-
alarm symptoms of constipation
- N/V
- black, tarry stools (blood)
- anorexia
- severe abdominal cramping and pain
- fever
- unexplained changes in bowel movements or weight loss
-
exclusions to self care of constipation
- alarm symptoms
- marked or unexplained flatulence
- para/quadriplegic
- daily laxative use
- change in caliber of stools (pencil thin)
- history of IBD
-
when can changes in bowel movements be seen when starting a high fiber diet?
3-5 days
-
first line therapy for constipation
- bulk forming agents
- --methylcellulose
- --polycarbophil
- --Psyllium
-
Bulk forming agent MOA
dissolves or swells in intestinal fluid to form a gel that facilitates the passage of stool and stimulates peristalsis
-
When do bulk forming agents begin to work and when can a bowel movement be expected?
- start working in 12-24 hours
- expect bowel movement in 1-3 days
-
bulk forming agent AEs
- bloating and flatulence at first
- obstruction of GIT if taken wo enough water
-
bulk forming agent DIs
- may alter absorption of other meds
- don't take within 2 hours of use
-
1st and 2nd line laxative therapy for constipation
- 1st: glycerine suppository and tap water or salt enema
- 2nd: oral sorbitol, low dose bisacodyl or senna, oral saline laxatives, PEG 3350
-
Which treatments for constipation cause evacuation within 30 min?
- glycerin suppositories
- enemas (saline, mineral oil, bisacodyl)
-
glycerin suppository MOA and safety
- osmotic MOA
- safe, even in children and infants
-
Saline enema MOA and uses
- osmotic MOA
- used before rectal exam
- used in ppl with rectal impaction
-
Saline enema AEs
- alter electrolye and fluid balance (contains Na phosphate and biphosphate) if used frequently
- not recommended for children <2 yo
-
mineral oil MOA
lubricant MOA
-
bisacodyl MOA
stimulant MOA
-
Which treatments for constipation cause watery evacuation within 1-6 hours?
- saline laxatives (Mg citrate and Mg hydroxide)
- Castor Oil
-
Mg citrate uses
- used before endoscopic exam
- remove drugs in suspected poisonings
-
Caster Oil MOA
- metabolized in GIT to active compound
- stimulates secretory process
- dec glucose absorption
- promotes intestinal motility
-
Caster Oil patient education
- give on empty stomach
- don't give at bedtime
-
Which treatments for constipation cause soft or semifluid stools within 6-12 hours?
stimulant laxatives (oral bisacodyl, senna)
-
oral bisacodyl MOA
stimulates mucosal nerve plexus of the colon
-
oral bisacodyl patient education
- don't crush or chew enteric coating
- don't take within 1 hr of milk, antacids, or H2RAs
-
bisacodyl class
diphenylmehtane derivative
-
Senna MOA
inhibits water and electrolyte absorption --> inc volume and pressure that inc intestinal motility
-
Senna AEs
may turn urine pink, red, violet, or brown
-
Which treatments for constipation cause soft stools in 6-8 hrs?
mineral oil
-
Mineral Oil MOA
- coats stool for easier passage
- inhibits absorption of water --> inc stool weight and dec intestinal transit time
-
mineral oil AEs
- may leak from anal sphincter
- dec absorption of fat soluble vitamins and many meds
Contraindication in bed ridden patients (aspiration can cause lipid pneumonia)
-
Which treatments for constipation cause soft stool in 1-3 days?
- osmotic laxatives (Sorbitol and lactulose - RX only)
- PEG 3350
-
Which treatments for constipation cause soft stool in 1 day?
lubiprostone (Amitiza)
-
Lubiprostone MOA
- selective chloride channel activator
- increases fluid secretion locally in the small intestine
- increases the passage of stool
-
lubiprostone
dose for the treatment of chronic idiopathic constipation - BID
-
agents for preventing constipation
- emollient/surfactant/stool softner:
- docusate sodoum (Colace)
- docusate calcium (Miralax)
-
docusate MOA
facillitate mixing of aqueous and fatty materials within the intestinal tract
ineffective if underlying cause of constipation not resolved
-
patients that use docusate
patients that shouldn't strain (MI, perianal disease, after rectal surgery)
-
docusate AEs
- generally safe
- can increase absorption of mineral oil
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