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36 Cards in this Set

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What is a patients main complaint with slow transit constipation?

patients complain of abdominal bloating and infrequent stools




** due to abnormal transit time

What do patients complain about with disorder defecation?

incomplete evacuation, sense of obstruction




*** need for digital removal

What are some causes of secondary constipation?

GI disorders: IBS, diverticulitis, tumors


Pregnancy


Lifestyle factors: inadequate fluid intake


DM w/ neuropathy , hypothyroidism

What medications can cause drug induced constipation?

-analgesics: opiates, NSAIDs




-anticholinergics: antihistamines, antiparkinsonian agents, TCAs




-calcium and aluminum based antacids




-CCBs




-Diuretics




-Iron



What should you do if u see a patient with a scheduled opioid regimen?

Make sure they have meds for constipation

Rome III Diagnostic Criteria for Constipation

Must include 2 or more of the following:




-Straining during at least 25% of defecations




-Lumpy or hard stools in at least 25% of defecations




-Sensation of incomplete evacuation for at least 25% of defecations




-Manual maneuvers to facilitate at least 25% of defecations




-Fewer than 3 defecations per week

What are some exclusions for self treatment?

Family history of IBD




Melena




Hematochezia




Family History of colon cancer




Anemia




Weight loss




N/V

How does fiber help with constipation

bulk matter that takes up room and stretches the receptors in the GI tract---> increase propulsive contractions




** increases retention of stool water

What is the recommended daily amount of fiber?

20-25 grams

How long does it take for an increase in fiber to start working?

3 - 5 days

MOA of bulk forming agents

absorb water and increase fecal mass ( similar to fiber)




-increase frequency and softening the consistency of stools

How long does it take for bulk forming agents to work

12-24 hours ( up to 72 h)

T or F




It is fine to take other medications with bulk forming agents

False




Separate medications by 2 hours

MOA of emollient laxatives

Increase stool moisture content




*** yields softer, easier to pass stool

How long do emollient laxatives take to work?

1 to 3 days

T or F




emollient laxatives are a safe and effective way to treat constipation

False, they do not treat constipation, but are useful in preventing the condition

How do lubricants such as mineral oil work?

coats stool for easier passage




inhibits water from being absorbed into the colon




increases stool weight




decreases transit time




*** 2-3 days to work

What is an example of an emollient laxative?

Docusate Sodium

How do osmotic laxatives work?

draw water into the feces, stimulate secretion and motility

What are some examples of osmotic laxatives?

enema ( fastest)




Magnesium sulfate/ Milk of Magnesia --> 30 min to 6 hours




Sodium phosphate: 3 to 6 hours




polyethylene glycol




glycerin suppository

How do stimulant laxatives work?

directly stimulate the mucosal nerve plexus




- causes electrolyte and fluid secretion into colon

Which drugs are stimulant laxatives?

bisacodyl and senna

Stimulant laxatives are first line agents in treating constipation




T or F

False, not recommended . reserved for intermittant use

What is the first line approach to treatment of constipation?

Fiber/ bulk forming agents




*** osmotic laxatives are useful if fiber / bulk forming agents are unsuccessful

Which medication can be used if patient complains of hard stools or straining?

docusate sodium

What is a simple small bowel obstruction?

fluid accumulation proximal to obstruction

stasis allows for bacterial overgrowth and gas production

*** when bacterial fermentation occurs, gases are produced


Small bowel obstruction : strangulation

small bowel occluded at 2 points




-accumulated gas and fluid cannot escape--> dilation occurs




-mucosal ischemia --> necrosis and perforation




*** intestinal ischemia can cause lactic acidosis

What type of test is necessary for SBO since lab tests are non specific

radiographs/ x-rays

Laxatives may help with symptomatic relieve in SBO




T or F

False, laxatives should be avoided

What agents should be avoided in opioid induced constipation?

1) docusate monotherapy b/c ineffective


***use senna w/ docusate BID instead




2)bulk forming laxatives b/c predispose pt to obstruction or impaction---> can lead to intestinal perforation


***use osmotic laxatives instead

Which drugs are the opiod receptor antagonists?

Alvimopan:indicated to accelerate recovery after surgery




Methylnaltrexone




Naloxegol

What is the max total treatment for Alvimopan?

15 doses

Can a patient be discharged home with Alvimopan?

NO




***hospital needs to enroll in EASE and REMs program

Alvimopan can be given in patients who have taken opioids for 7 or more days to relieve constipation




T or F

False, contraindicated

What are the counseling points for methylnaltrexone

D/c laxatives prior to initiation, may restart after 3 days




D/c when opioids are stopped




weight based dosing for severe illness




C/I in pts with GI obstruction




typically get bowel movement within 4 hours of first dose

When should the dose be reduced in Naloxegol

CrCl < 60 ml/min




in presence of moderate cyp3A4 inhibitors