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CLPH Geriatrics Constipation
constipation therapeutics
49
Pharmacology
Professional
12/10/2011

Additional Pharmacology Flashcards

 


 

Cards

Term
constipation occurs most frequenly in what population?
Definition
non-white, elderly women
Term
constipation is a disorder of...
Definition

colonic motility

or anorectal function

Term
acute constipation becomes chronic constipation when symptoms last longer than how many weeks?
Definition

6 weeks

(may respond to laxatives but returns when laxatives are removed)

 

*Does not respond to dietary changes alone*

Term
acute constipation
Definition
fewer than 3 bowel movements per week
Term

Common causes of Constipation

 

 

Definition
  • dietary (poor fluid intake, ↓caloric intake)
  • failure to heed defecation reflex
  • impaired physical mobility
  • lack of privacy
  • psychological distress
  • disease that slows GI motility
  • drugs
Term
Drugs that Commonly Cause Constipation
Definition
  • Opiods
  • Antacids
  • Anti-cholinergics
  • Antidepressants
  • Antihypertensives (verapamil, clonidine)
  • Iron
  • Diuretics
  • Chronic use of stimulant laxatives (only in those who have GI motility)
Term
When to refer a patient for constipation
Definition
  • sx for >2 weeks
  • black/tarry stools
  • abdominal pain/discomfort
  • fever
  • N/V
  • FH of inflamm bowel disease (crohn's) or colon cancer
  • drastic change in severity/nature of sx
Term
Tool to assist in patient assessment
Definition
poop journal for 2-4 weeks
Term
Questions to ask a patient complaining of constipation
Definition

Length of constipation

Frequency of normal bowel movements

Size and Color of stools

Constipation with bouts of diarrhea?

Change in caliber of stools

Gas

Appetite/Weight change

Term
Bristol Stool Scale is used to measure what?
Definition

Transit time in the GI

harder feces indicating slower transit

 

Term
desired outcome for constipation treatment
Definition
return to comfortable point and provide relief
Term
How many glasses of water per day qualifies as ample fluid intake to promote regular bowel habits?
Definition
6-8 glasses
Term
Measures to Help Promote Regular Bowel Habits
Definition
  • include ample fluids and fiber in diet
  • add high-fiber foods to diet slowly
  • do not ignore the urge to have a bowel movement
  • establish a regular, unhurried time for BM
  • encourage defecation first thing in AM or w/in 30 minutes after meals
  • routine physical activity
Term
What is the recommended amount of fiber per day for regular bowel habits?
Definition

20-30g/day

 

Term

Dried Plums

(affectionately known as Prunes)

Definition
  • contain high conc of simple sugars (sorbitol)
  • 1 cup = 12g of fiber
  • dihydrophenylsatin (natural laxative)

*Good for adding fiber to diet*

Term
Agents causing relief from acute constipation in 0.5 to 3 hours
Definition

magnesium citrate

sodium phosphate

Large doses of PEG

enemas

bisacodyl/glycerin suppositories

Term
Agents providing relief from acute constipation in 6-24 hours
Definition

Milk of Mag

standard doses of PEG (Miralax)

bisacodyl/senna tablets (oral)

 

Term
5 steps to treatment of chronic constipation
Definition
  1. dietary interventions (failed prior)
  2. bulk forming laxatives + adequate fluid intake
  3. sorbitol/lactulose/PEG
  4. stimulant laxative (short term)
  5. lubiprostone (Amitiza)(Rx only)
Term
therapy for constipation in spinal cord injury patients
Definition

routine use of stimulant laxative (suppositories)

attempt to "train bowel" (bowel program)

 

Term
tx for constipation during pregnancy
Definition

diet, fiber, docusate

senna in more severe cases

Term
tx of constipation in children
Definition

glycerin

Karo syrup (infants)

Term
tx of constipation for diabetics
Definition

metoclopramide (↑GI motility)

stimulant laxative

Term
tx of constipation for chronic opiod users
Definition

Stimulant laxative

Then add lactulose, sorbitol, or PEG PRN

AVOID Bulk laxatives (bc no GI motility, will only lead to increased probs due to inability to move feces out)

 

Methylnaltrexone (Relistor) mu opiod receptor antagonist

8-12mg SC every other day

BM w/in 30 min

 

Term
Preps for GI procedures
Definition

hyperosmotics/saline laxatives

clear liquid diet beginning day prior

prep with laxative starts afternoon before

large quantities of fluids

Term
Oral Prep Agents for GI Procedure should be avoided in patients with what
Definition

heart failure

renal disease

electrolyte abnormalities

 

*use in these patients is why these agents are Rx only

Term
Bulk laxatives mechanism of action
Definition
form emollient gel which retains water and stimulates a bowel movement
Term
advantages of bulk forming laxative
Definition

+ soften stools better than docusate

+ well tolerated with few SE

Term
disadvantages of bulk forming laxatives
Definition

- taste

-must have adequate fluid intake

- gas formation (only with metamucil)

- impacts drug absorb

- not good for bedridden patients (bc have poor GI motility)

- Not for patients on chronic opiods

Term
Examples of bulk laxatives
Definition

Metamucil (psyllium)

Citrucel (methylcellulose)

Fiber tabs

Term
Example of surfactant/emollient laxatives
Definition

aka stool softeners

 

Docusate (100mg QD or BID)

 

Term
Mechanism of action for surfactant/emollient laxatives
Definition

decrease fecal surface tension

stool softener

Term
Advantages/Disadvantages of surfactant/emollient laxatives
Definition

+ safe

+ helps prevent hard stools (hemorrhoids)

- efficacy is questionable

- Not Effective for Active Constipation

Term
Lubricant (aka slip-n-slide) laxatives
Definition

lubricate lumen of colon

 

Mineral Oil (30-60mL QD)

Term
Disadvantages of Lubricant Laxatives
Definition

- poor patient acceptance (oily and can be leaky)

- may ↓ absorption of fat-soluble vitamins (A,D,E,&K)

Term
Saline Laxatives
Definition

MOA: draw fluid into colon which stimulates motility

 

milk of mag

Mg Citrate

Phospha-soda

Fleet's Saline Enema

Term
Advantages/Disadvantages of Saline Laxatives
Definition

+ quick onset

+ most economical

 

- avoid in renal patients bc have a hard time excreting Na and Mg

Term
Hyperosmotic Agents MOA
Definition
draw fluid into colon due to high conc of sugar, PEG, or glycerin
Term
Examples of oral Hyperosmotic Agents
Definition

Sorbitol (30-60mL QD)

Lactulose (30-60mL QD)

PEG (17g in water QD)

 

PEG = Miralax

Term
Advantages/Disadvantages of oral Hyperosmotic Agents
Definition

+ well tolerated

+ softens while stimulating bowel movement

+ excellent for Chronic constipation

 

- 1-4 DAY onset

- sweet taste of some

- minor nausea, cramping

Term
Hyperosmotic suppository
Definition

glycerin

 

fast onset

Term

polythylene glycol

(Nulytely, Golytely, HalfLytely)

Definition

hyperosmotic agent

 

used as bowel prep (4L)

8oz Q 10 minutes

Term
Karo Corn Syrup
Definition

hyperosmotic agent

 

sometimes used in kids

1 tsp in 6-8 oz formula

Term
Examples of Stimulant Laxatives
Definition

Senna (2T QD to BID)

Bisacodyl (enteric coated) (1-2T QD)

Castor Oil (30-60mL)

 

Bisacodyl suppositories (10mg PR)

quick onset

Term
Stimulant laxative MOA
Definition
Locally irritates nerves which stimulates mobility
Term
Advantages/Disadvantages of oral Stimulant Laxatives
Definition

+ 6-12 H onset

+ works for patients with mobility issues

+ DOC for patients on opiods

 

- risk of cramping

- avoid long-term use in patients with GI motility

Term
Chloride Channel Activator
Definition

Lubiprostone (Amitiza)

24mcg BID with food

8mcg BID for women with IBS

 

increase influx of fluid into small intestine

Term
Disadvantages of lubiprostone
Definition

diarrhea/nausea/HA

Expensive

Avoid in pregnancy

Term
Follow up
Definition

1-2 days for acute

1-2 weeks for chronic constipation

 

look for:

stool frequency, diarrhea episodes, dietary changes

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