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Constipation Flashcards

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1
Q

Oral bulk forming laxatives

A

psyllium, methylcellulose, polycarbophil, inulin (“push”)

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2
Q

Psyllium

A

Metamucil

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3
Q

Methylcellulose

A

Citrucel

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4
Q

Polycarbophil

A

Fiber Con

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5
Q

Inulin gummies

A

Mirafiber

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6
Q

At what age can oral bulk forming laxative gummies be used?

A

2 or 4 years of age (labeled)

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7
Q

At what age can oral bulk forming laxative powders or tablets be used?

A

6 years of age or older

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8
Q

Oral bulk forming laxative MOA

A

Fibers absorbs water and expands. As the fiber expands, pressure is increased on the intestine walls and promotes a bowel movement.

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9
Q

Oral bulk forming laxative treat what symptoms?

A

PREVENT constipation or TREAT chronic constipation

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10
Q

When are oral bulk forming laxatives a first line treatment?

A

When rapid relief is not required and the patient drinks adequate fluids daily

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11
Q

Oral bulk forming laxatives cannot treat what?

A

Actue constipation due to slow onset and potential for worsening symptoms if a blockage is present

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12
Q

Side effects of oral bulk-forming laxatives

A

flatulence, abdominal bloating/gas buildup

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13
Q

If a patient is experiencing bothersome side effects with an oral bulk forming laxative such as psyllium, what is an alternative therapy?

A

Methylcellulose: an oral bulk forming laxative with a synthetic formulation; may be better tolerated

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14
Q

Is fiber systemically absorbed?

A

No, not systemically absorbed so no systemic side effects

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15
Q

Why is it important to take water with a fiber (oral bulk forming laxative) supplement?

A

May have stool softening effects if taken with adequate water; will harden stools if taken with not enough water

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16
Q

If an oral bulk forming laxative is intended to be used chronically, what must happen first?

A

PCP should be notified

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17
Q

Are oral bulk forming laxatives safe for pregnancy and lactation?

A

Yes

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18
Q

Oral bulk forming laxative onset

A

typically not fully effective for 72 hours

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19
Q

For what indication are oral bulk forming laxatives not appropriate for?

A

opioid-induced constipation

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20
Q

Why would an oral bulk forming laxative not be safe for someone who is bedridden, has dysphagia, or cannot drink adequate fluids?

A

Fiber can swell in the throat and cause choking if not taken with a full glass of fluid

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21
Q

Patient consultation notes: oral bulk-forming laxatives

A

1) May interact with the absorption of other drugs, so separate by two hours; 2) Minimize side effects by starting with a low dose and titrating up

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22
Q

What dosage forms are available for oral bulk forming laxatives?

A

tablets, capsules, powders, gummies, wafers, and sugar free options

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23
Q

Oral stimulant laxatives

A

bisacodyl, senna (“push”)

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24
Q

Bisacodyl (oral)

A

Dulcolax

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25
Senna
Senakot, Exlax
26
Rectal stimulant suppository
bisacodyl
27
Bisacodyl (suppository)
Fleet Bisacodyl
28
Stimulant laxative MOA
Stimulants irritate the GI mucosa, stimulating smooth contraction and secretion of water resulting in a bowel movement
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Symptoms treated by a stimulant laxative
TREAT acute constipation, TREAT & PREVENT acute and chronic opioid-induced constipation; pre-procedural emptying (e.g., colonoscopy prep)
30
Side effects of stimulant laxatives
GI cramping
31
If a stimulant laxative is overused/abused/take too long what can happen?
Patient may develop diarrhea with associated dehydration and/or electrolyte imbalance
32
Bisacodyl suppository onset
15-60 minutes
33
Oral stimulant laxative onset
6-10 hours
34
If a stimulant laxative is being used to treat opioid-induced constipation, what product may be used in addition?
PEG or docusate (to provide the "mush")
35
Is a stimulant laxative safe for breastfeeding?
Yes
36
Who may abuse stimulant laxatives?
People with eating disorders or those trying to "detox"
37
Is a stimulant laxative safe for pregnancy?
Safe for short-term use, but not preferred due to the GI cramping side effect which may be confused for contractions
38
Patient consultation notes: Senna
Senna can cause discoloration of urine (red/pink/brown); max 7 days of use unless physician-consulted or for prevention of opioid-induced constipation
39
Patient consultation notes: Bisacodyl ORAL
Bisacodyl tablets are EC and cannot be crushed/chewed/broken; do NOT take with PPIs/H2RAs/antacids/milk which can cause early dissolution of enteric coatings; max 7 days of use unless physician-consulted or for prevention of opioid-induced constipation
40
If a patient is on an acid-reducer (such as PPIs, H2RAs, or acid-reducers), which stimulant laxative can be recommended?
Senna
41
Bisacodyl tablets should be separated from milk by what time frame?
by 1 hour
42
Hyperosmotic laxatives
polyethylene glycol 3350, glycerin suppository
43
Polyethylene glycol 3350
Miralax
44
Glycerin suppository
Pedia-lax
45
At what age can Miralax be used?
FDA-approved OTC for 17 years of age or older; preferred product for children under supervision of a pediatrician
46
At what age can a glycerin suppository be used?
At any age
47
Hyperosmotic laxatives MOA
Contains large, poorly absorbed ions or molecules that draw water into the colon or rectum through osmosis to stimulate a bowel movement
48
What is a glycerin suppository indicated for?
TREAT acute constipation in all ages
49
What is PEG indicated for?
TREAT acute constipation in all ages; PREVENT & TREAT opioid-induced constipation; bowel evacuation prior to procedure
50
PEG side effects
abdominal discomfort, flatulence
51
Glycerin side effects
rectal irritation
52
If a hyperosmotic laxative is overused/abused/taken too long, what side effects may develop?
diarrhea associated with dehydration and/or electrolyte disturbances
53
Is PEG absorbed systemically?
No (virtually safe for everyone)
54
Pediatric dosing of PEG (preferred option for infants and children)
0.4 to 1.5 g per kg up to 17 g per day
55
Patient consultation notes: Glycerin Suppositories
Suppositories may be cut to a smaller dose because they contain no drug; Suppositories have rapid effects (15-30 minute onset--BM)
56
What is the max duration of use for hyperosmotic laxatives?
Per OTC labeling: max 7 days of use; Safe to use long-term if no diarrhea and PCP is aware
57
Patient consultation notes: Miralax/PEG
Onset is longer than glycerin suppositories and stimulant laxatives (12-72 hours); dosed once daily with 4-8 ounces of water
58
What is the onset of Miralax?
12-72 hours
59
What is the onset of a glycerin suppository?
15-30 minutes
60
Oral saline laxatives
magnesium citrate, magnesium hydroxide, mirafast
61
Rectal saline laxatives
sodium phosphate
62
Magnesium hydroxide
Philip's Milk of Magnesia-MOM, Pedialax chews
63
Dosage strength of MOM (magnesium hydroxide)
1200 mg/15 mL
64
Dosage strength of Pedialax chews
400 mg/chew
65
Dosage strength of Mirafast
1200 mg/chew
66
At what age can Mirafast be used?
At 4 years of age or older
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Sodium phosphate (rectal)
Fleet, Pedialax
68
What form of magnesium can NOT be used for constipation
Magnesium sulfate (Epsom salt)
69
Saline laxative MOA
Contains electrolytes that draw water into the small and large intestine (oral products) or distal colon (rectal products) by osmosis, increase intraluminal pressure and stimulate peristalsis
70
Saline laxative indications
TREAT acute constipation, bowel evacuation before procedure (e.g., colonoscopy)
71
Side effects of saline laxatives
abdominal cramping
72
Which saline laxative product may a physician recommend chronically?
MOM--Milk of Magnesia
73
If a saline laxative is overused/abused/taken too long, what side effects may occur?
diarrhea associated with dehydration and/or electrolyte disturbances
74
What is the onset of a saline laxative enema (sodium phosphate)?
2-15 min
75
What is the onset of magnesium citrate?
30 minutes to 3 hours
76
What is the onset of magnesium hydroxide?
30 minutes to 6 hours
77
Magnesium citrate is generally used for ______.
procedure prep
78
Magnesium hydroxide is generally used for ______.
occasional constipation
79
Are saline laxative products safe for lactation?
Yes
80
Which laxative is most likely to cause diarrhea, dehydration, and electrolyte imbalances?
Saline laxatives because they contain electrolytes that can be absorbed systemically
81
How often can a sodium phosphate enema be used?
MAX 1 enema/day for 3 days
82
For how long can oral saline laxatives be used?
Max 7 days of use (exception: physician-recommended MOM--Milk of Magnesia)
83
In what patient population should saline laxatives be avoided?
Older adults due to renal function decline associated with age; Patients with Na/K/Mg-restricted diets; Anyone with renal impairment
84
Sodium phosphate enemas should be avoided by which patient population?
Patients with uncontrolled HTN or edema, heart failure due to the absorption of sodium increasing fluid retention
85
Are saline laxative products safe for pregnancy?
Not recommended (unless physician-directed)
86
DDIs with magnesium products (saline laxatives)
Chelate certain drugs and decrease absorption; seperate dose from other medication by at least 2 hours
87
Oral emollient/stool softener (NOT A LAXATIVE)
docusate sodium
88
Docusate sodium
Colace
89
Oral emollient/stool softener MOA
Anionic surfactants that act in the small intestine to increase the wetting efficiency of instestinal fluid, facilitating a mixture of aqueous and fatty substances to soften the fecal mass ("mush")
90
What is an oral emollient/stool softener indicated for?
Prevention of straining and painful defecation; May be added to a stimulant for the treatment of opioid-induced constipation
91
Side effects of docusate sodium
No major side effects
92
In what patient population may docusate sodium be recommended?
To prevent rectal strain in patients who had surgery and/or are post-partum; Soften stool for patients with hemorrhoids
93
What is the onset of docusate sodium?
12-72 hours, but may take up to 5 days
94
Is docusate sodium absorbed systemically?
No
95
Is docusate sodium safe for pregnancy and lactation?
Yes
96
For which indication should docusate sodium not be used?
Do NOT use for acute constipation (only provides the "mush")
97
Lubricant laxative
ORAL and RECTAL mineral oil
98
Oral mineral oil
Fleet Oil
99
Rectal mineral oil
Fleets
100
Lubricant laxative MOA
Softens fecal contents by coating stool and preventing colonic absorption of fecal water
101
What is a lubricant laxative indicated for?
TREAT acute constipation
102
Side effects of a lubricant laxative
Aspiration pneumonia (oral product), Anal pruritis and leakage, Impaired absorption of fat-soluble vitamins (A, D, E, K) if overused
103
If a lubricant laxative is overused/abused/taken too long, what side effects occur?
diarrhea associated with dehydration and/or electrolyte disturbances
104
Onset of an oral lubricant laxative
6-8 hours
105
Onset of a rectal lubricant laxative
immediate (5-15 mintues)
106
Should a lubricant laxative be recommended?
No, there are better options to choose from
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