C & D - Constipation
24 important questions on C & D - Constipation
Idiopathic constipation associated with chronic or recurrent abdominal discomfort that is relieved by defecation
Constipation persists for several weeks or longer and the cause is unknown
Non-drug treatments for constipation
Limit caffeine and alcohol intake
Replace refined foods with foods high in fiber
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If constipation is not improved after how many days, should a healthcare provider be consulted?
OTC recommendation for iron-induced or hard stool
OTC if fast relief needed in adults
OTC if fast relief needed in children
1st line in most cases and treatment of choice in pregnancy
Contain large ions or molecules that are poorly absorbed to draw fluid into the bowel lumen through osmosis, which distends the colon and increases peristalsis. For CIC, can be monotherapy or given with fiber
Directly stimulate neurons in the colon, causing peristaltic activity
Emollients that reduce the surface tension of stool, allowing more water to mix with stool, which softens fecal mass and makes defecation easier. Often used by patients taking iron
Coat the bowel and stool with waterproof film to keep moisture in the stool and make defecation easier
What are the bulk-forming drugs?
Calcium polycarbophil (FiberCon)
Methylcellulose (Citrucel)
Wheat dextrin (Benefiber)
What are the osmotic drugs?
Polyethylene glycol (Miralax)
Glycerin
Lactulose
Sodium phosphates (Fleet Enema)
What is the one Rx osmotic drug?
What condition is lactulose commonly used for?
What are the stimulant + stool softeners?
What are the emollients (Stool softeners)?
When are emollients (stool softeners) preferred?
For hospitalized surgery patients to decrease risk of post-op ileus with a max of 15 doses
CI in opioids for >7 consecutive days right before use
Which PAMORAs are used only in patients taking opioids who have OIC?
Naloxegol (Movantik)
What is the 5-HT4 rec agonist used for CIC with a warning for suicidal ideation?
Diarrhea
BBW for sodium phosphates (OsmoPrep)
What are the laxatives used for whole bowel irrigation?
Sodium phosphates (OsmoPrep)
Sodium sulfate, potassium sulfate and magnesium sulfate (Suprep Bowel Prep Kit)
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