CONSTIPATION

Question 1

What are 3 risk factors of constipation

Answer 1

Women
Elderly
Pregnancy

Question 2

What are 5 red flags associated with constipation
I
B
A
U
N

Answer 2

Iron deficiency anaemia
Blood in stools
Abdominal pain
Unintentional weight loss
New onset over 50

Question 3

Non drug treatments [4]

Answer 3

Review causative medications
Increased fibre
Increase fluids
Increased exercise

Question 4

What medicines cause constipation
6

A
O
I
A
T
C

Answer 4

Antimuscarinics
Opioids
Iron
Aluminium antacids
TCA’s
Clozapine

Question 5

What should be used for acute constipation [ less than 3 months]

Answer 5

First line: bulk forming laxatives and hydration
Second line: Osmotic laxatives

Question 6

What should be used for chronic constipation

Answer 6

1st line : bulk forming laxatives

2nd line: Add or change to Macrogol or lactulose

3rd line: 2 laxatives from different class

Question 7

A patient has tried 2 laxatives from different classes for 6 months, what should be given to them

Answer 7

Prucalopride

Question 8

What is the treatment for opioid induced constipation

Answer 8

Osmotic and stimulant laxative

Question 9

What is naldemedine/ naloxegol used for

Answer 9

Opioid induced constipation that hasn’t responded to stimulant and osmotic laxatives

Question 10

What laxatives should be avoided in opioid induced constipation and why

Answer 10

Bulk forming laxatives

Intestinal obstruction

Question 11

What should be used for faceal impaction with soft stools

Answer 11

Stimulant laxatives

Question 12

What should be used for faceal impaction with hard stools

Answer 12

First line : macrogol
2nd line : stimulant

Question 13

How is constipation managed in pregnancy and breastfeeding

Answer 13

1st line - Increase fibre and exercise
2nd line - Bulk forming
3rd line - lactulose
4th line - senna

Question 14

When is senna allowed in pregnancy

Answer 14

Patient is not near term

Stools are soft with sensation of incomplete emptying

Question 15

How is constipation treated in children

Answer 15

1st line - lifestyle , macrogol and electrolytes

2nd line - stimulant

3rd line - osmotic laxative [if macrogol not tolerated]

Question 16

Isphagula husk is a

Answer 16

Bulk forming laxative

Question 17

Methylcellulose is a

Answer 17

Bulk forming laxative

Question 18

How long does it take bulk forming laxatives to work

Answer 18

2-3 days

Question 19

Increases fluid to decrease risk of intestinal obstruction

Answer 19

Bulk forming laxative

Question 20

Lactulose and macrogol are

Answer 20

Osmotic laxatives

Question 21

How long do osmotic laxatives take to work

Answer 21

2-3 days

Question 22

senna, bisacodyl , sodium picosulfate, docusate, glycerol are

Answer 22

Stimulant laxatives

Question 23

How long to stimulant laxatives take to work , including enema

Answer 23

6-12 hours

Enema =15-30 mins

Question 24

What laxative is used for the terminally ill

Answer 24

Co-danthramer

= stimulant

Question 25

3 main side effects of co-danthramer.

Answer 25

Red urine Carcinogenic Skin irritation

Question 26

docusate, arachis oil, glycerol are

Answer 26

Faecal softeners

Question 27

How long do faecal softeners take to work

Answer 27

15-30. Mins

Question 28

Side effects of bulk forming laxatives [2]

Answer 28

Farting bloating

Question 29

Side effects of osmotic laxatives [5]

Answer 29

Abdominal pain Cramps Bloating Flatulence Vomitting

Question 30

Side effects of stimulant laxatives [4]

Answer 30

Cramps Diarrhoea Vomitting Yellow brown urine [senna]

Question 31

Senna interacts with drugs that cause….

Answer 31

QT Prolongation

Question 32

Which laxative reduces release of enteric coated drugs by decrease colonic ph

Answer 32

Lactulose