Constipation

Question 1

mouth to anus transit time is normally ___ hours
* up to ___ may still be considered normal

Answer 1

30-40 hours
* 72 hours

Question 2

acute constipation:
less than ___ bowel movements/week

Answer 2

3

Question 3

chronic constipation:
symptoms lasting longer than ___ weeks
* may respond to laxatives but returns after they are stopped

Answer 3

6 weeks

Question 4

disease states that slow down GI motility

Answer 4

1. diabetes
2. Parkinson’s
3. CNS injury or disease
4. MS

Question 5

Common Drug Causes of Constipation

• opioids - __ receptor agonist in GI tract, slows everything down
• NSAIDs - inhibition of prostaglandins. ___ series play a significant role in ___ and fluid ___
• antacids containing ___ and ___.
• drugs with strong ___ properties
• Verapamil, clonidine, Ca channel blockers
• ___ preparations
• dramatic dose increase in ___

Answer 5

• mu
• E, motility, movement
• Ca, Al
• anticholinergic
• Iron
• diuretics

Question 6

T or F: as much fiber as possible should be added to the diet quickly

Answer 6

False; want to add fiber slowly ober 7-10 days to minimize gas

Question 7

Prunes have a high [ ] of simple sugars like ___ , ___ g of fiber, and a natural laxative called ___

Answer 7

sorbitol, 12 g, dihydrophenylsatin

Question 8

T or F: kiwi is a good alternative to prunes bc you wont toot as much

Answer 8

True;

Question 9

when is colonic activity the greatest

Answer 9

• first thing in the morning
• within 30 minutes after meals

Question 10

Bulk laxatives

psyllium - ___
methylcellulose - ___
calcium polycarbophil - ___
MOA: forms gels which retain ___, swells, and stimulates a BM

Answer 10

• Metamucil
• Cirucel
• Fibercon
  water

Question 11

T or F: bulk laxatives soften stool better than docusate

Answer 11

True

Question 12

Disadvantage of Bulk Laxatives
* __ formation
* impacts drug ___

Answer 12

• gas
• absorption

use cold water to decrease gas

Question 13

Surfactant/Emollient

Docusate
* Dose: 100 mg once or twice daily
* MOA: decreases fecal ___ (stool softener)
* not effective for ___ constipation, mostly preventitive

Answer 13

• surface tension
• active

Question 14

Lubricant

mineral oil
MOA: lubricates lumen of the ___
* only effective for ___
* may decrease absorption of ___ vitamins

Answer 14

colon
* prevention
* fat soluble

Question 15

Saline Laxatives

Examples: Milk of Magnesia, Fleet, and Mg citrate
MOA: draws fluid into the colon to stimulate motility
* ___ onset
* used for ___ management
* avoid in ___ patients

Answer 15

• quick
• acute
• renal

Question 16

Hyperosmotic agents

• excellent for ___ constipation
• softens while stimulating BM

Answer 16

chronic

Question 17

Hyperosmotic agents

glycerin suppositories
* ___ onset

Answer 17

quick

Question 18

Hyperosmotic agents

PEG 3350 - ____
* onset: ___

Answer 18

MiraLAX
1-3 days

Question 19

Stimulant Laxatives

Senna: 2 tabs 1-2x daily
Bisacodyl: 1-2 tabs daily
* ___ coated
* MOA: locally stimates ___ nerves to produce __ and mobility; also increased fluid and Na secretion into the lumen

Answer 19

• enteric
• enteric, contractions

Question 20

Stimulant Laxatives

Advantages:
* ___ hr onset
* works for patients with ___ disorders
* drug of choice for ___

Disadvantages:
* avoid ___ term continuous use in patients with normal GI motility

Answer 20

• 6-12 hr
• motility
• opioid induced constipation

Question 21

Stimulant Laxatives

Bisacodyl ___
10 mg PR
___ onset

Answer 21

suppositories
quick

Question 22

Chloride Channel Acitvators

• activates chloride channels in ___ resulting in ___ influx which increases fluid movement into intestinal lumen
• negative goes through channel, positive follows to balance, brings its BFF water with it

Answer 22

• Small intestine
• Na

Question 23

Chloride Channel Activator

Lubiprostone ( ___ )
Indicaions: chronic ___ consitpation IBS-C, ___ with chronic, non-cancer pain
* Dose: 24 mcg ___ with food + water
* avoid in ___
* reserved for patients who do not respond or tolerate other laxatives

Answer 23

Amitiza
* idiopathic, OIC
* BID
* pregnancy

Question 24

Guanylate Cyclase-C receptor activator

Linaclotide ( ___ )
* increases chloride and ___ secretions into the lumen and inhibits ___ absorption
* indicated for ___
* Dose: ___ mcg once daily
* take 30 min before 1st meal of the day
* 72 mcg appears as effective with less diarrhea
* $$$

Answer 24

Linzess
* bicarbonate
* sodium
* CIC
* 145 mcg

Question 25

# Guanylate Cyclase-C receptor activator Plecanatide ( ___ ) Dose: ___ mg once daily may be administered at any time of day, with or without food

Answer 25

Trulance 3 mg

Question 26

# Chronic constipation treatment tiers 1. relieve acute constipation with ___ modifications 2. ___ forming laxatives and fluids 3. PEG, lactulose, sorbitol 4. short term use of ___ 5. lubiprostone, linaclotide, prucalopride, plecanatide

Answer 26

* dietary * bulk * stimulants

Question 27

# Special Populations spinal cord injury pts: * routine use of ___ * usually ___ form

Answer 27

* stimulants * suppository

Question 28

# Special Populations pregnancy * diet, fiber, ___ * ___ in more severe cases

Answer 28

* docusate * senna

Question 29

# Special Populations diabetics * prokinetic agents: ___ and ___ * stimulants

Answer 29

metoclopramide prucalopride

Question 30

patients on opioids * stimulants * then add __, lactulose, or ___ prn * avoid ___ laxatives * opioid receptor ___ when other treatment doesnt work

Answer 30

* docusate, PEG * bulk * antagonists

Question 31

T or F: bulk laxatives are first line therapy for patients on opioids

Answer 31

FALSE; avoid bulk laxatives

Question 32

# Special Populations patients on opioids * methylnaltrexone ( ___ ) * mu opioids receptor ___ * dose based on ___ * 8-12 mg ___ every ___ day * expect a BM within ___ minutes * $$$

Answer 32

* Relistor * antagonist * weight * SC, other * 30 min

Question 33

# Special Populations patients on opioids * Naloxegol ( ___ ) * mu opioid receptor ___ * 25 mg __ once daily * 1 hr prior to first ___ or 2 hrs after * needs to be taken on a ___ stomach * high ___ meal increases rate of ___ * tablet can be ___ * $$$

Answer 33

* Movantik * antagonist * PO * meal * empty * fat, absorption * crushed

Question 34

# Prep for colonoscopy PEG * 2-4 L * drink 8 oz q ___ * refrigerate

Answer 34

10 minutes

Question 35

# Prep for colonoscopy prior day to procedure, "enjoy ___ all day" * mix 1 bottle of ___ into 2 bottles of gatorade (cannot do red flavor) * drink extra 8 oz of clear fluid every hour * take ___ 5 mg bisacodyl tabs at noon * at 2 pm, begin drinking gatorade solution, 8 oz q 10-20 minutes over an ___. * Wait ___ minutes, then drink 2nd bottle

Answer 35

clear liquids * Miralax * 4 x * hour * 30 minutes