W.10 Constipation pt 2

Question 1

oral treatment for constipation

Answer 1

• PEG 1.5/kg/day is agent of choice (safest)
• Mg hydroxide, MG citrate, lactulose, sorbitol, senna, bisacodyl
• pros: less invasive, empowers child,

Cons: non-compliance

Question 2

enams for constipation

Answer 2

• bisacodyl and glycerin suppositiroies are the first choice: rapid onset, can be low in rectum)
• phosphate sodium enema have adverse effects in children with intestinal or renal system abnormalities
• some bases can cause lethargy, hypocalemia, hyperphosphatemia, one cardiac arrest in infant
• not for <4 or <5

Question 3

saline laxatives use

Answer 3

• higher risk of dehydration
• contraindiciated if on diuretics and HCF
• also lack of evidence only level B

Question 4

goal of enpoints for therapy

Answer 4

• eminimate cramping/bloating: want it to return to baseline, happen 1 one day
  pain: keep controlled and get relief in 1-2 hours
• prevent future constipation: return in >3/week. in 3-4 days

Question 5

bulk laxatives for chornic constipation

Answer 5

safest for long term use

• do not use if patient is dehydrated/fluid restricted
• will alleviate in 102 days
• administer w/ 250mL water/juice to prevent impaction

*improved consistency and freq, 85% imporvement in normal transit consitpation, pooor in slow colonic transit for pelvic floor disorder

Question 6

treatment of chronic consitation with somotic laxatives

Answer 6

• both PEG and lactulose are efficacious
• lactulose has 80% eficacy but many patients get abdominal cramping
• PEG results in least straining and greatest efficacy and tolerability

*PEG is 1st line in pediatrics

• no real adverse effects

*if have chronic constipation can use PEG on regular basis safely, but a bit more expensive that lactulose (lactulose is covered under ODB too)

Question 7

saline laxatives for chronic constipation

Answer 7

not recommended for treatment in elderly patient

• alck of evidence to suport

fast acting and effective

• dminister fluid to prevent dehydration
• not great compliance bc chalky taste

***Causes electrolyte disturbances for long term usage and diarrhea

*large risk in dehydration, avoid in elderly, HF and renal issues

Question 8

stool softeners for chronic diarrhea

Answer 8

not really effective dont use

Question 9

stimulant laxatives for chronic diarrhea

Answer 9

3rd line

• lack evidence
• still thought best with opiod induced cosntipation
• use at bedtime tho bc 6-12 h in delay
• concern is risk of independent

Question 10

stepwise aproach to manage chronic constipation

Answer 10

1. patient education, lifestyle modication and deit
2. Fiber supplement or bulk forming laxative
3. osmotic laxatives or saline alxatives
4. emmollients and sitmulants. limit to short term use if failure of toher agents or anrcotic load

*acute episode: saline laxatives, glycerin suppository and/or enemas as resuce if no BM in 3 days

Question 11

follow up plan for constipaion

Answer 11

Keep diary of bowel habits mother for both self and child

Follow up by pharmacist in 24hrs to ensure BM

Mother to follow up in 1 month with pharmacist regarding son’s progress

Documentation at pharmacy

OTC record in pharmacy computer system

Notes regarding therapeutic efficacy and outcomes

Question 12

treatment for opiod induced contipation

Answer 12

• often req Rx therapy
• methylnaltrexone
  
  • Blocks u-receptor in gut, blcoks effect of opiod constipation but does not afefct pain
  • used for opiod induced constipation: dosage, efficacy, onset, side effects, cost
• Nalogegol
  
  • tablet form
  • for opoid induced non cancer pain in adults
    
    • do not use if risk of GI obstruction
  • Dose
    
    • 25mg daily if cramping and pain restart at 12.5mg
  • take on empty stomach and avoid grapefruit juice

Question 13

Linaclotide (constella)

Answer 13

• treatment for chronic idopathic constipation not revlieved by OTC
• Rx therapy
• class secretagogue: guanylate cyclase C agonist 2C
• draws fluid into intestine, very good to soften stools
• actiate cGMP to activate chloride channels in cells of intestinal cell lumen

Question 14

prucalopride (resotran)

Answer 14

• chronic idopathic constpation, secondary to parkinsons or opiods
• has refractory gastropareisis
• is a serotonin 5-HT4 receptor, causes gastric propsulion along tract

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Question 15