Week 5 - Constipation

Question 1

what is constipation

Answer 1

• defined as infrequent or hard to pass bowel movements

Question 2

what is constipation a common cause of??

Answer 2

• painful defacation

Question 3

what can severe constipation cause (2)?

Answer 3

• obstipation (failure to pass stools and gas)

- fecal impaction

Question 4

what can obstipation & fecal impaction progress to? (2)

Answer 4

• bowel obstruction

- life-threatening

Question 5

list 6 causes of constipation

Answer 5

• idiopathic primary or functional constipation
• diet
• meds
• metabolic & muscular
• structural & functional abnormalities
• psychological

Question 6

what is idiopathic primary or functional constipation

Answer 6

• ongoing symptoms for greater than 6 months in the absence of other cause

Question 7

what kind of diet promotes constipation (3)

Answer 7

• low fibre
• low liquid
• dieting (bc it lowers fecal bulk)

Question 8

list a few examples of meds that cause constipation

joe said we dont have to memorize all these

Answer 8

• opioids
• diuretics
• antidepressants
• antihistamines
• anticonvulsants
• aluminum or calcium antacids
• calcium channel blockers

Question 9

list a few examples of metabolic & muscular disorders that cause constipation

(once, again dont need to memorize all these but can if you want)

Answer 9

• hypercalcemia
• hypothyroidism
• DM
• celiac
• cystic fibrosis
• muscular dystrophy

Question 10

list a few examples of structural & functional abnormalitirs that cause constipation

(same thing as others)

Answer 10

• spinal cord lesions
• parkinsons
• colon cancer
• anal fissures
• paralytic ileus

Question 11

what is meant by psychological causes of constipation

Answer 11

• voluntary withholding of the stool

ex. fear of using public toilets

Question 12

what is the type of drugs for constipation called?

Answer 12

laxatives

Question 13

list 6 categories of antilaxatives

Answer 13

• bulk forming
• emollient (stool softener)
• hyperosmotics
• saline
• stimulants
• peripherally acting opioid antagonists

Question 14

what are emollients?

Answer 14

• stool softeners & lubricants

Question 15

what is the MOA of emollients (2)

Answer 15

• promote more water & fat in the stools

- lubricate the fecal material & intestinal walls

Question 16

what is an example of stool softeners

Answer 16

• docusate salts (Colace)

Question 17

what is an example of lubricants

Answer 17

• mineral oil

Question 18

what are bulk forming agents?

Answer 18

• fiber based laxatives

Question 19

what is the MOA of bulk forming agents (2)

Answer 19

• absorb water to increase bulk

- distend bowel to initiate reflex bowel activity

Question 20

list 2 examples of bulk forming agents

Answer 20

• psyllium (Metamucil)

- methylcellulose (Citrucel)

Question 21

what are hyperosmotics (osmotic agents)

Answer 21

• laxatives that work through osmosis

= draws water into the intestine & colon & increase fecal water content

Question 22

what do hyperosmotics result in? (3)

Answer 22

• bowel distension
• increased peristalsis
• evacuation

Question 23

what are 2 examples of hyperosmotics

Answer 23

• polyethylene glycol (PEG, lax-a-day)

- lactulose

Question 24

what is another use of lactulose

Answer 24

• to reduce elevated serum ammonia levels

Question 25

what are saline agents?

Answer 25

- agents that increase osmotic pressure within the intestinal tract = more water enters the intestines

Question 26

what do saline agents result in? (3)

Answer 26

- bowel distension - increased peristalsis - evacuation

Question 27

what is an example of a saline agent

Answer 27

- magnesium hyroxide (milk of magnesia)

Question 28

what is the MOA of stimulants

Answer 28

- increases peristalsis via intestinal nerve stimulation

Question 29

what are 2 examples of stimulants

Answer 29

- senna (Senekot) | - bisacodyl (Dulcolax)

Question 30

describe the use of peripherally acting opioid antagonists

Answer 30

- treatment of constipation related to opioid use and bowel resection therapy

Question 31

what is the MOA of peripherally acting opioid antagonists (3)

Answer 31

- block entrance of opioid into the bowel - but not from the brain or spinal cord - allow bowel to function normally with continued opioid use

Question 32

what is one important thing to remember with peripherally acting opioid antagonists

Answer 32

- strict regulations for use

Question 33

what are 2 examples of peripherally acting opioids antagonists

Answer 33

- methylnaltrexone (relistor) | - naloxegol (movantik)

Question 34

what are 2 side effects of all laxatives

Answer 34

- diarrhea | - electrolyte imbalances (K, bicarb)