Constipation

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  1. 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
  2. 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
  3. when can changes in bowel movements be seen when starting a high fiber diet?
    3-5 days
  4. first line therapy for constipation
    • bulk forming agents
    • --methylcellulose
    • --polycarbophil
    • --Psyllium
  5. Bulk forming agent MOA
    dissolves or swells in intestinal fluid to form a gel that facilitates the passage of stool and stimulates peristalsis
  6. 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
  7. bulk forming agent AEs
    • bloating and flatulence at first
    • obstruction of GIT if taken wo enough water
  8. bulk forming agent DIs
    • may alter absorption of other meds
    • don't take within 2 hours of use
  9. 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
  10. Which treatments for constipation cause evacuation within 30 min?
    • glycerin suppositories
    • enemas (saline, mineral oil, bisacodyl)
  11. glycerin suppository MOA and safety
    • osmotic MOA
    • safe, even in children and infants
  12. Saline enema MOA and uses
    • osmotic MOA
    • used before rectal exam 
    • used in ppl with rectal impaction
  13. Saline enema AEs
    • alter electrolye and fluid balance (contains Na phosphate and biphosphate) if used frequently
    • not recommended for children <2 yo
  14. mineral oil MOA
    lubricant MOA
  15. bisacodyl MOA
    stimulant MOA
  16. Which treatments for constipation cause watery evacuation within 1-6 hours?
    • saline laxatives (Mg citrate and Mg hydroxide)
    • Castor Oil
  17. Mg citrate uses
    • used before endoscopic exam
    • remove drugs in suspected poisonings
  18. Caster Oil MOA
    • metabolized in GIT to active compound
    • stimulates secretory process
    • dec glucose absorption
    • promotes intestinal motility
  19. Caster Oil patient education
    • give on empty stomach
    • don't give at bedtime
  20. Which treatments for constipation cause soft or semifluid stools within 6-12 hours?
    stimulant laxatives (oral bisacodyl, senna)
  21. oral bisacodyl MOA
    stimulates mucosal nerve plexus of the colon
  22. oral bisacodyl patient education
    • don't crush or chew enteric coating
    • don't take within 1 hr of milk, antacids, or H2RAs
  23. bisacodyl class
    diphenylmehtane derivative
  24. Senna MOA
    inhibits water and electrolyte absorption --> inc volume and pressure that inc intestinal motility
  25. Senna AEs
    may turn urine pink, red, violet, or brown
  26. Which treatments for constipation cause soft stools in 6-8 hrs?
    mineral oil
  27. Mineral Oil MOA
    • coats stool for easier passage
    • inhibits absorption of water --> inc stool weight and dec intestinal transit time
  28. 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)
  29. Which treatments for constipation cause soft stool in 1-3 days?
    • osmotic laxatives (Sorbitol and lactulose - RX only)
    • PEG 3350
  30. Which treatments for constipation cause soft stool in 1 day?
    lubiprostone (Amitiza)
  31. Lubiprostone MOA
    • selective chloride channel activator
    • increases fluid secretion locally in the small intestine
    • increases the passage of stool
  32. lubiprostone
    dose for the treatment of chronic idiopathic constipation - BID
  33. agents for preventing constipation
    • emollient/surfactant/stool softner:
    • docusate sodoum (Colace)
    • docusate calcium (Miralax)
  34. docusate MOA
    facillitate mixing of aqueous and fatty materials within the intestinal tract

    ineffective if underlying cause of constipation not resolved
  35. patients that use docusate
    patients that shouldn't strain (MI, perianal disease, after rectal surgery)
  36. docusate AEs
    • generally safe
    • can increase absorption of mineral oil

Card Set Information

Author:
 jcu1
ID:
 202902
Filename:
 Constipation
Updated:
2013-02-24 19:32:14
Tags:
GI Exam
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Description:
Exam 1
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