Constipation

• N/V
• black, tarry stools (blood)
• anorexia
• severe abdominal cramping and pain
• fever
• unexplained changes in bowel movements or weight loss

• alarm symptoms
• marked or unexplained flatulence
• para/quadriplegic
• daily laxative use
• change in caliber of stools (pencil thin)
• history of IBD

3-5 days

• bulk forming agents
• --methylcellulose
• --polycarbophil
• --Psyllium

dissolves or swells in intestinal fluid to form a gel that facilitates the passage of stool and stimulates peristalsis

• start working in 12-24 hours
• expect bowel movement in 1-3 days

• bloating and flatulence at first
• obstruction of GIT if taken wo enough water

• may alter absorption of other meds
• don't take within 2 hours of use

• 1st: glycerine suppository and tap water or salt enema
• 2nd: oral sorbitol, low dose bisacodyl or senna, oral saline laxatives, PEG 3350

• glycerin suppositories
• enemas (saline, mineral oil, bisacodyl)

• osmotic MOA
• safe, even in children and infants

• osmotic MOA
• used before rectal exam 
• used in ppl with rectal impaction

• alter electrolye and fluid balance (contains Na phosphate and biphosphate) if used frequently
• not recommended for children <2 yo

lubricant MOA

stimulant MOA

• saline laxatives (Mg citrate and Mg hydroxide)
• Castor Oil

• used before endoscopic exam
• remove drugs in suspected poisonings

• metabolized in GIT to active compound
• stimulates secretory process
• dec glucose absorption
• promotes intestinal motility

• give on empty stomach
• don't give at bedtime

stimulant laxatives (oral bisacodyl, senna)

stimulates mucosal nerve plexus of the colon

• don't crush or chew enteric coating
• don't take within 1 hr of milk, antacids, or H2RAs

diphenylmehtane derivative

inhibits water and electrolyte absorption --> inc volume and pressure that inc intestinal motility

may turn urine pink, red, violet, or brown

mineral oil

• coats stool for easier passage
• inhibits absorption of water --> inc stool weight and dec intestinal transit time

• may leak from anal sphincter
• dec absorption of fat soluble vitamins and many meds

Contraindication in bed ridden patients (aspiration can cause lipid pneumonia)

• osmotic laxatives (Sorbitol and lactulose - RX only)
• PEG 3350

lubiprostone (Amitiza)

• selective chloride channel activator
• increases fluid secretion locally in the small intestine
• increases the passage of stool

dose for the treatment of chronic idiopathic constipation - BID

• emollient/surfactant/stool softner:
• docusate sodoum (Colace)
• docusate calcium (Miralax)

facillitate mixing of aqueous and fatty materials within the intestinal tract

ineffective if underlying cause of constipation not resolved

patients that shouldn't strain (MI, perianal disease, after rectal surgery)

• generally safe
• can increase absorption of mineral oil