T/F: Some patients mistakenly believe that a daily bowel movement is necessary.

Answer 9

True!

Question 10

The most important preventive measure for hemorrhoids is to avoid _____ constipation, which may include hard and infrequent stools.

Answer 10

Chronic

Question 11

The average number of bowel movements for adults and children 3 years of age and older in the Western world varies from ______ daily to ______ every 3 days.

a) 3; 2
b) 1; 1
c) 3 ; 1
d) 2; 3

Answer 11

c) 3 ; 1

Some patients incorrectly believe that a daily bowel movement is necessary and that anything less means they are constipated. In fact, the average number of bowel movements for adults and children 3 years of age and older in the Western world varies from 3 daily to 1 every 3 days. Each person’s “normal” can vary.

Question 12

Chronic constipation may lead to serious complications such as _______, fecal impaction, anal ______, ______ , megacolon, and ______ organ prolapse in women.

Answer 12

Obstruction ; [Anal] Fissures; Hemorrhoids

Question 13

T/F: Constipation can be a symptom secondary to various factors such as drugs or diseases that affect the normal functioning of the gut.

Answer 13

True!

Along with secondary links mentioned, note that constipation that occurs chronically that does not have drug, anatomic or physiologic causes is termed functional or chronic idiopathic constipation.

Question 14

The Bristol Stool Form Scale (BSFS)

Answer 14

A tool to help patients describe bowel patterns in a way that is more useful for diagnosis and evaluation of treatment

Question 15

Which types on the Bristol Stool Form Scale indicate constipation?

a) Types 3–4
b) Types 1–2
c) Types 5–7
d) Types 1–3

Answer 15

b) Types 1–2

Question 16

Which type on the Bristol Stool Form Scale represents the more ideal stool consistency for ease and comfort?
a) Type 1
b) Type 2
c) Type 3
d) Type 4
e) None of the above

Answer 16

d) Type 4

Although Types 3 and Types 4 both consistent of ideal stool consistencies, Type 4 is the one that is smooth and probably the easiest kind to pass.

Question 17

Approximately ___% of our immune system is located in out gut.

Answer 17

70%

Question 18

The _______ of different factors within the gastrointestinal (GI) system, such as the ________ muscles in the intestines plays a crucial role in regulating bowel movements.

Answer 18

Interplay ; Smooth

Question 19

Physiology of the Gut - Constipation: Intestinal Smooth Muscle -

The contraction and relaxation of intestinal smooth muscles are essential for moving ______ and _____ through the ______.

Answer 19

[moving] FOOD and WASTE through the DIGESTIVE TRACT.

Question 20

Physiology of the Gut - Constipation: Intestinal Smooth Muscle -

________ Nervous System activity stimulates motility, promoting bowel movements.

In contrast, ______ nervous system activity inhibits motility, which can contribute to constipation.

Answer 20

Parasympathetic ; Sympathetic

Question 21

Physiology of the Gut - Constipation: Intestinal Smooth Muscle -

Parasympathetic Nervous System activity stimulates motility, promoting __________ . In contrast, sympathetic nervous system activity inhibits motility, which can contribute to constipation.

Answer 21

Bowel Movements (BMs)

Question 22

Physiology of the Gut - Constipation: Intestinal Smooth Muscle -

Parasympathetic Nervous System activity _____ motility, promoting bowel movements.

Answer 22

Stimulates

Question 23

Physiology of the Gut - Constipation: Intestinal Smooth Muscle -

Parasympathetic Nervous System activity stimulates motility, promoting bowel movements.

In contrast, Sympathetic Nervous System activity ______ motility, which can contribute to constipation.

Answer 23

Inhibits

Question 24

Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones

Various hormones produced in the GI tract regulate ______ and _____.

Answer 24

Digestion and Motility

Question 25

Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones These hormones influence the movement of food through the digestive system and can affect bowel _______. Imbalances in these hormones may contribute to constipation.

Answer 25

Habits

Question 26

Physiology of the Gut - Constipation: Intestinal Smooth Muscle - GI Hormones These hormones influence the movement of food through the digestive system and can affect bowel imbalances. Imbalances in these hormones may contribute to _______.

Answer 26

Constipation

Question 27

Which of the following statements regarding the timing of the gastro-colic reflex is true? a) The gastro-colic reflex occurs immediately after the first meal of the day. b) The gastro-colic reflex typically occurs about 1 hour after consuming food. c) The most optimal timing for the gastro-colic reflex is approximately 30 minutes after the first meal of the day. d) The gastro-colic reflex is not influenced by the timing of meals.

Answer 27

c) The most optimal timing for the gastro-colic reflex is approximately 30 minutes after the first meal of the day.

Question 28

Which division of the autonomic nervous system is responsible for inhibiting gastrointestinal motility and secretion during the "fight or flight" response? a) Parasympathetic nervous system b) Sympathetic nervous system c) Enteric nervous system d) Somatic nervous system

Answer 28

b) Sympathetic nervous system

Question 29

Which of the following is NOT a function of the parasympathetic nervous system in regulating gastrointestinal (GI) activity? a) Stimulating peristalsis b) Increasing saliva production c) Relaxing the lower esophageal sphincter d) Inhibiting gastric acid secretion

Answer 29

d) Inhibiting gastric acid secretion

Question 30

Which hormone stimulates the secretion of gastric acid and increases gastric motility? a) Gastrin b) Secretin c) Cholecystokinin (CCK) d) Ghrelin

Answer 30

a) Gastrin

Question 31

Physiology of the Gut - Constipation: Intestinal Smooth Muscle - Influence of Neurotransmitters... The gut contains a significant amount of ______, a neurotransmitter involved in regulating mood and behaviour.

Answer 31

Serotonin (also known as 5-HT)

Question 32

What role does the neurotransmitter, Serotonin (5-HT), have on the GI functions?

Answer 32

- Regulates motility. - Alterations in serotonin levels or signalling in the gut can impact bowel movements and contribute to constipation. ***Keep this in mind when discussing about diarrhea, as well as IBS, IBD and other related conditions in both this class and in PHAR 123 later on FYI ****

Question 33

In the event of constipation, serotonin levels are usually _______ a) Increased b) Decreased

Answer 33

b) Decreased 5-HT [serotonin] = Constipation (increased serotonin is usually affiliated with diarrhea)

Question 34

Alterations in _______ levels or signalling in the gut can impact bowel movements and contribute to constipation.

Answer 34

Serotonin

Question 35

Physiology of the Gut via Intestinal Smooth Muscles: Central Nervous System (CNS) ~ e.g., emotions Emotions and stress can influence GI function through the ________.

Answer 35

Gut-Brain Axis

Question 36

The Gut-Brain Axis involves _____ communications between the gut and the brain. Whereas the Gastro-Colic Reflex is a _____, reflexive response triggered by stretching of the stomach, and it does not involve bidirectional communication between the gut and the brain.

Answer 36

Complex ; Simple

Question 37

Physiology of the Gut via Intestinal Smooth Muscles: ________ ~ e.g., emotions The CNS can modulate gut motility and sensation, affecting bowel habits. Psychological factors such as anxiety or depression can exacerbate constipation or contribute to its development.

Answer 37

Central Nervous System (CNS) The CNS can modulate gut motility and sensation, affecting bowel habits. Psychological factors such as anxiety or depression can exacerbate constipation or contribute to its development.

Question 38

Physiology of the Gut via Intestinal Smooth Muscles: Central Nervous System ~ e.g., emotions The CNS coordinates how the body system will respond or behave based on the combined information coming in about emotions, movements, thoughts, as well as things like HR, and homeostasis. Psychological factors such as anxiety or depression can ______ constipation or contribute to its ______.

Answer 38

Promote; Development

Question 39

T/F: The gut-brain axis can be influenced by factors like stress, emotions, and dietary choices.

Answer 39

True! The gut-brain axis is sensitive to various factors such as stress, emotions, and dietary choices, which can influence its function and the communication between the gut and the brain.

Question 40

What triggers the gastro-colic reflex? a) Release of neurotransmitters b) Stretching of the stomach c) Activation of the vagus nerve d) Increase in blood glucose levels

Answer 40

b) Stretching of the stomach The gastro-colic reflex is triggered by the stretching of the stomach when food enters it. This stretching signals the colon to start moving and make room for incoming food.

Question 41

T/F: The gastro-colic reflex is a complex network of communication involving hormones, neurotransmitters, and nerves.

Answer 41

False! The gastro-colic reflex is a relatively SIMPLE reflexive response triggered by stretching of the stomach and does not involve the complex network of communication seen in the gut-brain axis. It primarily involves activation of nerves in the gastrointestinal tract when eating and digesting.

Question 42

Constipation: Physiology of the Gut: This reflex involves the stimulation of colonic motility following the consumption of food. The presence of food in the stomach triggers contractions in the colon, facilitating the movement of waste through the digestive tract. Disruption of this reflex can lead to constipation.

Answer 42

Gastro-Colic Reflex The gastro-colic reflex is like a signal from your stomach to your colon, telling it to get ready for more food coming down the line. When you eat, your stomach starts to stretch as it fills up. This stretching triggers a reflex that stimulates movement in your colon, which helps push out any waste that's already there to make room for the new food. It's like your body's way of clearing the runway for the next meal!

Question 43

Some people might have the urge to poop very soon after eating and some people might assume the food they just ate is being immediately evacuated out of them. Is this a true statement?

Answer 43

No. Even though it might feel like this, it is not true because it takes approx. 1-2 days before food travels through the entire GI tract. If they poop after eating, it's likely because they are passing the food that was eaten a few days ago.

Question 44

The need or urgency to poop shortly after eating a meal is likely associated with the ______.

Answer 44

Gastro-Colic Reflex (and urgency depending on individual intensities of their reflex system).

Question 45

What is the most optimal time for the gastro-colic reflex to occur from the time of eating first meal of the day?

Answer 45

30 minutes after first meal of the day is the most optimal for the gastro-colic reflex.

Question 46

Patient L.T. has a spinal cord injury at the thoracic level presents with constipation. Which of the following mechanisms is primarily responsible for the constipation in this patient? a) Increased parasympathetic activity b) Decreased sympathetic activity c) Impaired serotonin signalling d) Disruption of the gastro-colic reflex

Answer 46

d) Disruption of the gastro-colic reflex Spinal cord injuries can disrupt neural pathways involved in the gastro-colic reflex, leading to impaired colonic motility and constipation.

Question 47

A 50-year-old patient with a history of depression presents with chronic constipation. Which of the following factors is most likely involved in the pathophysiology of constipation in this patient? a) Increased parasympathetic activity b) Decreased sympathetic activity c) Dysregulation of GI hormones d) Impaired gastro-colic reflex

Answer 47

c) Dysregulation of GI hormones Depression can affect the secretion and function of GI hormones, leading to alterations in gut motility and contributing to constipation.

Question 48

Constipation & the Physiology of the Gut: Understanding the different Nervous Systems involved in the GI tract.... __________ - Stimulates gut motility and promotes bowel movements. ________ - Inhibits gut motility and therefore illicit constipation. _______ - triggers somatic states based on rounding up the information gathered from controlling thought, movement, and emotion, as well as breathing, heart rate, hormones, and body temperature and coordinates the activity within the body.

Answer 48

Parasympathetic Nervous System; Sympathetic Nervous System; Central Nervous System

Question 49

Which of the following is a characteristic of the gut-brain axis? a) Unidirectional communication from the gut to the brain only b) Simple reflexive response triggered by stomach stretching c) Involvement of hormones, neurotransmitters, and nerves d) Activation primarily by psychological stressors

Answer 49

c) Involvement of hormones, neurotransmitters, and nerves The gut-brain axis involves complex communication between the gut and the brain, including the release of hormones, neurotransmitters, and activation of nerves to influence various physiological functions.

Question 50

Physiology of the Gut via Intestinal Smooth Muscles: Which of the following nervous systems is responsible in stimulating motility and therefore promoting bowel movements? a) Central Nervous System b) Enteric Nervous System c) Parasympathetic Nervous System d) Sympathetic Nervous System e) Both b and c f) Both b and d

Answer 50

c) Parasympathetic Nervous System * Stimulates Motility and therefore promotes BMs

Question 51

Physiology of the Gut via Intestinal Smooth Muscles: Which of the following nervous systems is responsible in the inhibition of gut motility and therefore influencing constipation? a) Central Nervous System (CNS) b) Enteric Nervous System c) Parasympathetic Nervous System d) Sympathetic Nervous System e) Both b and c f) Both b and d

Answer 51

d) Sympathetic Nervous System "These mechanisms, being involuntary in nature, are under the control of the sympathetic nervous system; consequently the primary cause of the constipation must be sought for in some inhibitory influence acting on any or all of the mechanisms referred to." doi:10.1001/jama.1900.24610210012001c

Question 52

T/F: Drugs that block muscarinic receptors in the GI tract are likely to increase gastrointestinal motility.

Answer 52

True! Muscarinic receptors are a type of receptor that responds to the neurotransmitter acetylcholine, which is released by nerves in the GI tract. Activation of muscarinic receptors by acetylcholine stimulates smooth muscle contraction and promotes GI motility.

Question 53

Physiology of the Gut - Constipation: Intestinal Smooth Muscle - Parasympathetic Nervous System activity stimulates motility, promoting bowel movements. In contrast, Sympathetic Nervous System activity inhibits motility, which can contribute to _______.

Answer 53

Constipation

Question 54

The gut-brain axis can be thought of like a phone line them, allowing them to ______ messages. This connection influences how your gut works, like how it _______, absorbs nutrients, and even affects your ______ and emotions. So, basically, it's the link between your gut and your brain that helps them communicate and affect each other's functions.

Answer 54

EXCHANGE messages; DIGEST FOOD; Affects your MOOD and EMOTIONS.

Question 55

Patient "J.J." recently started taking a new medication and complains of constipation. The medication is known to have anticholinergic effects. Which of the following mechanisms is likely responsible for the constipation seen in this patient? a) Increased parasympathetic activity b) Decreased sympathetic activity c) Inhibition of GI hormones d) Suppression of the gastro-colic reflex e) Impacts on the gut-brain axis

Answer 55

d) Suppression of the gastro-colic reflex Anticholinergic medications inhibit parasympathetic activity, leading to decreased GI motility and suppression of the gastro-colic reflex, which can result in constipation.

Question 56

The gastro-colic reflex is a natural physiological response that occurs after eating, particularly after the first meal of the day. Why is 30 minutes after consuming first meal of the day the most optimal in most cases?

Answer 56

Because the stomach is filling up with food, and the reflex helps to stimulate movement in the colon, aiding in the propulsion of waste and making room for incoming food.

Question 57

Ada presents with chronic constipation and reports a history of frequent use of antacid medications for heartburn. Which of the following mechanisms is likely contributing to the constipation in this patient? a) Enhanced parasympathetic activity b) Reduced sympathetic activity c) Dysregulated gut-brain axis d) Excessive serotonin production e) Supression of the gastro-colic reflex

Answer 57

c) Dysregulated gut-brain axis Prolonged use of antacid medications can disrupt the gut-brain axis, affecting communication between the gut and the central nervous system, which may lead to constipation.

Question 58

The gut-brain axis influences: a) Only digestion and nutrient absorption b) Mood and emotions, but not gastrointestinal functions c) Various physiological functions in both the gut and the brain d) None of the above

Answer 58

c) Various physiological function in both the gut and the brain The gut-brain axis influences not only digestion and nutrient absorption but also mood, emotions, immune function, and other physiological processes in both the gut and the brain.

Question 59

A patient with a history of irritable bowel syndrome (IBS) presents with alternating episodes of constipation and diarrhea. Which of the following mechanisms is implicated in the pathophysiology of IBS-related constipation? a) Increased sympathetic activity b) Dysregulated gut-brain axis c) Hyperactive gastro-colic reflex d) Enhanced serotonin production

Answer 59

b) Dysregulated gut-brain axis In patients with IBS, the gut-brain axis is often dysregulated, leading to alterations in GI motility and symptoms such as constipation or diarrhea. IMPORTANT to remember for IBS discussion and IBD section in 123 ***

Question 60

Constipation can be caused by drugs that: a) Increase parasympathetic activity b) Inhibit serotonin reuptake c) Stimulate smooth muscle contraction d) Block opioid receptors in the gut

Answer 60

d) Block opioid receptors in the gut When opioid receptors in the gut are activated, they inhibit the release of neurotransmitters such as acetylcholine, which are responsible for promoting GI motility and secretion. This inhibition slows down the movement of food and waste through the GI tract, resulting in constipation. Conversely, blocking opioid receptors in the gut with certain drugs, such as opioid receptor antagonists or partial agonists, can counteract the constipating effects of opioids

Question 61

T/F: Nearly twice as many women suffer from digestive health issues on a weekly basis compared to men.

Answer 61

True! The interplay of hormonal, anatomical, dietary, psychosocial, and reproductive factors can all contribute to the higher prevalence of digestive health issues in women compared to men.

Question 62

T/F: One non-pharmacological treatment considerations for constipation can include increasing calories consumed in a day if low caloric intake

Answer 62

TRUE! This helps improve colonic transit for those who have a lower caloric daily intake.

Question 63

Fibre is recommended as a first-line therapy for patients with hemorrhoids primarily because it helps to: a) Reduce inflammation b) Improve stool consistency c) Increase blood flow d) Enhance intestinal absorption

Answer 63

b) Improve stool consistency

Question 64

There is moderate-quality evidence to support the use of _______ in the medical treatment of symptomatic hemorrhoids.

Answer 64

Dietary fibre (FYI: remember this is NOT the same as the use of bulk-forming laxatives like BeneFibre for example)

Question 65

What should be ruled out if a patient on opioids has not passed a stool in more than 3 days? A) Fecal impaction B) Intestinal obstruction C) Rectal prolapse D) Perforated bowel

Answer 65

A) Fecal impaction

Question 66

Women aged 19-50 years are recommended to consume _______ grams of dietary fibre daily.

Answer 66

25 grams

Question 67

The recommended daily intake of dietary fibre for women aged 51 and older is: a) 25 grams b) 21 grams c) 28 grams d) 30 grams

Answer 67

b) 21 grams

Question 68

What is the recommended daily intake of dietary fibre for pregnant women? a) 25 grams b) 28 grams c) 30 grams d) 38 grams

Answer 68

b) 28 grams

Question 69

What is the recommended daily intake of dietary fiber for breastfeeding women? a) 25 grams b) 28 grams c) 29 grams d) 30 grams

Answer 69

c) 29 grams

Question 70

The daily recommended dietary fibre intake for adult MEN aged 19-50 years is _______ grams.

Answer 70

38 grams

Question 71

Men aged 51 and older are advised to have _______ grams of dietary fibre in their daily diet

Answer 71

30 grams

Question 72

To minimize problems with bloating and abdominal discomfort associated with fibre intake, it is recommended to slowly _______ fibre intake.

Answer 72

Increase

Question 73

Fibre may help improve constipation, pruritus due to fecal soilage, and _______ related to hemorrhoids.

Answer 73

[Rectal] Bleeding

Question 74

Which of the following demographics has the highest recommended daily intake of dietary fibre for men in Canada? a) Pregnant women b) Adult men ages 19-50 c) All adults 51+ yo d) Breastfeeding women e) Adult women ages 15-50

Answer 74

d) Breastfeeding women --- they are recommended to have 29 grams of dietary fibre in daily intake.

Question 75

The recommended daily intake of dietary fibre for adults in Canada depends on their _______ and/or ______.

Answer 75

Age and/or State of health.

Question 76

T/F: Peripheral acting mu-opioid receptor antagonists are considered second-line treatment for opioid-induced constipation if traditional laxatives fail.

Answer 76

True! Peripheral acting mu-opioid receptor antagonists are considered second-line treatment for opioid-induced constipation if traditional osmotic and stimulant laxatives fail to provide adequate relief. These agents work by blocking the effects of opioids in the gastrointestinal tract, thereby alleviating constipation. They are particularly useful in patients who require high-dose opioids for pain management.

Question 77

The concept of ________ in the gut refers to the process by which the gastrointestinal (GI) tract absorbs and reabsorbs fluids to maintain fluid balance within the body. - This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.

Answer 77

Fluid Recovery

Question 78

Fluid Recovery refers to how the GI tract _____ and ______ fluids to maintain fluid balance within the body. This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.

Answer 78

Absorbs and reabsorbs

Question 79

In fluid recovery, the GI Tract absorbs and reabsorbs fluids to maintain fluid _____ within the body. This process is crucial for preventing dehydration and ensuring the proper functioning of various physiological processes.

Answer 79

[Fluid] Balance

Question 80

Why is Fluid Recovery an important process? (3)

Answer 80

- Maintains fluid balance - Prevents dehydration - Ensures proper functioning of various physiological processes

Question 81

In the gut, fluids enter the ______ every day, which is the first part of the _____ intestine, from both dietary intake and intestinal secretions.

Answer 81

Duodenum; Small

Question 82

In the gut, fluids enter the duodenum on a daily basis, which is the first part of the small intestine, from two main sources. List the TWO (2) Sources of Fluid in the Fluid Recovery Process.

Answer 82

1) Dietary Intake (2L) 2) Intestinal Secretions (7L)

Question 83

T/F: Among the two sources in fluid recovery, intestinal secretions account for the majority of fluid entering the body as it makes up for approximately 9L of the fluid entered daily.

Answer 83

FALSE. While the intestinal secretions does contribute to the majority of fluid entering the duodenum, the daily contributions totals to around 7 L per day (not 9) (When accounting for the dietary fluid source giving approx 2L daily, the total amount of fluid being sourced daily equals to 9)

Question 84

Which of the following statements is INCORRECT in regards to the Fluid Recovery Process in the Gut? a) 9 L of fluid enters the duodenum/day b) There are two sources of fluid: dietary intake (2L) and the intestinal secretions (7L) c) Once in the duodenum, these fluids undergo absorption along the length of the small and large intestines. Small intestines absorbs the majority of the incoming fluid and is responsible for absorption of nutrients and the fluid balance process. d) Approximately 50 mL of fluid is excreted in the stool per day, contributing to its consistency and aiding in the elimination of waste from the body.

Answer 84

d) Approximately 50 mL of fluid is excreted in the stool per day, contributing to its consistency and aiding in the elimination of waste from the body IS FALSE... - After the absorption process, the remaining fluid, along with indigestible materials and waste products, moves through the colon to form feces. - Approximately 150mLs of the fluid is excreted in the stool each day (NOT 50 mLs)

Question 85

Fluid recovery in the gut involves the absorption of fluids from dietary intake and intestinal secretions, primarily by the small and large intestines. This process ensures the maintenance of fluid balance within the body and facilitates the absorption of nutrients while allowing for the elimination of waste products through ______.

Answer 85

Stool formation

Question 86

Fluid Recovery in the Gut: What is the total volume of fluid entering the duodenum daily? a) 5 litres b) 7 litres c) 9 litres d) 10 litres

Answer 86

c) 9 L

Question 87

Fluid Recovery in the Gut: How much fluid entering the duodenum daily is from dietary intake? a) 1 L b) 2 L c) 3 L d) 4 L

Answer 87

b) 2 L

Question 88

Fluid Recovery in the Gut: How much fluid is absorbed by the small intestine daily? a) 150 mL b) 850 mL c) 1 L d) 2 L e) 7 L f) None of the above

Answer 88

f) None of the above! In the fluid recovery process in the gut, the small intestine will absorb approx. 8L per day.

Question 89

Fluid Recovery in the Gut: Approximately how much fluid is absorbed by the large intestine daily? a) 8 L b) 850 mL c) 500 mL d) 1 L

Answer 89

b) 850 mL

Question 90

T/F: Fluid recovery in the gut primarily involves the excretion of excess fluids to maintain electrolyte balance.

Answer 90

False! Fluid recovery in the gut primarily involves the ABSORPTION of fluids rather than excretion to maintain fluid balance within the body.

Question 91

The main function of the GI tract, particularly the _____ intestine, is to absorb nutrients, water, and electrolytes from the ingested food and fluids.

Answer 91

Small

Question 92

Carrying off from their counter intestine, the ______ intestine, particularly the colon, further absorbs water and electrolytes from the remaining indigestible materials. This absorption process helps in concentrating the stool and conserving water within the body.

Answer 92

Large

Question 93

While a ____ amount of fluid is excreted in the stool, the main function of the GI tract is to absorb water and ______ to prevent dehydration and maintain homeostasis.

Answer 93

Small [amount]; Electrolytes

Question 94

Which of the following statements accurately describes the order of processes in the fluid recovery in the gut? a) 9L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL). b) 9L of Fluid enters the duodenum from dietary intake (7 L) while 2L from intestinal secretions -> Absorption of fluid by the large intestine (850 mL) -> Absorption of fluid by the small intestine (8 L) -> Excretion of fluid in the stool (150 mL). c) 9 L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the large intestine (850 mL) -> Absorption of fluid by the small intestine (8 L) -> Excretion of fluid in the stool (150 mL). d) 9L of Fluid enters the duodenum from dietary intake (7 L) and from the intestinal secretions (2 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL).

Answer 94

a) 9L of Fluid enters the duodenum from dietary intake (2 L) and from intestinal secretions (7 L) -> Absorption of fluid by the small intestine (8 L) -> Absorption of fluid by the large intestine (850 mL) -> Excretion of fluid in the stool (150 mL).

Question 95

T/F: Adequate fluid consumption is necessary during pregnancy and breastfeeding to prevent dehydration and stimulate milk production.

Answer 95

True!!

Question 96

Which type of fibre has better evidence for improving constipation symptoms? a) Insoluble fibre b) Soluble fibre c) Bran fibre d) Wheat fibre

Answer 96

b) Soluble fibre Soluble fibre has better evidence than insoluble fibre.

Question 97

A 45-year-old individual presents with complaints of alternating episodes of constipation and diarrhea, accompanied by abdominal pain and bloating. They report that their bowel movements often resemble soft blobs with clear-cut edges. Upon further examination, they are diagnosed with irritable bowel syndrome (IBS). What type on the Bristol Stool Form Scale is most likely to be observed in this patient? a) Type 1 b) Type 3 c) Type 5 d) Type 7

Answer 97

c) Type 5

Question 98

List some examples of foods that contain high soluble fibres.

Answer 98

- Beans (black beans, kidney beans) - Brussel sprouts - Sweet potatoes - Broccoli - Apple - Avocados - Pears - Flax seeds

Question 99

What is the recommended daily target ranges for fibre intake in young adults? a) 10-20 grams b) 15-25 grams c) 25-38 grams d) 30-40 grams

Answer 99

c) 25-38 grams

Question 100

________ can be particularly applicable in settings such as nursing homes and pediatric care, where individuals may face challenges with bowel function due to factors such as aging, medical conditions, or developmental issues.

Answer 100

Bowel Retraining Bowel Re-Training

Question 101

A 55-year-old patient has difficulty establishing a regular bowel routine and often ignores the urge to defecate. Which non-pharmacologic therapy should be emphasized? a) Increase caloric intake b) Encourage regular bowel regimen c) Consume a high-fibre diet d) Spend prolonged periods of time at the toilet

Answer 101

b) Encourage regular bowel regimen **this is especially important for older people as they age** Patients should attempt to have a bowel movement at the same time each day especially after breakfast, since colonic activity is highest at that time. Encourage patients to heed the urge to defecate and discourage them from spending prolonged periods of time at the toilet.

Question 102

Opioid-induced constipation is a risk in patients with a high burden of __________ medications and high/chronic opioid doses.

Answer 102

anti-cholinergic

Question 103

Drug-Induced Constipation: What are the two different situations to be considered?

Answer 103

Beforehand & After-the-Fact.

Question 104

Drug-Induced Constipation: J.D. is a young adult who just had wisdom teeth surgery at 6 AM. He's been prescribed Tylenol #3 (codeine/acetaminophen) QID. He took his first dose at around 2 PM... He normally has daily BMs after suppertime. How much Senokot should he take? a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy. b) 1-2 tablet(s) of regular (8.6-17.2mg) on night 1, then go to 2 tabs HS for the rest of the nights. c) 2 tablet of the regular strength (8.6mg x 2) on night 1, then go to 4 tablets (8.6mg x 4) HS for the rest of the time d) 1 tablet of the extra strength (17.2mg) on night 1, then can go 1-2 tablet(s) of extra strength (17.2-34.4mg) HS thereafter depending on ability to do BMs.

Answer 104

a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy. - This scenario is a *Beforehand* Drug-Induced Constipation scenario. - If patient previously had daily BMs after supper AND had taken his first T3 dose at 2pm today, we will want to get him to take 1 regular strength blindly then take 2 tabs HS for the rest of the nights blindly and *getting ahead of the game* instead of catch-up.

Question 105

Drug-Induced Constipation: Tink is a teenage boy who had emergency tooth extraction late last night at around midnight at the hospital. The discharge nurse gave Tink a T3 to take before heading home at around 6:30am and also sent him a RX for home QID use. How much Senna is recommended if we are considering beforehand situations in this case? *Need to know this!* a) 1 tablet of regular strength (8.6mg) on night 1, then increase to 2 tabs HS for the rest of the week/therapy. b) 2 tablet(s) of regular (8.6 x 2 ) on night 1, then stay on 2 tabs HS for the rest of the nights. c) 2 tablet of the regular strength (8.6mg x 2) by lunch time. If this lunch time senna works, wait until the NEXT evening to take 2 tabs HS going forward. d) 2 tabs of regular (8.6 x 2) before noon, then either use an enema or dulcolax suppository for HS to make sure a BM occurs, then go to 2 tabs HS for the rest of the therapy starting HS dosing on Night 2.

Answer 105

b) 2 tablet(s) of regular (8.6 x 2 ) on night 1, then stay on 2 tabs HS for the rest of the nights. This is still an example of beforehand situation.

Question 106

Drug-Induced Constipation: Kendra is a 25-yo female who just had a root canal at 9am done and is in a lot of pain so was prescribed T3s. She took her first T3 at 2pm on Monday and normally poops after suppertime but she can't really eat much right now. She continues to take T3s... She comes to the pharmacy on Wednesday at 6pm asking for help because she hasn't had a BM since Sunday PM... She feels backed up but no stomach pain or anything like that. How much Senna is recommended if we are considering the circumstances AND the time you are seeing her? a) Enema or Dulcolax suppository as soon as they get home that night, then go to 1-2 tab(s) of Senokot regular HS going forward until T3s are done. b) Take 1 tab of regular (8.6mg) at 11pm, see if any success by morning. If it works, increase to 2 tabs (8.6mg x 2) HS until T3s are done. c) Take 2 tablets of the regular strength (8.6mg x 2) by 10pm that night OR an enema OR Dulcolax suppository. Then try 2 tabs of Senokot at 10am next day and 2 tabs HS. If this works, then reduce dosing to just 2 tabs HS by night 3 (since starting laxative treatment) until T3s are done. d) Take 2 tabs at 11pm that evening. If no success by AM, should take 2 tabs at 11am, then use an enema or a Dulcolax suppository HS.

Answer 106

d) Take 2 tabs at 11pm that evening. If no success by AM, should take 2 tabs at 11am, then use an enema or a Dulcolax suppository HS. This is an example of *After-the-Fact* treatment If patient was experiencing mild cramping when they saw you, option a would have been the choice to run with.

Question 107

Shawn is suffering from drug-induced constipation since starting his Wellbutrin XL approx. two weeks ago... - His BM are limited. His stool descriptions match to Type 1 of the Bristol scale. - He reports to having maybe 2 BM each week since this started Pharmacist has advised Shawn to complete an enema as soon as he gets home, and advises him to start taking Senna 17.2mg HS after the enema. If he successfully has a BM by the next AM (not including the enema, if applicable), he can continue to take Senokot (8.6-17.2mg) HS going forward. What is wrong with the advice given by pharmacist?

Answer 107

Senokot is meant for acute treatment and not recommended to be used long-term due to dependency issues. Wellbutrin XL has anticholinergic properties and if continues to take, could have constipation for a while. - Wellbutrin XL is not the same as a short-term T3 use. - Pharmacist could advise patient to follow the regimen they told except modify to say should be only for a few days, stop senna and see if able to do BM on own while advising patient on prune and increased dietary fibre intake - Consider bulk-forming agents like psyllium if need for longer term usage - Consult MD to switch medication and/or dosing of Wellbutrin XL if constipation does not improve

Question 108

A 40-year-old individual complains of infrequent bowel movements and difficulty passing stool. They have a sedentary lifestyle and consume a low-fibre diet. What non-pharmacologic therapy would be most appropriate to recommend? a) Increase caloric intake b) Consume a high-fibre diet c) Encourage regular bowel regimen d) Spend prolonged periods of time at the toilet

Answer 108

b) Consume a high-fibre diet ... recommended to improve colonic transit and alleviate constipation symptoms. Although encouragement of regular bowel regimen is a non-pharmacological option for adults with constipation, note how it was mentioned they already have a low-fibre diet. Mild-to-Moderate exercise is also a good thing to add too.

Question 109

Which of the following is NOT recommended as a non-pharmacological therapy for constipation in children? a) Increasing fluid intake b) Increasing fruit and vegetable intake c) Using fibre supplements d) Limiting fruit juice intake

Answer 109

c) Using fibre supplements Current evidence does not support fibre supplements in treatment of pediatric functional constipation. Rather, increased fluid, fruit and vegetable intake may reduce the risk of functional constipation.

Question 110

What is the recommended daily dietary fibre level for children aged 3–7 years?

Answer 110

≥ 10 g for children 3–7 years of age

Question 111

What is the recommended daily dietary fibre level for children aged 8–14 years? a) ≥5 g b) ≥10 g c) ≥15 g d) ≥20 g

Answer 111

c) ≥ 15 g Aim for a daily dietary fibre level: - ≥15 g for children 8–14!! (Ages 3-7 is 5 grams less)

Question 112

Which type of juice is recommended for infants aged 6–12 months to help alleviate constipation? a) Orange juice b) Grape juice c) Prune juice d) Cranberry juice

Answer 112

c) Prune juice Juices that contain sorbitol (e.g., prune, apple and pear) can increase the frequency of bowel movements and water content of stools. Obviously, other demographics, we would prefer the actual fruit to juice, but infants can't eat prunes yet.

Question 113

Which product can be used for both constipation and is also regarded to be a prebiotic?

Answer 113

Inulin

Question 114

T/F: Consuming apples, pears, and prunes can help alleviate constipation due to their high sorbitol content.

Answer 114

True!

Question 115

For children aged 1–6 years, what is the recommendation regarding fruit juice intake? a) No restriction b) Limit fruit juice intake c) Encourage fruit juice intake d) Substitute fruit juice with water

Answer 115

b) Limit fruit juice intake Kids can be picky and we want to make sure they gets fluids in them. It's okay to give them juice just make sure to limit the amount they consume.

Question 116

Which types on the Bristol Stool Form Scale indicate diarrhea and urgency? a) Types 3–4 b) Types 1–2 c) Types 5–7 d) Types 6–7

Answer 116

c) Types 5–7

Question 117

Which of the following bulk-forming agents has the most well-known onset of action of 3-5 days and is commonly used for preventative therapy for constipation? A) Psyllium (Metamucil) B) Bran C) Inulin (Benefiber) D) Calcium polycarbophil (Prodiem tablets)

Answer 117

B) Bran Bran is a natural bulk-forming agent with a well-known onset of action of 3-5 days. It is commonly used for preventative therapy for constipation rather than acute treatment. Bran increases stool volume and promotes regularity. However, it is not meant to be used for acute constipation and is typically used for long-term management.

Question 118

Which non-pharmacological intervention has been shown to improve the relief of symptoms in children with functional constipation? a) Increasing fibre supplements b) Increasing physical activity intensity c) Behavioural therapy added to diet/laxative therapy d) Avoiding fruits and vegetables

Answer 118

c) Behavioural therapy added to diet/laxative therapy Evidence suggests that behavioural therapy added to diet/laxative therapy improves the relief of symptoms. - Children with functional constipation should be encouraged to attempt defecation 5–10 minutes after each meal until they have a bowel movement that day.

Question 119

T/F: Increasing fluid intake, fruit, and vegetable intake may reduce the risk of functional constipation in children.

Answer 119

True!

Question 120

T/F: Spending prolonged periods of time at the toilet is recommended to facilitate bowel movements in individuals with constipation.

Answer 120

False! Do not recommend prolonged periods of sitting on the toilet as this can increase risks of constipation likelihood as well as increase straining.

Question 121

T/F: Increasing the intensity of exercise has been shown to improve levels of constipation according to studies.

Answer 121

False. - Mild-to-Moderate is good enough for adults. - Children's normal physical activity is good enough.

Question 122

Which age group should limit sorbitol-based juices to manage constipation effectively? a) Infants aged 6–12 months b) Children aged 1–6 years c) Children aged 7–18 years d) Adults

Answer 122

c) Children aged 7–18 years Ages 1-6 is limiting fruit juice (not necessarily just sorbitol juices)

Question 123

What is the recommended fluid intake ratio for every gram of fibre consumed in children? a) 20 mL of fluid b) 30 mL of fluid c) 40 mL of fluid d) 60 mL of fluid

Answer 123

d) 60 mL of fluid

Question 124

Which of the following fruits contains the natural laxative sorbitol? a) Bananas b) Oranges c) Apples d) Grapes

Answer 124

c) Apples

Question 125

I am struggling with constipation and my doctor has told me to try adding some prunes to my diet since their sorbitol acts as a natural osmotic and works faster than fibre. How many prunes should I start with?

Answer 125

Start with around 4 prunes per day.

Question 126

I am struggling with constipation and my doctor has told me to try adding some prunes to my diet since their sorbitol acts as a natural osmotic and works faster than fibre. I tried eating prunes but I don't like the texture when chewing it but found some prune juice... How much prune juice should I start with?

Answer 126

Approx. ½ cup of prune juice.

Question 127

What type of exercise has been shown to improve colonic transit time and defecation patterns in individuals with constipation? a) High-intensity interval training b) Strength training c) Yoga d) Mild to moderate exercise

Answer 127

d) Mild to moderate exercise [for adults]

Question 128

T/F: Spending prolonged periods of time at the toilet may worsen constipation symptoms by promoting straining.

Answer 128

True!

Question 129

T/F: Encouraging fruit and vegetable intake may help reduce the risk of functional constipation in children aged 3–7 years

Answer 129

True!

Question 130

Which age group of children should limit fruit juices to manage constipation? a) 1-6 years b) 3-7 years c) 8-14 years d) 7-18 years

Answer 130

a) 1-6 years

Question 131

What percentage of women experience constipation during late pregnancy and up to 3 months postpartum? A) 10–15% B) 25–30% C) 40–45% D) 50–55%

Answer 131

B) 25–30% (CPS, 2023)

Question 132

List the 5 Types of Laxatives.

Answer 132

- Bulk-forming agents, - Emollient (AKA: Stool softeners), - Osmotics (Saline vs. Non-Saline), - Stimulants; - Purgatives/High-dose osmotic agents

Question 133

Increasing fecal mass/volume = _______

Answer 133

Stimulation of peristalsis (AKA: GI Motility)

Question 134

As pharmacists, which two age categories should we caution to be referred to an MD for further assessments for constipation?

Answer 134

- Children < 2 years of age - Individuals who are >50 years of age IF there's a family history of Colon Cancer

Question 135

At what point in time should individuals experiencing constipation be seen by a MD/NP?

Answer 135

Constipation for >2 wk (or no bowel movement for >7 days) despite use of laxatives, - This is especially important to note for the elderly, as well as in those with chronic medical conditions such as diabetes or Parkinson disease.

Question 136

Other possible red flags for possible referral in the event of constipation includes (but is not limited to): - Eating disorders such as bulimia nervosa - _________ thirst - Unexplained weight loss of greater than 5%

Answer 136

Moderate to Extreme thirst

Question 137

When should a laxative be started in patients receiving opioid therapy, especially people like the elderly? A) After symptoms of constipation develop B) At the beginning of opioid therapy C) After a trial of other interventions D) When constipation becomes severe **NEED TO KNOW THIS***

Answer 137

B) At the beginning of opioid therapy - If using opioids, a laxative should be started at the beginning of therapy to prevent or mitigate the development of opioid-induced constipation. CPS (2023) reports that caution should be applied to avoid these medications and, if required, to keep doses to the lowest possible effective dose. If using opioids, a laxative should be started *at the beginning of therapy*.

Question 138

A 35-year-old patient presents with complaints of infrequent bowel movements and difficulty passing stool. Upon examination, their stools are hard lumps that are separated, resembling nuts or rabbit droppings. Which type on the Bristol Stool Form Scale is most likely to be observed in this patient? a) Type 1 b) Type 2 c) Type 3 d) Type 4

Answer 138

a) Type 1

Question 139

Abby is a 30-yo female. She currently takes amitriptyline and an oral birth control. For the past 5 days, she has struggled to feel a sense of emptying when she takes her daily BMs. She has had a combination of diarrhea and constipation. Each occasion this week, she has had cramping and has been straining a lot when sitting on the toilet. She says her poop looks like sausages but are lumpy when they are more solid forms. She has been eating normally and drinking a lot of water but has reported to have lost 6 lbs so far. She reports this happens to her at least 2x a month since high school. What would you recommend for her? What could be happening?

Answer 139

Refer to MD - Alternating between constipation and diarrhea can be indicative of IBS, IBD, or a GI infection, for instance. - We do not know how significant (% wise) is her weight loss; however, the fact she has lost weight despite continuing to eat and drink water and the BMs is a concern for the weight loss - Amitriptyline can also cause constipation as TCAs have anticholinergic properties

Question 140

T/F: Emollient laxatives (AKA: Stool Softeners) are often recommended for patients recovering from surgery or childbirth.

Answer 140

True! Emollient laxatives, also known as stool softeners, are gentle and well-tolerated, making them suitable for patients recovering from surgery or childbirth. They help soften stools and reduce straining during bowel movements.

Question 141

______ (Linaclotide) is an RX medication under the guanylate cyclase-C receptor agonist drug class that increases chloride and bicarbonate secretions into the gut and blocks sodium absorption; the net result is increased fluid in the gut lumen, which results in improvement in the number of spontaneous bowel movements per week.

Answer 141

Constella

Question 142

Which of the following bulk-forming laxatives is one that are not just available at pharmacies, and is reported to have side effects such as: - Diarrhea, - Bloating, - Flatulence

Answer 142

Bran! Unlike Metamucil (psyllium), BeneFibre (Ilium), and Prodiem (calcium polycarbophil - GREEN) OTC products, CPS indicates that Bran can cause some diarrhea, which is not as common with the OTC products.

Question 143

Which bulk-forming laxative is unique in that it can be administered in a cup of water or sprinkled onto food? A) Bran B) Psyllium (Metamucil) C) Inulin (Benefiber) D) Calcium polycarbophil (Prodiem tablets)

Answer 143

C) Inulin (Benefiber)

Question 144

What is the Onset of Action for Bran? a) 12-72 hours b) 24-72 hours c) 3-5 days d) Up to a week

Answer 144

c) 3-5 days

Question 145

Bulk-Forming Agents used to treat constipation is primarily used for: a) Acute relief b) Prevention *NEED TO KNOW THIS!!!**

Answer 145

b) Prevention

Question 146

Which of the following bulk-forming laxatives has a lesser likelihood of causing increased flatulence and abdominal bloating? a) Bran b) Metamucil (psyllium) c) BeneFibre (Inulin) d) Prodiem (calcium polycarbophil) green e) Prodiem (sennosides) blue

Answer 146

d) Prodiem (calcium polycarbophil) GREEN label ***** ^^ this is a synthetic form of a bulk-forming laxative. These are ones that you are less likely to suffer from bloating and/or increased gas. (RXFiles, 2023) Natural fibre products like Metamucil, BeneFibre and Bran products are likely to increase likelihood of gas and bloating.

Question 147

Why is it important to administer bulk-forming agents like Metamucil and BeneFiber with 250 mL or more of water or juice? a) To enhance absorption of the laxative into the bloodstream b) To minimize the risk of gastrointestinal irritation c) To prevent esophageal obstruction and fecal impaction d) To increase the laxative's effectiveness in stimulating bowel movements e) It is the only way the medication can be ingested in the body and able to travel through the GI tract

Answer 147

c) To prevent esophageal obstruction and fecal impaction Without sufficient fluid intake, the laxative may form a thick, gel-like mass (especially for psyllium) in the esophagus, leading to difficulty swallowing or obstruction. Additionally, proper hydration helps facilitate the passage of the laxative through the digestive tract, reducing the risk of fecal impaction.

Question 148

Metamucil (psyllium) and BeneFibre (Inulin) are both bulk-forming OTC laxatives that are available to purchase OTC at the pharmacy for instance. These are both regarded as Natural Fibre products (RXFiles, 2023). T/F: Allergic reactions and anaphylaxis is unlikely to occur in such products and synthetics are more common to see this occur.

Answer 148

False! - Anaphylaxis, asthma and other allergic reactions have been reported even for the natural fibre products. (CPS, 2023 ; RXFiles, 2023)

Question 149

________ is the only bulk-forming agent in the Canadian market that has indications for children 2-5 years old.

Answer 149

Calcium polycarbophil (Prodiem - green packaging)

Question 150

What is the Onset of Action of OTC Bulk-Forming Laxatives (e.g., psyllium, inulin, Calcium polycarbophil - green)?

Answer 150

12-72 hours

Question 151

Bulk-Forming Agents are classified as which kind of fibre? a) Soluble b) Insoluble c) Has both soluble and insoluble fibres

Answer 151

a) Soluble

Question 152

Which of the following cases of constipation would products like Metamucil (psyllium) or BeneFibre (inulin ) may not be beneficial for? a) Max, a 30-year-old male who suffers from chronic functional constipation b) Gina, a 21-year-old female who is 3 days postpartum who gave birth to a beautiful, healthy boy via C-section. c) Adam, a 55-year-old male with Parkinson's Disease who takes a few medications, including benztropine. d) Lily, a 52-year-old female with dyslipidemia (i.e., Hyperlipidemia) who takes atorvastatin 40mg QD e) Both a and b f) Both b and c g) None of the above - they are all candidates to use bulk-forming agents.

Answer 152

f) Both b and c RXFiles (2023) indicates that bulk-forming laxatives might not serve to be beneficial to individuals w/ constipation due to slow-transit, pelvic floor dysfunction or medication-induced. b) Gina is 3 days postpartum... Pregnancy and child-birth (natural or C-section) can cause for pelvic floor dysfunction. c) Adam has Parkinson's Disease and takes benztropine, which is an example of an anticholinergic - which can induce constipation.

Question 153

What is the youngest age in which Health Canada has approved the use of Metamucil (psyllium) and/or BeneFiber (inulin) without the need to consult an MD? a) 4-years-old (and older) b) 6-years-old (and older) c) 12-years-old (and older) d) 18-years-old (and older) e) None of the above - dosing is weight-dependent (as long as 17 kg and over).

Answer 153

b) 6-years-old (and older) is the approved minimum age (according to CPS (2023) and RXFiles (2023)) as of April 2024

Question 154

Bulk-forming agents does have some drug interaction and certain minerals. What is the recommended/suggested spacing time one should be advised when using bulk-forming agents?

Answer 154

Wait at least 2 hours between bulk-forming agent dose and other medications.

Question 155

What is the approved frequency schedule for Metamucil (psyllium) and BeneFiber (Inulin) powder products? a) Once daily b) BID c) TID d) All of the above

Answer 155

d) All of the above - Both psyllium and Inulin powdered products can be used UP TO THREE TIMES DAILY for both adults and children (6 years and older); however, the dose will differ depending on the patient and patient age.

Question 156

What the difference between the blue-labeled Prodium and green-labeled Prodium products? ** Sneaky little bish... Need to know because most patients don't look at the difference ***

Answer 156

There IS a difference!! - Prodium in the blue packaging = Sennosides 15mg and for ACUTE, Overnight RELIEF - Prodium in green packaging = Calcium polycarbophil and is for PREVENTION

Question 157

T/F: Both Prodium versions [blue vs. green] have different onset of actions but are both classified as bulk-forming agents.

Answer 157

False! Do NOT mix these two up! - Prodium [blue] is Sennoside therefore is classified as a STIMULANT laxative and meant for acute relief. - Prodium [green] is calcium polycarbophil which is classified as a bulk fibre therapy (Onset of action: Can be up to 5 days) and for preventative purposes.

Question 158

Metamucil vs Benefiber... Which is more effective?

Answer 158

Metamucil - Psyllium has more efficacy data

Question 159

How common is psyllium-induced obstruction? (answer is not a specific number FYI)

Answer 159

Low... Can be considered extremely rare. In such reported cases, most times, drug was blamed for it but it's more likely that the psyllium just added to whatever was obstructed in there in the first place... So not exactly fair to say induced by Metamucil.

Question 160

T/F: We can sprinkle or add either psyllium or inulin powder to food alternatively to taking it as a drink.

Answer 160

False. Inulin is the only bulk-forming agent that can add to both food and fluid. Psyllium should only be added to a glass of water, stir, and try to drink before it gels up.

Question 161

How do stool softeners like Colace (docusate Na+) or Surfak (docusate Ca++) work? a) By stimulating intestinal motility b) By increasing stool bulk c) By reducing stool surface tension d) By inhibiting water absorption in the colon

Answer 161

c) By reducing stool surface tension ... which then increases fluid penetration into the stool.

Question 162

What's the difference between Colace capsules and Colace suppositories?

Answer 162

Different active ingredients & formulations - Capsules = Docusate Na+ [stool softener] - Suppositories = Glycerin [osmotic]

Question 163

What is the reported onset of action for stool softeners like docusate sodium and docusate calcium? a) 1-2 hours b) 6-12 hours c) 12-72 hours d) 3-5 days

Answer 163

c) 12-72 hours (but for some people, can take up to 5 days - just like bulk-forming agents)

Question 164

Stool softeners like docusate are primarily used as ______ treatment for constipation. a) Acute relief b) Prevention **Need to know this**

Answer 164

b) Prevention

Question 165

Which population may require higher doses of stool softeners like Colace? a) Palliative Care patients b) Pregnant and postpartum c) Nursing Home patients d) Athletes

Answer 165

a) Palliative care patients could see the highest dosages as patients could be taking up to 8 capsules per day. BUT Nursing Home patients are also likely to also take higher than normal doses as they could be taking up to 4 capsules per day.

Question 166

What is an important contraindication (C.I) to know or advise when using stool softeners with mineral oil? a) They may increase stool bulk b) They may decrease fluid penetration into the stool c) They may increase mineral oil absorption d) They may cause nausea or GI cramps e) They may increase the stool softener absorption

Answer 166

c) They may increase mineral oil absorption Advise patient to NOT use both docusate and mineral oil at the same time. Short-Term: increases M.O. absorption Long-Term: increases M.O. absorption AND can result in mineral oil to travel outside the GI along with lipids to undesirable locations in the body and can cause health implications.

Question 167

Should individuals suffering from constipation and having abdominal pain use stool softeners for their constipation?

Answer 167

No. - It will likely make stomach pain worse and is a contraindication

Question 168

Which OTC product is a combination of both a stool softener + stimulant?

Answer 168

Senokot-S (docusate 50mg + sennaside) Note it has less docusate in this formulation than if were to take Colace capsule on its own.

Question 169

Colace (docusate Na+) vs. Surfak (docusate Ca++): Which stool softener (or docusate product) is more potent?

Answer 169

NEITHER! Colace capsules and Surfak are considered to have **EQUAL POTENCIES** despite the fact that Surfak capsules are 240mg (vs. Colace has 100mg).

Question 170

Mineral Oil is under which drug class/agent? a) Lubricant b) Osmotic c) Emollient d) Stimulent e) Stool softener

Answer 170

a) Lubricant

Question 171

What is the primary function of lubricating laxatives such as mineral oil? a) Increase intestinal motility b) Soften fecal matter c) Enhance water absorption in the GI tract d) Reduce inflammation in the gastrointestinal tract

Answer 171

b) Soften fecal matter

Question 172

Which of the following is a potential complication associated with the use of mineral oil for constipation? a) Increased absorption of fat-soluble vitamins b) Improved stool consistency c) Risk of anal seepage d) Prevention of lipid pneumonia

Answer 172

c) Risk of anal seepage When mineral oil is ingested orally as a laxative, it forms a slick layer along the walls of the gastrointestinal tract, including the rectum. This lubrication is intended to facilitate the passage of stool through the intestines. However, excessive lubrication from mineral oil can result in stool that is overly slippery and difficult to control, increasing the risk of leakage or seepage of stool from the anus

Question 173

When is the onset of action of mineral oil when taken orally? a) 1-2 hours b) 3-4 hours c) 6-8 hours d) 10-12 hours e) 12-72 hours

Answer 173

c) 6-8 hours is the Onset of Action when taken orally.

Question 174

What is the maximum amount of days that mineral oil can be used for constipation? a) Up to 14 days b) Up to 21 days c) Up to 7 days d) Up to 30 days

Answer 174

c) Up to 7 days max

Question 175

T/F: Mineral oil can be safely used in infants under the age of 1 for the management of constipation.

Answer 175

False. Not only is it not recommend for children <1 yo to use, but mineral oil is also not recommended for those who have difficulty swallowing or bedridden among some cautioned peoples. Increased risk of aspiration plus not something should use for < 1 yo

Question 176

To avoid the risk of lipid pneumonia, mineral oil doses should be taken ______ a) With food b) Without food c) During the heaviest meal of the day d) Before laying down e) Sitting up

Answer 176

e) Sitting up This also is about aspiration risks, too.

Question 177

Why do prunes have a natural, laxative effect in the body?

Answer 177

Contains sorbitol (which is an osmotic) - Natural source of sorbitol and therefore a natural osmotic Prunes also have BOTH insoluble and soluble fibres

Question 178

How many grams of fibre does 1 cup of pitted, uncooked prunes have?

Answer 178

12 grams of fibre (in every cup of pitted, uncooked prunes)

Question 179

If I were to eat 3 dried PLUMS, how much fibre would this have?

Answer 179

3.9 grams of fibre

Question 180

T/F: Prunes are just as effective as dietary fibre to help with constipation.

Answer 180

False! Sorbitol does more work for constipation (as an osmotic) than fibre when trying to address constipation. - Sorbitol works much faster than fibre as a result.

Question 181

What is preferred as initial treatment of constipation during pregnancy or breastfeeding to increase the frequency of defecation and soften stools? A) Docusate B) Psyllium C) Heavy mineral oil D) Milk of magnesia

Answer 181

b) Psyllium - Psyllium, - Dietary bran, or - Wheat fiber are preferred as initial treatment of constipation during pregnancy or breastfeeding to increase the frequency of defecation and soften stools. (CPS, 2023)

Question 182

List the two types of osmotic laxatives.

Answer 182

1) Saline Osmotic Laxative 2) Non-Saline Osmotic Laxative

Question 183

RNI for Magnesium?

Answer 183

RNI of Magnesium: 320-420 mg

Question 184

What is something we as pharmacist almost never tell patients about using Magnesium [side effects]?

Answer 184

Can possibly cause diarrhea.

Question 185

What is a safe estimated dose to take for Magnesium that is not likely to cause diarrhea?

Answer 185

250mg is a safe range

Question 186

What do both types of osmotic laxatives [saline and non-saline] generally have in common?

Answer 186

Both osmotic laxatives work by drawing water into the intestines to soften stool and promote bowel movements while increasing stool frequency. However, they differ in their chemical composition, mechanism of action, onset of action, and other pharmacological properties.

Question 187

All forms of Osmotic Laxatives (saline and non-saline) are linked to electrolyte imbalances within the colonic lumen and can result in ______kalemia, as well as salt & fluid overload, as well as diarrhea.

Answer 187

HYPOkalemia

Question 188

Due to risks of possible electrolyte imbalances when using any kind of osmotic laxative, which 2 demographics/populations discussed in class should consider a good amount of caution before using osmotics?

Answer 188

1) Patients w/ Congestive Heart Failure 2) Chronic Renal Dysfunction (and/or chronic kidney disease, CKD)

Question 189

What is the mechanism of action for Saline Osmotic Laxatives? a) When ingested, non-absorbable ions/salts remain undigested in the colon (stays in the gut) and draw water into the intestines through osmosis, increasing the volume of stool and stimulating bowel movements. b) contain sugars or sugar alcohols such as lactulose, sorbitol, or polyethylene glycol (PEG). These agents are poorly absorbed in the intestines and exert an osmotic effect similar to their counter osmotic laxatives, and draws water into the colon and softening stool.

Answer 189

a) When ingested, non-absorbable ions/salts remain undigested in the colon (stays in the gut) and draw water INto the intestines through osmosis, increasing the volume of stool and stimulating bowel movements. - contain non-absorbable ions/salts such as magnesium hydroxide (milk of magnesia), magnesium citrate, or sodium phosphate.

Question 190

What is the Onset of Action for many Saline Osmotic Laxatives?

Answer 190

~ 0.5–3 hours after ingestion (CPS, 2023) Depending on which one you are using, might need to have a bathroom nearby. For example, enemas are VERY fast!

Question 191

Saline Osmotic Laxatives: Milk of Magnesia - What are its Onset of Action?

Answer 191

Milk of Magnesia: when used as an overnight relief laxative, can range from 0.5 - 6 h (or more). **Note there are different doses based on laxative use vs. antacid relief. NEED TO KNOW THAT - have a card later

Question 192

Saline Osmotic Laxatives: Fleet Enemas Onsets of Action?

Answer 192

As quick as 2-5 minutes! - CPS (2023) says 5-15 mins. - RXFiles (2023) says 2-15 minutes. Run to the bathroom!

Question 193

There are different osmotic approaches for constipation... What are their main difference?

Answer 193

SPEED! How fast do we want this to work?!

Question 194

Is Milk of Magnesia a reasonable agent to use as a laxative for overnight constipation treatment? What is the issue?

Answer 194

Yes, it is a reasonable product to try. - It is NOT popular choice... One of the reasons is because it's CHALKY - Senna is more popular osmotic [non-saline] over M.o.M.

Question 195

It is more common to use Milk of Magnesia as an osmotic saline laxative... If I am constipated and wanted to use this product for overnight relief, what is the dosage (in mLs) needed to achieve laxative effects? **NEED TO KNOW THE DOSES**

Answer 195

Laxative Dose of Milk of Magnesia: 30 to 60 mLs HS

Question 196

Although it is not a common indication of use, we can technically use Milk of Magnesia as an Antacid... What is the common dosage (in mLs) and frequency needed to achieve antacid effects? **Need to know these doses**

Answer 196

Antacid Dose of Milk of Magnesia: 5 to 15 mLs QID

Question 197

Saline Osmotic Laxatives: Enemas Which age group do we avoid the use of enemas and are not usually recommended for use to?

Answer 197

Any children under the age of 2-years-old.

Question 198

Why is it NOT recommended to use Enema products for children < 2 yo?

Answer 198

Toddlers and children this young are small and have small bodies. - It's not the drug we are worried about for young toddlers, but more about the effects the enema can have for children so small.

Question 199

If we can't recommend Enemas for children < 2 yo, what option(s) do we have if we are looking for an Osmotic laxative?

Answer 199

Glycerin suppositories (which are the non-saline osmotic laxatives) - Glycerin suppositories are typically the drug of choice for constipation for youngsters.

Question 200

What is the mechanism of action for Non-Saline Osmotic Laxatives? a) When ingested, non-absorbable ions/salts remain undigested in the colon (stays in the gut) and draw water into the intestines through osmosis, increasing the volume of stool and stimulating bowel movements. b) contain sugars or sugar alcohols such as lactulose, sorbitol, or polyethylene glycol (PEG). These agents are poorly absorbed in the intestines and exert an osmotic effect similar to their counter osmotic laxatives, and draws water into the colon and softening stool.

Answer 200

b) contain sugars or sugar alcohols such as lactulose, sorbitol, or polyethylene glycol (PEG). These agents are poorly absorbed in the intestines and exert an osmotic effect similar to their counter osmotic laxatives, and draws water into the colon and softening stool.

Question 201

Glycerin suppositories are the drug of choice [osmotics] for children especially for those under the age of 2 yo. We consider these suppositories to have a more local irritant effect than anything else... If that's the case, how is this an effective form of treatment for infants?

Answer 201

For infants, just having the physical mass alone to act as a local irritant can lead to the evacuation of the bowels. It takes about 30 minutes or so.

Question 202

What are the common adverse effects or side effects when using Glycerin suppositories?

Answer 202

Rectal Irritation is the only adverse effect noted for Glycerin suppositories (for both children and adults).

Question 203

Regardless of the age of use, the onset of action of Glycerin suppositories is ______

Answer 203

Within 30 minutes!

Question 204

Glycerin suppositories would be classified as one to be used for _______

Answer 204

Acute treatment for constipation.

Question 205

Lactulose is an example of _______ a) Saline osmotic laxative b) Non-saline osmotic laxative c) Bulk-forming agent d) Stimulent laxative

Answer 205

b) Non-Saline osmotic laxative

Question 206

What is the typical dosing (in mLs) for adults who use lactulose for constipation/laxative purposes?

Answer 206

15 to 60 mLs of Lactulose once daily

Question 207

T/F: The onset of action for lactulose is typically 24-48 hours.

Answer 207

True! It can take 1-2 days on average for Lactulose to do its thing.

Question 208

Can people with diabetes safely use something like lactulose?

Answer 208

Yes! - Lactulose is safe for diabetics BECAUSE it is not absorbed.

Question 209

How does Lactulose work? The process in which it works in the body as an osmotic laxative. (5 points of process) In colon --> Bacteria --> Lactic Acid --> Osmotic Pressure --> Increased Stool Volume

Answer 209

Ingestion: Lactulose is ingested orally as a liquid solution. Colon metabolism: Lactulose reaches the colon (large intestine) largely undigested because human digestive enzymes cannot break it down. Bacterial fermentation: In the colon, lactulose is fermented by colonic bacteria. These bacteria metabolize lactulose into various organic acids, primarily lactic acid and acetic acid. Osmotic effect: The presence of organic acids, particularly lactic acid, in the colon increases the osmotic pressure in the intestinal lumen. This osmotic effect draws water into the colon from surrounding tissues through osmosis. Increased stool volume: The influx of water into the colon softens the stool and increases its volume. This softening and volumizing effect helps to stimulate bowel movements and promote the passage of stool.

Question 210

What is the drug of choice among the non-saline osmotic laxatives, especially for elderly and geriatric patients as preventative therapy?

Answer 210

PEG 3350 (polyethylene glycol)

Question 211

Joey is a 65-year-old man with advanced cancer who has been experiencing severe constipation for the past week. He is currently on high-dose opioids for pain management. Despite using stimulant laxatives as prescribed, Joey has not had a bowel movement in 5 days and is feeling increasingly uncomfortable. What is the next appropriate step in the management of John's constipation? A) Bulk-forming laxatives and determine if obstruction is occurring. B) Osmotic laxatives C) Stool softeners D) Stimulant laxatives E) None of the above - need to rule out fecal impaction first before making the next move.

Answer 211

E) None of the above - need to rule out fecal impaction first before making the next move. If no bowel movements for 3+ days, should rule out impactions! - *Once fecal impaction has been ruled out*, traditionally, stimulant laxatives have been the mainstay of therapy with rescue enemas or bisacodyl suppositories used when required for a period not exceeding 3 days. Higher doses of stimulant laxatives may be necessary in palliative patients - Stool softeners are unlikely to have any benefit in this population. - Do NOT use bulk-forming agents since this can cause impaction!

Question 212

Polyethylene glycol 3350 (PEG 3350) is used as preventative therapy for constipation. How long does it take to work (onset of action)?

Answer 212

It can take a few days for sure! CPS (2023) says 24-96 hours is onset of action

Question 213

What does the labels of RestoraLAX state that might be a bit of an exaggeration? It's very conservative and legalistic but the reason why this product can remain available as an OTC for example...

Answer 213

It says: - Use for less than 7 days unless MD says . - Should not be used for people <18 yo

Question 214

If a patient was told by their MD to try using PEG 3350 to help prevent constipation but not given any other information on how to start... What would you advise this patient?

Answer 214

Start with 1 capful (17 grams) once daily, then titrate Q 2-3 days as required (until get mushy stool consistency)...

Question 215

If a person just started PEG 3350 about 3 days ago and needs to titrate up, how much should they titrate their dose by?

Answer 215

Increase dosage by 25%... If too much, dial it back to 25%.

Question 216

When using things like PEG 3350, what is a key thing to do when using it ?

Answer 216

Making adjustment is key! Titrate up or down if needed every few days until find that proper balance.

Question 217

If we advise patients to titrate up by 25% of PEG 3350 Q 2-3 days, how does patient know when they've gotten the optimal amount? What goal is to be considered optimal dosing?

Answer 217

Want to achieve a mushy stool consistency. Bristol Stool Chart of Type 6

Question 218

For palliative patients, what is the typical max dosing for PEG 3350?

Answer 218

80 grams

Question 219

T/F: Can use up to 2 to 3 capfuls of PEG 3350 per day.

Answer 219

True!

Question 220

Which laxative is not recommended for use during pregnancy or breastfeeding due to its potential to induce premature uterine contractions? A) Psyllium B) Docusate C) Heavy mineral oil D) Lactulose

Answer 220

C) Heavy mineral oil As well as *Castor Oil*

Question 221

Milk of Magnesia, Fleet Enemas, Magnesium Citrate, and Sodium phosphate are all examples of ______. ***FYI: Lactulose in this figure but not part of this category of laxative being referred in this question***

Answer 221

SALINE Osmotic Laxatives. FYI: Lactulose is a non-saline osmotic laxative

Question 222

Dulcolax (bisacodyl), Senokot (senna or sennoside), and Ex-Lax (sennosides or senna) are all examples of Stimulant laxatives... How do they generally work?

Answer 222

Stimulates the nerves in your colon to force a bowel movement.

Question 223

Dulcolax (bisacodyl) is what kind of Laxative?

Answer 223

Stimulant

Question 224

Dulcolax (bisacodyl) is typically used as a(n) ________ relief treatment for constipation. a) Overnight b) Fast relief c) Both d) None of the above - should not be used for constipation but only for surgical prep and for people with IBD.

Answer 224

a) Overnight

Question 225

What kind of formualtion(s) can people get Dulcolax (bisacodyl) in?

Answer 225

Oral AND Rectal forms - Oral: EC Tablets, Chews (kids and adults) {+ Dulcolax Canada website also mentions there's a liquid form, too?) - Rectal: Suppositories

Question 226

Ron is a 60-year-old gentleman who comes to the pharmacy asking for your help finding the products he needs for his upcoming colonoscopy prep... One of the items on the list is oral tablets of Dulcolax (bisacodyl) 15mg. When you look on the shelf, you notice we are sold out of all Dulcolax tabs except for the Dulcolax Women. What is the difference between the two Dulcolax regular vs women?

Answer 226

NOTHING!!! Dulcolax tablets in the green packaging is the *SAME THING (active ingredient is the same)* as the Dulcolax Women in pink box.

Question 227

Dulcolax (bisacodyl) tablets are commercially available in Canada in what strength(s) as OTC? a) 5mg b) 10mg c) 20mg d) both a and b e) None of the above

Answer 227

a) 5mg As of 2024, Dulcolax OTC tablets are only available to purchase as 5mg. ***NOTE: If patients come to the pharmacy and need Dulcolax for colon prep, make sure to read dosing carefully and ensure counsel patient properly on how many tablets to take **

Question 228

T/F: All Dulcolax products available as OTC (tablets, chews, liquid, suppositories) all have the same ranges in Onsets of Action.

Answer 228

False!! Dulcolax products available in Canada as OTCs have *different* Onsets of Action depending on which product and formulation you get. - EC Tablets: 6-12 hours (overnight relief) *vs.* - Suppositories: 15-60 minutes (acute treatment or relief)

Question 229

What is the difference between Senokot vs. Senokot-S?

Answer 229

Senokot only contains Sennoside [stimulant laxative]. Senokot-S is a combo product with both Sennoside [stimulant] and docusate sodium [stool softener].

Question 230

Do we like Senokot for Acute constipation?

Answer 230

Sure.

Question 231

What is the difference in senna content between Senokot regular and Senokot Extra Strength tablets? A) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 17.2 mg. B) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 11.2 mg. C) Both Senokot regular and Senokot Extra Strength contain the same amount of senna but possesses different stool softeners in them. D) Senokot regular needs to be taken BID, whereas Senokot Extra Strength is just taken at bedtime

Answer 231

A) Senokot regular contains 8.6 mg of senna, while Senokot Extra Strength contains 17.2 mg.

Question 232

What is the recommended adult dosing for Senokot regular tablets? A) 1-2 tablets once or twice daily, preferrably at bedtime B) 2-4 tablets once or twice daily, preferably at bedtime C) 1-2 tablets once or twice daily in the morning and bedtime D) 2-4 tablets once or twice daily in the morning and at suppertime

Answer 232

B) 2-4 tablets once or twice daily, preferably at bedtime

Question 233

T/F: Senokot regular tablets contain half the amount of senna compared to Senokot Extra Strength tablets.

Answer 233

True. - Senokot (regular) = 8.6mg senna - Senokot Extra Strength = 17.2 mg senna

Question 234

Emily, a 10-year-old girl, has been experiencing occasional constipation for the past week. Her parents are seeking a gentle laxative option for her. Which of the following bulk-forming agents would be the most appropriate recommendation for Emily? Options: A) Bran B) Psyllium (Metamucil) C) Inulin (Benefiber) D) Calcium polycarbophil (Prodiem tablets)

Answer 234

B) Psyllium (Metamucil) OR PEG 3350 too Given Emily's age and the need for a gentle laxative option, psyllium (Metamucil) would be the most appropriate recommendation. Psyllium is approved for use in individuals ages 6 and up and is considered one of the most effective bulk-forming agents for constipation management

Question 235

Which of the following accurately distinguishes between Senokot and Senokot-S? A) Senokot-S contains an additional active ingredient compared to Senokot. B) Senokot-S is formulated specifically for pediatric use, whereas Senokot is for adults only. C) Senokot-S is a stimulant laxative containing docusate sodium, while Senokot is solely a stimulant laxative. D) Senokot is available over-the-counter, while Senokot-S requires a prescription from a healthcare professional.

Answer 235

C) Senokot-S is a stimulant laxative containing docusate sodium, while Senokot is solely a stimulant laxative.

Question 236

Sarah, a 45-year-old woman, is experiencing occasional constipation and seeks advice from her pharmacist on which laxative to choose between Senokot and Senokot-S. She has no known allergies or medical conditions and is not currently taking any medications. Sarah wants to know the key differences between the two products and which one would be more suitable for her condition. Question: Based on Sarah's situation, which of the following factors should be considered when choosing between Senokot and Senokot-S? A) Sarah's age and gender B) The severity and frequency of Sarah's constipation C) The cost difference between Senokot and Senokot-S D) Sarah's preference for tablets versus liquid formulation E) How soon she wants the medication to work (i.e., onset of action)

Answer 236

B) The severity and frequency of Sarah's constipation ----- While Sarah's age and gender may provide some context, they are not the primary factors in choosing between Senokot and Senokot-S. The cost difference and Sarah's preference for formulation are also secondary considerations. The key factor in selecting the appropriate laxative is the severity and frequency of Sarah's constipation, as this will help determine whether she requires a stimulant laxative alone (Senokot) or a combination of a stimulant laxative and a stool softener (Senokot-S).

Question 237

Ex-Lax is another form of which kind of laxative? - Please identify both the drug class as well as the active ingredient(s).

Answer 237

Drug Class: Stimulant Laxative Chemical: Sennosides (or Senna)

Question 238

Ex-Lax Regular *vs.* Ex-Lax Maximum Strength... What is the dosage differences for the Sennosides?

Answer 238

Ex-Lax REGULAR: 15mg *vs.* Ex-Lax MAXUMUM: 25mg

Question 239

Ex-Lax Regular and Ex-Lax Maximum have different doses BUT have the same regimen... Which of the following is the correct statement in regards to these products? a) 1 tab once or twice daily with onset of action of ~6-12 h b) 2 tabs once daily with onset of action of ~6-12 h c) 2 tabs once or twice daily with onset of action of ~6-12 h d) 1 tab BID with onset of action of ~6-12 h

Answer 239

c) 2 tabs once or twice daily with onset of action of ~6-12 h

Question 240

Tommy is a 22-year-old uni student who has been stressed about final exams and has not had a bowel movement in 3 days and feels blocked as a result. He is currently staying with his older sister, her husband, and their 2-year-old toddler. He wants to try Ex-Lax Chocolate pieces as he doesn't like to take pills. What is something is worth mentioning during counselling? a) Confirm he does not suffer from any electrolyte imbalances, kidney dysfunctions, or take anything like diuretics or potassium as the ingredients can make things worse for electrolytes. b) Advise patient that this can cause stomach upset and cramping and might want to consider an alternative depending on what he means when he says he feels "blocked" c) Do not have the medication within reach of the toddler as this can be dangerous. d) Both a and c e) Both b and c f) All of the above

Answer 240

f) All of the above!! - Ex-Lax contains different minerals and ingredients like potassium and calcium. This product can increase electrolyte imbalances especially if already taking things like diuretics which can already increase potassium levels and such. - Although senna is a more mild stimulant, if a person is already experiencing upset stomach and such, this can make it worse and uncomfortable and is not always recommended if that is the case. - Need to be cautious if something like a chocolate medicine is nearby children as they might mistake this as sweets. Taking 2 pieces is already too high of a dose than what is typically recommended for a 2-5 year age group child.

Question 241

John, a 42-year-old man, has a history of irritable bowel syndrome (IBS) with constipation. He is looking for a natural laxative option to regulate his bowel movements. Which of the following products would be the most appropriate recommendation for John? A) Metamucil (Psyllium) B) BeneFiber (Inulin) C) Miralax (Polyethylene Glycol 3350) D) Mineral Oil (Lubricating Laxative)

Answer 241

A) Metamucil (Psyllium) BeneFiber (inulin) is also a natural bulk-forming agent that is technically not a wrong choice; however, Metamucil (psyllium) is one that has more clinical efficacy backing, has more options (flavoured powder, capsules, etc) to choose from, and due to its gelling, this gel adds bulk to stool and helps to soften it, making it easier to pass. Inulin, while also a fibre supplement, may not have the same degree of solubility or viscosity, potentially making it less effective at regulating bowel movements. And has an added bonus of being able to lower cholesterol.

Question 242

Which of the following statements is true regarding the difference between Bisacodyl (Dulcolax) and Sennosides (Senokot, Ex-Lax, Prodiem)? A) Bisacodyl has a faster onset of action compared to Sennosides. B) Sennosides are considered to have a stronger stimulant effect compared to Bisacodyl. C) Both Bisacodyl and Sennosides have the same onset of action when taken orally. D) Sennosides are typically prescribed for acute constipation, while Bisacodyl is used for chronic constipation.

Answer 242

C) Both Bisacodyl and Sennosides have the same onset of action when taken orally. *Both Dulcolax and Senna (standalone) oral tablets have an onset of action of 6-12 h*

Question 243

Which of the following best describes a purgative laxative? A) A laxative that softens the stool and promotes bowel movements gradually over time. B) A laxative that adds bulk to the stool, facilitating its passage through the intestines. C) A laxative that induces a rapid and complete emptying of the bowel. D) A laxative that lubricates the intestinal walls, easing the passage of stool.

Answer 243

C) A laxative that induces a rapid and complete emptying of the bowel. High-dose osmotic agents used as purgative laxatives are typically administered under the supervision of a healthcare professional and may require specific instructions regarding dosage, timing, and preparation. It's important to follow these instructions carefully to ensure safe and effective bowel cleansing

Question 244

Which of the following is a true statement regarding the use of Sennosides? A) Sennosides are often recommended for rapid relief of constipation. B) Sennosides have a milder impact as a stimulant laxative compared to Bisacodyl. C) Sennosides should be avoided in patients with acute constipation. D) Sennosides are usually administered rectally for quicker results.

Answer 244

B) Sennosides have a milder impact as a stimulant laxative compared to Bisacodyl. RXFiles (2023) reports that sennosides have a similar laxative impact to when using Milk of Magnesia as a laxative.

Question 245

What is the primary mechanism of action of docusate sodium and docusate calcium? A) They stimulate peristalsis in the colon. B) They increase the water content of the stool, making it softer. C) They promote the formation of a gel-like substance in the intestines. D) They lubricate the intestinal walls, facilitating the passage of stool.

Answer 245

B) They increase the water content of the stool, making it softer.

Question 246

T/F: The adult dosing for Senokot Extra Strength tablets is lower than that of Senokot regular tablets. *MAKE SURE to understand the differences*

Answer 246

False. If you do the math, it is relatively the same... Senokot (regular) has 8.6mg per tablet and indicative to take 2-4 tabs [17.2-34.4mg] OD-BID, preferably at HS.... - Daily intake (regular) would range from 17.2mg to 68.8mg/day Senokot XS has 17.2mg per tablet and indicates to take 1-2 tabs [17.2-34.4mg] OD-BID, preferably at HS... = - Daily intake (XS) would range from 17.2mg to 68.8mg/day

Question 247

What is the recommended dosing for Senna?

Answer 247

Start with 8.6mg on Night #1 for the "average" patient, then make adjustments every night thereafter PRN .

Question 248

Can you predict the "right" amount of Senna for dosing?

Answer 248

No, trial and error like a lot of this stuff.

Question 249

Senna Dosing while taking Tylenol #3s ***NEED TO KNOW THIS!!!!*** If senna is being used because of using T3s, how should we take senna? - If T3s are started early in the day... vs. - T3s started late in the day... WILL BE COVERED AGAIN IN A BIT.

Answer 249

- If started T3s *earlier in the day*... Should take 16mg of senna on the 1st night - If started T3s *later in the day*... Should take 8mg of senna on the 1st night We don't like playing catch-up if we can help it... But we also want to make sure we don't take a strong enough senna dose that disrupts are sleep unless it's really necessary

Question 250

Which laxative carries the risk of maternal sodium retention, particularly in mid- to late pregnancy? A) Psyllium B) Lactulose C) PEG D) Milk of magnesia

Answer 250

D) Milk of magnesia Milk of magnesia is a somewhat effective laxative, but the salt osmotic gradient may cause maternal sodium retention, posing a risk in mid- to late pregnancy.

Question 251

What is the primary mechanism of action of bulk-forming laxatives such as psyllium and inulin? A) They increase fluid retention in the colon. B) They stimulate peristalsis in the intestines. C) They soften stool by increasing water content. D) They add bulk to stool, promoting bowel movements. E) All of the above

Answer 251

D) They add bulk to stool, promoting bowel movements.

Question 252

T/F: Stimulant laxatives like bisacodyl and senna can be taken with milk, PPIs, or antacids without any interactions.

Answer 252

No!! They are Food- and Drug-Interactions to be mindful of! - They should *not* be taken with milk, antacids or PPIs because these products increase the pH of the upper GI tract causing the premature disintegration of the enteric coating in the stomach before the product reaches the colon.

Question 253

Jack, a 57-year-old man, presents at the pharmacy complaining of occasional constipation. He prefers a gentle laxative and wants to avoid any harsh effects. Which of the following would be the most appropriate recommendation for Jack? A) Dulcolax (Bisacodyl) B) Senokot (Sennosides) C) Ex-Lax (Sennosides) D) Milk of Magnesia (Magnesium hydroxide)

Answer 253

B) Senokot (Sennosides) Senokot (Sennosides) is the recommended stool softener for Jack due to its mild stimulant effect, gentle action, oral administration, effective relief, minimal side effects, and suitability for occasional use. It provides a balanced approach to relieving constipation without causing discomfort or inconvenience for Jack.

Question 254

Which of the following is an example of an osmotic laxative? A) Docusate sodium (Colace) B) Psyllium (Metamucil) C) Magnesium hydroxide (Milk of Magnesia) D) Polyethylene glycol 3350 (Restoralax, Miralax)

Answer 254

D) Polyethylene glycol 3350 (Restoralax, Miralax) ^^^ specifically a non-saline osmotic laxative

Question 255

Acute vs. Preventative Therapy??? Bulk-Forming Agents: Bran, Psyllium, Inulin, and Calcium Polycarbophil ***Need to know this! Plus their onset of actions *** (among other things)

Answer 255

*PREVENTATIVE* ONSET OF ACTION: - Bran: 3-5 days - Psyllium: 12-72 hours - Inulin: 12-72 hours - Calcium Polycarbophil: 12-72 hours

Question 256

Acute vs. Preventative Therapy?? Enemas **Need to know this, plus their onset of action, safety profile** (among other things)

Answer 256

*ACUTE* Onset of Action: 5 to 15 minutes.

Question 257

Acute vs. Preventative Therapy?? Constella (RX)

Answer 257

Preventative... For CHRONIC Idiopathic Constipation.

Question 258

Acute vs. Preventative?? Lubricants: Heavy Mineral Oil & Castor Oil **NEED to know this**

Answer 258

*ACUTE* - not even recommended but if being used, should only be used for a very short period of time!! - They are often used for short-term relief of constipation when immediate action is needed due to their lubricating properties, which help facilitate bowel movements Onset of Action: 6-8 hours

Question 259

Acute vs. Preventative?? Saline Osmotic Laxatives: Milk of Magnesia, Magnesium Citrate, Sodium Phosphate solution **Need to know this and their onsets of action... Also be able to distinguish between the two kinds of osmotic laxatives**

Answer 259

*ACUTE* Onset of Action: 0.5 to 3 hours - Often used for their fast-acting effects in providing relief from constipation. - However, it's important to use them as directed and not to exceed the recommended dosage *to avoid dehydration or electrolyte imbalances*

Question 260

Acute vs. Preventative?? Non-Saline Osmotic Laxative: - Glycerin [suppositories] **NEED TO Know this** - there are more non-saline osmotic laxatives FYI

Answer 260

*ACUTE* Onset of Action: *Within 15-30 minutes* - Safe to use for children under the age of 2.

Question 261

Acute vs. Preventative?? Non-Saline Osmotic Laxatives: - Lactulose **NEED TO Know this** - there are more non-saline osmotic laxatives FYI

Answer 261

It can be used for *BOTH* Preventative & Acute Treatment for Constipation (depending on the individual's needs and the clinical scenario)... ONSET OF ACTION: 24-48 hours - *Preventative* for things like chronic constipation or in situations where long-term management is required. It is commonly prescribed for individuals who need to maintain regular bowel movements over an extended period. -- - *Acute* particularly in cases where other treatments have been ineffective or when there is a need for rapid relief. It is often administered in higher doses or more frequent doses initially to produce a laxative effect and alleviate symptoms of constipatio

Question 262

Acute vs. Preventative?? Non-Saline Osmotic Laxatives: - Polyethylene Glycol (PEG 3350) *NEED to know this, its onset of action, etc*

Answer 262

*PREVENTION* usually... (but in rare cases, can also be delivered in high-doses as a Purgatives for acute purposes, too) Onset of Action: 48-96 hours (i.e., 2-4 days)

Question 263

Acute vs. Preventative?? Stimulant: bisacodyl (Dulcolax) *NEED to know this* There are other stimulant laxatives FYI

Answer 263

All forms of Dulcolax (bisacodyl) stimulant formulations are for *ACUTE* Treatments... But they have their own Onsets of Action Suppositories - Onset of Action: 15 mins to 1 hr Soft Chews: - Onset of Action: 30 mins to 6 hours (onset for PO on CPS says 6-12 hrs) EC Tablets - Onset of Action: 6-12 hours All used when immediate relief is needed or as part of bowel preparation for medical procedures like colonoscopy...

Question 264

Acute vs. Preventative?? Stimulants: Senna / Sennosides (Senokot, Ex-Lax, Prodiem - blue) **Need to know** in addition to other things.

Answer 264

*ACUTE* Relief Onset of Action: 6-12 hours

Question 265

Acute vs. Preventative?? Stool Softeners/Emollients: - Docusate Sodium - Docusate Calcium **Need to know this** plus the differences, onset of action, MoA, etc.,

Answer 265

*ACUTE* (both docusates) -- Onset of Action: 12-72 hours Docusate Sodium (Colace) is available in multiple dosage strengths and formulations - making it more flexible ADI to consider for different demographics, including children. Either taken once daily or can sometimes manipulate dosing by half and dose BID. Docusate Calcium (Surfak) is available only as a 240mg capsule and can be taken either once daily or BID. Only suitable for adults due to the dosing of the capsule.

Question 266

Acute vs. Preventative?? Combination Products: Senokot-S [Stimulant + Stool Softener] **Need to know this** do not confuse drugs with Senokot (stand-alone)! Know the differences

Answer 266

*ACUTE* Relief... Should not be used long-term. Onset of Action: 6-12 hours * Same as Senokot in terms of OoA BUT role it plays on constipation is slightly different.* - Senna alone works to promote prostalsis and bowel movement. - Addition of docusate sodium works by increasing the amount of water absorbed into the stool, making it softer and easier to pass.

Question 267

_______ increases chloride and bicarbonate secretions into the gut and blocks sodium absorption. This results in increased fluid in the gut lumen, which results in improvement in the number of spontaneous bowel movements per week a) Magnesium citrate b) Saline Osmotic laxatives c) Constella d) Milk of magnesia f) Inulin

Answer 267

c) Constella

Question 268

Which of the following laxative agents is most suitable as a first-line treatment for chronic constipation? A) Docusate sodium (Colace) B) Psyllium (Metamucil) C) Magnesium hydroxide (Milk of Magnesia) D) Polyethylene glycol 3350 (Miralax, Restorlax, or Lax-A-Day) E) Both b and d

Answer 268

D) Polyethylene glycol 3350 (Miralax, Restorlax, or Lax-A-Day) - There's limited efficacy for stool softeners in promoting regular BMs - Psyllium can be used for chronic constipation but is recommended to be used for at least 2-3 months consistently for proper observable benefits. - MgO not typically recommended as a first-line treatment for chronic constipation due to its potential to cause electrolyte imbalances with long-term use. - Even though their labels say otherwise, it is considered one of the preferred first-line treatments for chronic constipation due to its efficacy, safety, and minimal side effects. It is generally well-tolerated and can be used long-term for maintenance therapy in individuals with chronic constipation.

Question 269

Which of the following is a true statement regarding psyllium and inulin? A) Psyllium and inulin are both commonly used as stool softeners. B) Psyllium is a synthetic fibre, while inulin is a natural plant extract. C) Inulin is often recommended for rapid relief of constipation. D) Psyllium and inulin should be taken with a full glass of water to prevent choking.

Answer 269

D) Psyllium and inulin should be taken with a full glass of water to prevent choking. - Inulin can also be used on food FYI

Question 270

Which of the following statements about the use of bran as a laxative is false? A) Bran has an onset of action of 3-5 days. B) Bran is commonly used for acute constipation. C) Bran is approved for use in individuals ages 6 and up. D) Bran may interfere with the absorption of certain minerals and vitamins.

Answer 270

B) Bran is commonly used for acute constipation. It's for prevention (think about how onset of action is 3-5 days)

Question 271

Which of the following options is the most suitable first-line treatment for chronic constipation in both adults and children? A) Docusate sodium (Colace) B) Psyllium (Metamucil) C) MgO (Milk of Magnesia) D) Polyethylene glycol 3350 (Miralax) E) Increased dietary fibre and fluid intake F) Regular physical activity and exercise

Answer 271

D) Polyethylene glycol 3350 (Miralax) Although increasing dietary fibre and fluid intake and implementing physical activity and excercise, chronic cases are often diagnosed if incidences occurred within the past 3 months, or symptom onset within the past 6 months therefore, it is likely that need more than just increased fibre and physical activity. Not to mention that adults for acute constipation prevention normally calls for mild-to-moderate exercise whereas kids are regular.

Question 272

Jenna, a 30-year-old woman, has been experiencing occasional constipation for the past week. She prefers a natural approach to relieving her symptoms. Which of the following options would be the most appropriate recommendation for Sarah? Options: A) Dulcolax (Bisacodyl) B) Senokot (Sennosides) C) Metamucil (Psyllium) D) Milk of Magnesia (Magnesium hydroxide) E) Enema

Answer 272

C) Metamucil (Psyllium)

Question 273

T/F: Stool softeners should not be taken with mineral oil to prevent increased absorption of mineral oil leading to possible complications to a person's health.

Answer 273

True!!

Question 274

What is a potential side effect of stimulant laxatives with prolonged use? A) Hypotension B) Dependence C) Gastric ulcers D) Insomnia

Answer 274

B) Dependence ... Where the body becomes reliant on the laxative to produce bowel movements. This dependence can develop over time due to several factors related to the mechanism of action and physiological response to stimulant laxatives. Stimulant laxatives work by directly stimulating the muscles of the intestines to contract, which promotes bowel movements. With prolonged use, the intestines may become less responsive to the effects of the laxative, requiring higher doses or more frequent use to achieve the same laxative effect. This can lead to a cycle of increasing dependence on the laxative to produce bowel movements, as the body becomes accustomed to its effects.

Question 275

What is the primary side effect of osmotic laxatives? A) Abdominal cramping B) Diarrhea C) Electrolyte imbalances D) Constipation

Answer 275

C) Electrolyte imbalances ^^ (particular for saline osmotic laxatives? CHECK)

Question 276

Glycerin suppositories are recommended as the drug of choice for children under the age of ______.

Answer 276

2

Question 277

What is the primary mechanism of action of osmotic laxatives? A) Increasing peristalsis in the intestines B) Softening the stool by adding bulk C) Drawing water into the intestines to soften stool D) Lubricating the intestinal walls for easier passage of stool

Answer 277

C) Drawing water into the intestines to soften stool

Question 278

Emily, a 10-year-old girl, has been experiencing constipation for several days. Her parents are concerned and want to try a gentle laxative to help relieve her symptoms. Which laxative agent would be the most suitable recommendation for Emily? Options: A) Bisacodyl (Dulcolax) B) Polyethylene glycol 3350 (Miralax) C) Sennosides (Senokot) D) Psyllium (Metamucil)

Answer 278

B) Polyethylene glycol 3350 (Miralax)

Question 279

How do bulk-forming laxatives promote bowel movements? A) By stimulating the muscles of the intestines B) By adding bulk to the stool, promoting peristalsis C) By increasing water content of the stool D) By adding bulk to the stool via increasing the water content of the stool.

Answer 279

B) By adding bulk to the stool, promoting peristalsis

Question 280

Pico-Salax is a product that is commonly used as bowel prep for things like colonoscopies. What kind of laxative is this?

Answer 280

High-dose osmotic agents that is being used and/or classified as a kind of Purgative Laxatives

Question 281

T/F: Bulk-forming laxatives increase stool volume and are considered the safest agents suitable for long-term use.

Answer 281

True! Bulk-forming laxatives work by increasing stool volume, which promotes bowel movements and regularity. They are considered the safest agents for long-term use because they have a gentle mechanism of action and do not stimulate the intestines like other types of laxatives.

Question 282

Patient X was diagnosed with chronic constipation approximately 2 months ago. They've been educated extensively about the importance of increasing dietary fiber and implementing lifestyle changes such as mild-to-moderate exercise. So far, these measures have provided some relief, but Patient X still experiences occasional episodes of constipation. What is the next step in the management of Patient X's chronic constipation? Options: A) Add second-line agents such as osmotic laxatives (e.g., lactulose, polyethylene glycol) B) Initiate third-line agents such as emollients and stimulants for short-term use C) Start prosecretory or prokinetic agents for an 8- to 12-wk trial D) Use rescue treatment with stimulant laxatives (e.g., bisacodyl, senna) or glycerin suppository/enemas

Answer 282

A) Add second-line agents such as osmotic laxatives (e.g., lactulose, polyethylene glycol) [Refer to the Table of Chronic constipation is treated in a stepwise approach on CPS (2023)] Since Patient X still experiences occasional episodes of constipation despite lifestyle modifications and dietary fiber supplementation, the next step in their management would be to add second-line agents such as osmotic laxatives. These agents, such as lactulose or polyethylene glycol, can help to further alleviate constipation by increasing stool hydration and softening. They should be added after a 4- to 6-week trial of initial lifestyle modifications and dietary changes.

Question 283

Patient X was diagnosed with chronic constipation approximately 2 months ago. Has been using fibre and has implemented lifestyle changes but recently experiencing another episode. She was recommended to try using an osmotic laxative to help with the constipation. When counselling X, what should you advise to them in terms of when rescue treatment is required is what agents should they use in such event?

Answer 283

If there has been no improvement and/or no BM for *2 consecutive days*, Patient X can consider using *Stimulant laxatives* : - Bisacodyl (suppositories for faster relief), - Senna, - Glycerin suppositories, and/or - Enema

Question 284

Patient X was diagnosed with chronic constipation approx. 2 months ago. They've been educated extensively about the importance of increasing dietary fibre and implementing lifestyle changes such as mild-to-moderate exercise but needed to start osmotic laxatives trial. After initiating treatment with osmotic laxatives, they report improvement in symptoms but still have persistent issues. What is the appropriate next step in the management of Patient X's condition? Options: A) Increase the dose of osmotic laxatives for better efficacy B) Use third-line agents such as stool softeners and stimulants for short-term use C) Consider Prosecretory or prokinetic agents may be tried for chronic idiopathic constipation for an 8- to 12-wk trial prior to reassessment D) Reassess and refer to a specialist for further evaluation

Answer 284

B) Use third-line agents such as stool softeners and stimulants for short-term use

Question 285

What is the onset of action for bulk-forming agents like psyllium, inulin, and calcium polycarbophil? A) 0.5 minutes to 3 hours B) 6-12 hours C) 12-72 hours D) 2-4 days

Answer 285

C) 12-72 hours

Question 286

Which of the following lubricant laxatives is not generally recommended due to its risk of lipid aspiration and binding of fat-soluble medications? A) Castor Oil B) Mineral Oil C) Heavy Mineral Oil D) Olive Oil

Answer 286

C) Heavy Mineral Oil

Question 287

What is the youngest approved age indication for enema usage? A) 1 year old B) 2 years old C) 5 years old D) 10 years old

Answer 287

B) 2 years old

Question 288

Which osmotic laxative has an onset of action within 15-30 minutes of insertion and is the drug of choice for children under the age of 2? A) Magnesium Citrate B) Milk of Magnesia C) Glycerin Suppositories D) Dulcolax suppositories E) Lactulose

Answer 288

C) Glycerin Suppositories

Question 289

T/F: Mineral oil is recommended for long-term use as a lubricant laxative.

Answer 289

Absolutely. FALSE!!! We don't even like people using it in general!! So, HELL NO!!!

Question 290

Which type of laxative has an onset of action that can be as little as 0.5 minutes to 3 hours and is often used for acute relief of constipation? A) Lubricant laxatives B) Saline osmotic agents C) Non-saline osmotic agents D) Stimulant laxatives

Answer 290

B) Saline osmotic agents

Question 291

What is the onset of action for PEG 3350, a non-saline osmotic laxative? A) 0.5 minutes to 3 hours B) 6-12 hours C) 12-72 hours D) 2-4 days

Answer 291

D) 2-4 days

Question 292

T/F: Enemas for laxative use have no known drug interactions

Answer 292

True... As of right now. (CPS, 2023)