5 - GI: Constipation Flashcards by Karlo Sison

What is Constipation?

Abnormally slow movement of feces through colon w/ accumalation

Straining to have stool

Dry / Hard / Small stools

Feelings of Incomplete bowel evacuation

BLOATING

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Epidemiology of Constipation

WOMEN > men

no difference in age groups

Higher in > 65 y/o

Common in Pregnancy

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Etiology of Constipation

Disease Induced
- Ulcers / Fissures / hemorroids
- gallbladder disease apppendicitis / ileitis
- hypothyroidism / diabetic neuropathy / CVA / MS / IBS / DVT
Drug Induced
- OPIATES + more
Psychogenic
- Depression / eating disorders
Lifestyle
- low calorie / carbs / fiber / inadequite fluid intake

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Special Populations in Constipation

Older Adults >65 y/o
- Physiologic changes / meds / disease
Children
- emotions / febrile / dietary changes / POOR EATING habits
Women
- PREGNANCY / HORMONES
- IBS / slower gut transit times
- surgery after childbirth

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Common Symptoms of Constipation

Decreased Frequency of bowel movements
Difficult Passage of HARD stool
Anorexia
Dull Headache
Lassitude (lack of energy / awareness)
Lower Back pain
Abdominal Distention

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EX-ST of Constipation

SIGNIFICANT abdominal pain / distention / cramping
Marked or unexplained flatulence
FEVER + N/V
Paraplegia / Quadriplegia
Changes in bowel habits
Bloody / Dark / Tarry stools
- change in CALIBER o stool
Symptoms perisiting fo_r_ >2 weeks or recur _over 3 month_s
H/o of IBD
Daily laxative use

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Non-Pharmacologic Treatment

of Constipation

Regular bowel habits
Increase DIETARY INSOLUBLE FIBER
- Wheat / grains / oats / fruits / veggies
  - 14g/1000kcal
Increase WATER intake
Avoid constipating foods
Regular EXERCISE
Stress management

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Pharmacologic intervention if quicker relief is needed!

Bulk forming Laxatives
Lubricants / Emollient
Stimulants
Saline Laxatives
Hyperosmotic Laxatives

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Bulk-Forming Laxatives

Onset / Use

Metamucil / Fibercon

Psyllium / calcium polycarbophil / methylcellulose

Onset is 12-24 hours

Duration of <72 hours

Used for Treatment & Prevention of Constipation

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Bulk-Forming Laxatives

ADR / DI / Counseling

Metamucil / Fibercon

Cramping / Flatulence

8oz of WATER Per dose!

obstruction if inadequate fluid intake

Tetracyclines

Seperate by 1-2 hours from all medications

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Emollient Laxatives

Onset / Use

Colace = Docusate

Used for PREVENTION

Avoid STRAINING

surfactant = increase wetting / soften fecal mass

onset is 1-3 days

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Emollient Laxatives

ADR / DI / Counseling

Colace / Docusate

Abdominal Pain / Diarrhea

MINERAL OIL

1-2 times a day w/ fluids

not for children <6 y/o

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Saline Laxatives

Onset / Use

Milk of Magnesia

Mag citrate / MgOH2 / Fleet enema

Osmotics

used for TREATMENT / BOWEL PREP

Onset = 30min - 3 hours (orally)

<1 hour (rectally)

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Saline Laxatives

ADR / DI / Counseling

Milk of Magnesia

N/V/D

Fluid/e- imbalance + Craming

Warfarin / Digoxin / TCA’s / SPS

not for pts w/ :*
ileostomy / colostomy / dehydration / renal impairment / CHF*

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Stimulant Laxatives

Onset / Use

Senokot / Dulcolax

Sennosides / biscodyl / castor oil

Stimulate Peristalsis

used for TREATMENT / BOWEL PREP

Onset is 6-12 hours (orally)

15-60 minutes (rectally)

DNU for > 7 days

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Stimulant Laxatives

ADR / DI / Counseling

Senokot / Dulcolax

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DNU > 7 days

commonly abused

Cramping / Loss of normal bowel fxn

Fluid/e- imbalance

castor oil may induce LABOR

Hyperosmotic Laxative

Use / Onset

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Miralax

PEG 3350 / Glycerin

Osmotic / Local irritant Effect (draws water into rectum)

Used for TREATMENT / PREVENTION / BOWEL PREP

Onset for glycerin is 30 min

onset for PEG = 1-3 Days

Hyperosmotic Laxative

ADR / DI / Counseling

Miralax

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Bloating / Cramping

Abdominal discomfort / Flatulance

Caution in renal disease

Glycerin is just Cramping / irritation / burning

Glycerin Dose / Drug Type

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Hyperosmotic Laxative

for constipation

Adult dose = 3g PR

Children < 6 y/o = 1g - 1.5g PR

cramping / irritation / burning

Recomended Laxatives for

Acute Treatment

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Bulk Forming

Metamucil / Fibercon

Hyperosmotic Laxative

Miralax (PEG)

Stimulant

Senokot / Dulcolax (biscodyl)

Recommended Laxatives for

CHRONIC treatment

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Fluids / Dietary Changes / Physical Activity

Bulk Forming

Metamucil / FiberCon

Occational Stimulants

Senokot / Dulcolax

Senakot + Senakot S

Dose / Indication

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Sennosides +/- docusate

Stimulant Laxative +/- Emollient

8.6 mg +/- 50mg docusate

2 tabs (17.2) at bedtime

2nd dose may be given during the day

Senakot + Senakot S

CIP / DI

Sennosides +/- Docusate

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Appendicitis / Ab pain / n/v

Rectal bleeding / Failure to bowel move

DNU >7 days

Senakot + Senakot S

ADR / Consult

Sennosides +/- Docusate

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Electrolyte/fluid deficiency

hypoKALEMIA / loss of protein

Chest pain / Malabsorption

Ask why they need a laxative?

Bowel habits / appearance

RECTAL BLEEDING SEE MD

Try dietary fiber / fluid intake / exercise

**Dulcolax** **Dose / Indication**

_Biscodyl_ **_Stimulant Laxative_** **5mg Tab / 10mg suppository** **_2-3 tabs in single dose / day_** **_Results in 8-12 hours if bedtime_** **_6 hours if taken before breakfast_** **1 suppository = results in 1 hour**

**Dulcolax** **CIP / DI** Biscodyl

***Appendicitis / Ab pain / n/v*** ***Rectal bleeding / Failure to bowel move*** *DNU \>**7 days*** ***\<6yo*** ***milk or antacids*** ***catharsis of drugs in colon***

**Dulcolax** **ADR / Consult** Biscodyl

***Electrolyte/fluid deficiency*** ***hypoKALEMIA / loss of protein /*** ***Malabsorption*** ***_DO NOT CRUSH OR CHEW TABLETS_*** \<7 days **Bowel habits / appearance** **_RECTAL BLEEDING SEE MD_** **_Try dietary fiber / fluid intake / exercise_**

**Colace** **Dose / Indication**

_Docusate Sodium_ **_Emollient Laxative_** **50 / 100 / 250 mg, syrup = 60mg/15ml** **_50-200mg qd_** **_Results in 1-3 days after 1st dose_** **_15 min after microenema_** _take liqid with milk/fruit juice_

**Colace** **CIP / DI** Docusate

***Rectal bleeding / Failure to bowel move*** *DNU \>**7 days***

**Colace** **ADR / Consult** Docusate

***Bitter Taste / Throat irritation*** *N/V from syrup or liquid* ***DNU \<7 days*** **Bowel habits / appearance** **_RECTAL BLEEDING SEE MD_** **_Try dietary fiber / fluid intake / exercise_**

5 - GI: Constipation Flashcards

(30 cards)