1
Q
risk factors for constipation
A
female non white over 65 fewer years of formal education low caloric intake increased number of meds lower socioeconomic status sedentary lifestyle travelling toilet training in children ignoring the urge to defecate physical and sexual abuse
2
Q
diseases causing constipation
A
IBS IBD stroke, MS, parkinsoons diabetes chronic renal failure carcinoma psychiatric anal fissures
3
Q
meds that cause constipation
A
antacids anticholinergics iron supplements analgesics antihypertensive agents
4
Q
lifestyle causes of constipation
A
inadequate fibre inadequate fluids lack of exercise travel pregnant ignore urge to defecate
5
Q
signs and symptoms of constipation
A
infrequent defecation abdominal discomfort nausea vomiting anorexia early satiety small hard stools incomplete rectal emptying rectal bleeding due to hemorrhoids weight loss
6
Q
red flags
A
symptoms last longer than 2 weeksor no bowel movement in 7 days with laxative use blood in stool - dark tarry mucus rectal bleeding severe pain fever unexplained weight loss family history of colon cancer under 2 unremitting nocturnal symptoms recent ab surgery anemia vomiting chronic illness associated eating disorder diarrhea alternating with constipation rectal or ab mass
7
Q
goals of therapy
A
relieve contipation and symptoms improve stool consistency reestablush normal bowel function prevent recurrence avoid complication
8
Q
preventing constipation
A
high fibre- popcorn, green pea, avocado adequate fluid routine private toilet regimen defecate when feel the urge daily physical activity
9
Q
non pharms
A
increase calories eat more fruit exercise footstool puts pelvis lower than knees biofeedback try defecate 5-15 min after meal juice with sorbitol
10
Q
agents that cause softening of feces in 12-72 hours
A
bulk forming
emollient
11
Q
agents that work in 6-12 hours
A
bisacodyl
senna
12
Q
agents that work in 0.5-3 hours
A
magnesium products
oral sodium phosphates
13
Q
lactulose onset
A
24-48 hours
14
Q
glycerin suppository onset
A
15-30min
15
Q
peg onset
A
2-4 days
16
Q
enema onset
A
5-15 min
17
Q
mineral oil, lansoyl onset
A
6-8 hours
18
Q
use of product for treatment?
prevention?
A
1 week treatment
duration ongoing for prevention
19
Q
treatment for under 1 year
A
increase fluid
pediatric glycerin suppositories
20
Q
children over 1 first line agents
A
PEG, lactulose, sorbital
21
Q
ogents for only over 6 years old
A
bulk formin
mineral oil
lansoyl
senna tablets
22
Q
agent for only above 12
A
bisacodyl
23
Q
agents for only over 18
A
PEG
24
Q
cause of constipation in pregnancy
A
elevations in progesterone causign relaxtion in intestinal tract reduced motilin levels intestinal pressure decreased exercise ability iron and calcium supplements
25
first line treatment in pregnancy
bulk forming laxative
| glycerin supp
26
treatment in elderly
bulk forming agents - must increase fluid but cant if have CHF, renal failure
glycerin supp
PEG
senna, bisacodyl
27
treatment in cancer patients
stimulatn laxatives
| avoid bulk formin becuase may cause impaction
28
when should laxatives be taken in relation to other drugs
2 hours after
29
whats a habitual laxative abuser
believes should have a bowel movement everyday
30
signs and symptoms of laxative abuse
```
diarrhea - severe chronic watery at night
ab pain, NV
weight loss
muscle weakness
hypokalemia, hypocalemia
```
31
treatment of laxative abuse
referral
weaning off
add high fibre and bulk forming
encourage exercise and fluid intake
32
examples of bulk forming agents
psyllium
polycarbophil
inulin
bran
33
MOA bulk forming
dissolve in intestinal fluid by attracting water forming a gel and stimulatin peristalsis
increases stool frequency and weight
34
CI bulk forming
```
partial mechanical obstruction
fluid restricted patients
partial bowel obstruction
fecal impaction
dysphagia
Gi strictures
throat problems
```
35
side effects of bulk forming
flatulence
| bloating
36
examples of stool softeners/emollients
docusate sodium
| docusate calcium
37
side effects of stool softeners
mild transient nausea
gi cramps
rash
38
stool softener MOA
surfactant that helps water in the bowel mix with fecal mass
39
use of stool softeners
prevention only and even that is lacking evidence
40
lubricant MOA
lubricates feces and mucosa
| reduce water reabsorption
41
example of lubricant
mineral oil
| laxative jelly
42
CI lubricants
```
bedridden
appendicitis
rectal bleeding
dysphagia
gastric retention
gerd
MS PD
children, elderly
high risk of aspiration
```
43
stimulant MOA
increase peristalsis
44
stimulant examples
senna - anthraquinones
cascara sagrada
bisacodyl - diphenylmethane
45
what should you avoid with bisacodyl
```
milk
antacids
PPIs
crushing, breaking, chewing
because enteric coatin
```
46
first line for opiate constipation
stimulants
47
side effects of stimulants
ab pain
NV
hypokalemia,dehydration, hyponatremia - long term
48
MOA osmotics
ions draw water into intestine increasing the intraluminal pressure applying a mechanical stimulus for motility
49
examples of osmotics
```
glycerin supp
lactulose
sorbitol
PEG
magnesium hydroxide/citrate
sodium phosphate
```
50
can lactulose be used in diabetes
yes
51
safest and most effective product
glycerin suppository
52
what is used for bowel cleansing
magnesium citrate
53
why should you never use oral sodium phosphate as a purgative
serious electrolyte, kidney, cardiovascular, and neurological problems
54
options for enemas
mineral oil
phosphate
tap water
Clinical part B
flashcards
Decks in class (15)
# Cards
-
Allergic rhinitis69
-
Cough27
-
Common Cold21
-
common vitamins and minerals41
-
Hormonal Contraception68
-
Vaginal Conditions57
-
Influenza53
-
Diabetes46
-
Pain part 264
-
Osteoarthritis5
-
Intro to Psychiatry39
-
Diarrhea68
-
Drug use in pregnacy and lactation45
-
Nausea and vomiting in pregnancy18
-
Constipation54
