scott constipation

Question 1

chronic constipation

Answer 1

sx last >6 wks
may not respond to laxative by returns when laxatives d/c

Question 2

common causes of constipation

Answer 2

especially in elderly
dietary
-poor fluid itake
-decreased calorie intake
failure to heed defecation reflex
impaired phsycial mobility

Question 3

drug causes of constipation

Answer 3

analgesics/ opioids
Mu receptor agonist in GI tract

Question 4

NSAID-induced constipation

Answer 4

must less than opioids
inhibition of PGs
prostaglandin E series play a significant role in GI physiology

Question 5

antacid induced constipatio

Answer 5

aluminum, calcium

Question 6

agents with strong anticholinergic properties that cause constipation

Answer 6

antihistamines
antimuscarinics
amitriptyline

Question 7

more drug induced constipation

Answer 7

verapamil, clonidine, ca channel blockers
iron prep
diruetic
chronic use of stimulant laxatives

Question 8

bulk laxatives

Answer 8

psyllium-metamucil
methylcellulose-citrucel
BEST AT SOFTENING STOOL
gas

Question 9

surfactant laxative

Answer 9

docusate-colace
chronic only-softens stool*****

Question 10

lubricant laxative

Answer 10

mineral oik
rarely used

Question 11

saline laxative

Answer 11

milk of magnesia
mg citrate
fleet’s saline enema

Question 12

hyperostmotic laxatives

Answer 12

PEG- miralax
lactulose
glycerin suppositories

Question 13

stimulant laxative

Answer 13

senna- senokot
bisacodyl- dulcolax
castor oil

Question 14

NEWER laxatives

Answer 14

lubiprostone
linaclotide
plecanatide
lacititol
LAST RESORT

Question 15

if you want relief asap,

Answer 15

take enema or bisacodyl/glycerin suppository

Question 16

if you want relief within 3-6 hours,

Answer 16

use citrate or magnesia
larger doses of PEG

Question 17

if you want relief within 24 hours,

Answer 17

biscodyl or senna tablets

Question 18

if you want relief witin 48 hours,

Answer 18

milk of mag
or miralax

Question 19

steps to relieve chronic constipation

Answer 19

1. relieve acute constipation
2. bulk forming lax (psyllium or methylcellulous) + fluids
   3.PEG, lactulose, sorbitol
3. short term use of stmulant then maintenance agent
4. new agent

Question 20

non pharm treatment:

Answer 20

squatty potty

Question 21

follow up and assessment

Answer 21

1-2 days for acute constipation
1-2 weeks for chronic constipation

Question 22

one of the most important questions to ask:

Answer 22

what is your normal frequency of bowel movements?

Question 23

what to give to patients on opioids with constipation

Answer 23

stimulants
then add docusate, lactulose, or PEG prn
AVOID BULK LAXATIVES LIKE PSYLLIUM AND METHYLCELLULOSE
use opiooid receptior antagonist when other tx dont work

Question 24

Methylnaltrexone

Answer 24

Mu opioid receptor antagonist
dosed based on weight
8-12 mg SC every other night
except BM within 30 minutes
$$$

Question 25

Nalozegal (movantik)

Answer 25

mu opioid receptor antagonist 25 mg PO once daily, 12.5 mg if CrCl <60 ml/min ***1 hr prior to 1st meals or 2 hours after meals** ***empty stomach and high fat meal increased extent and rate of absorption*** tablet can be crushed

Question 26

prep for GI procdures

Answer 26

hyperostomics or saline laxatives

Question 27

how to prep for GI procedure

Answer 27

clear liquid diet starts day prior to procedure -jello, brother, popsicles, gatorade, clear juices, coffee prep startsin PM prior to procedure drinking large quantities of fluids is key

Question 27

DO NOT USE BULK LAX FOR ACUTE OR OPIOID

Question 28

oral prep agents

Answer 28

POLYETHYLENE GLYCOL frequently used as abowel prep refrigerate

Question 29

SAS prep

Answer 29

clear liquids all day mix 1 bottle of miralax into 2 bottles of gatorade refigerate drink an extra 8 oz of clear fluid every hour 4x 5 mg bisacodyl tabs at noon at 2 om, begin drinking miralax/gatorade soltuion at rate of 8 oz every 10-20. minutes over 1 hour wait 30 minutes, then drink second bottle at same rate