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36 Cards in this Set
- Front
- Back
What is a patients main complaint with slow transit constipation? |
patients complain of abdominal bloating and infrequent stools ** due to abnormal transit time |
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What do patients complain about with disorder defecation? |
incomplete evacuation, sense of obstruction *** need for digital removal |
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What are some causes of secondary constipation? |
GI disorders: IBS, diverticulitis, tumors Pregnancy Lifestyle factors: inadequate fluid intake DM w/ neuropathy , hypothyroidism |
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What medications can cause drug induced constipation? |
-analgesics: opiates, NSAIDs -anticholinergics: antihistamines, antiparkinsonian agents, TCAs -calcium and aluminum based antacids -CCBs -Diuretics -Iron |
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What should you do if u see a patient with a scheduled opioid regimen? |
Make sure they have meds for constipation |
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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 |
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What are some exclusions for self treatment? |
Family history of IBD Melena Hematochezia Family History of colon cancer Anemia Weight loss N/V |
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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 |
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What is the recommended daily amount of fiber? |
20-25 grams |
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How long does it take for an increase in fiber to start working? |
3 - 5 days |
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MOA of bulk forming agents |
absorb water and increase fecal mass ( similar to fiber) -increase frequency and softening the consistency of stools |
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How long does it take for bulk forming agents to work |
12-24 hours ( up to 72 h) |
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T or F It is fine to take other medications with bulk forming agents |
False Separate medications by 2 hours |
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MOA of emollient laxatives |
Increase stool moisture content *** yields softer, easier to pass stool |
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How long do emollient laxatives take to work? |
1 to 3 days |
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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 |
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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 |
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What is an example of an emollient laxative? |
Docusate Sodium |
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How do osmotic laxatives work? |
draw water into the feces, stimulate secretion and motility |
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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 |
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How do stimulant laxatives work? |
directly stimulate the mucosal nerve plexus - causes electrolyte and fluid secretion into colon |
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Which drugs are stimulant laxatives? |
bisacodyl and senna |
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Stimulant laxatives are first line agents in treating constipation T or F |
False, not recommended . reserved for intermittant use |
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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 |
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Which medication can be used if patient complains of hard stools or straining? |
docusate sodium |
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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 |
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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 |
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What type of test is necessary for SBO since lab tests are non specific |
radiographs/ x-rays |
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Laxatives may help with symptomatic relieve in SBO T or F |
False, laxatives should be avoided |
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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 |
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Which drugs are the opiod receptor antagonists? |
Alvimopan:indicated to accelerate recovery after surgery Methylnaltrexone Naloxegol |
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What is the max total treatment for Alvimopan? |
15 doses |
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Can a patient be discharged home with Alvimopan? |
NO ***hospital needs to enroll in EASE and REMs program |
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Alvimopan can be given in patients who have taken opioids for 7 or more days to relieve constipation T or F |
False, contraindicated |
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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 |
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When should the dose be reduced in Naloxegol |
CrCl < 60 ml/min in presence of moderate cyp3A4 inhibitors |