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CONSTIPATION (Causes: (Medical Conditions:
ulcers
anal fissures
…
CONSTIPATION
Causes:
Medical Conditions:
- ulcers
- anal fissures
- (openings/cuts)
Medication:
- Ca or Al Antacids
- narcotic analgesics
- anticholingergics
- tricyclics
- antidepressants
- CCBs
- antispasmodics
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Lifestyle:
- diet
- intake of fluids
- avoiding the urge
Advanced Age:
- Physiologic changes
- Multiple medical conditions
- Multiple medications
- Lifestyle—failure to establish a schedule BM
Women:
- Medical Conditions (menopause)
- hormonal changes
- slower transit time
- pregnancy
- uterus compressing intestine
- low motility
Children :
- unavailable toilet facilities
- changes in routine/environment
- DEC fiber intake (fruits and veggies)
Treatment Approach:
Lifestyle:
- high fiber diet (20-30 g/day)
- caution: impaction already present
- high fiber = erratic bowel habits, flatulence, abd discomfort in the beginning
- inc water/fluids
- exercise
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Definition
- PT:
- straining to have stool
- hard, dry stool
- incomplete evacuation
- abdominal pain or bloating
- others: change in frequency/consistency
LAXATIVES
Bulk Forming
- Psyllium husk (Metamucil)
- methylcellulose
- carboxymethylcellulose sodium
- partially hydrolyzed guar gum
- polycarbophil
- plantago seeds
Recommended as Initial Therapy:
- mimics normal evacuation conditions
- geriatrics preferred
- pregnant women
MOA:
- water is retained in intestines, swelling occurs, peristalsis stimulated
ONSET:
- 12-24 hours, up to 72 hours
Adverse:
- abd cramping
- flatulence
- esophageal obstruction
Interactions (may interact with many drugs):
- Cellulose
- oral coagulants
- digitalis
- salicylates
- Calcium Polycarbophil
Contraindications:
- Pt w/ stenosis or intestinal ulcerations :red_cross:
- leads to fecal impaction or intestinal obstruction
- if fluid required: pt w/ CNF or renal failure (issue)
Caution: :no_entry:
- <6 - must have suff water intake
- diabetics - dextrose content
- some contain aspartame
- avoid in phenylketonuria pts
Metamucil :
- approved for lowering risk of heart disease ( lowers cholesterol in low fat diets)
- feel less hungry b/t meals
- promote & maintain digestive health
- used to be constipation only, but now a fiber supplement
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Lubricant
- is mineral oil (liquid petroleum)
- MOA:
- 6-8 hours oral
- 5-15 minutes rectally
- Contraindications:
- < 6 y/o
- bedridden
- caution in elderly: lipid pneumonia (lungs)
- pregnant W
- Adverse Rxn:
- repeated & prolong use
- oil
DRUG INTERACTIONS
- fat-soluble vitamins
- emollients INC lubricant absorption
Saline (osmotic)
- magnesium citrate (Citroma)
- magnesium hydroxide (Phillips)
- magnesium sulfate (Epsom Salt)
- dibasic sodium phosphate (Phosphosoda)
- monobasic sodium phosphate (Fleet enema)
- sodium biphosphate (Fleet Enema)
MOA:
- draws ion water into intestine, INC intraluminal pressure --> INC motility
- 20% of Na abs back into vascular system (not good for ppl who can't afford extra fluids)
Onset:
- 30 mins - 3hrs (oral)
- 2-5 mins (rectal)
Indication:
**- for acute evacuation ( endoscopy, suspected poisonings)
- CAN be used for for long-term constipation :check:
Contraindications:
- oral <5 y/o
- rectal < 2 y/o
- pregnancy (inc fluids)
- illeostomy or colostomy
- renal function impairment
- CHF
Caution:
- Na restricted diets
- avoid in elderly ( sodium load, 20% goes back)
Acute Phosphate Nephropathy:
- Oral Sodium Phosphate -
- acute renal failure assoc with OSP for bowel cleansing
- PTs at risk
- advanced age
- dec volume (kidney disease)
- meds that affect renal perfusion or function (diuretics, ACE inhibitors, ARBS, & maybe NSAIDS)
Hyperosmotic
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Active Ingredients:
- glycerin
- polyethylene glycol
- other rx only
Onset:
- 1-3 days (oral)
- 30 mins (rectal)
Glycerin: infants, children, adults
Polyethylene Glycol:
16 y/o
- max 4-8 oz liquid one daily (max 7 days)
- no cramps & gas
Stimulants (cathartic)
Active Ingredients:
- sennosides & senna
- bisacodyl
- castor oil
- Senna and sennosides – inhibit water and electrolyte absorption from the large intestine; thus increasing intestinal volume and pressure—increasing motility
- Bisacodyl – acts on the mucosal nerve plexus and causes contraction of the entire colon
- Castor oil - unknown (ricinoleic acid)
MOA: local irritation of mucosa
Onset:
- Senna: 6-12 hours oral (up to 24)
- Bisacodyl: 6-10 hours orally; 15 – 60 minutes rectal
- Castor oil: 2-6 hours oral
Indication:
- Before radiologic or endoscopic exam
- Before GI surgery
- Tx of opiate induced chronic constipation
- Bisacodyl – OK with colostomy
Adverse Effects:
- Cathartic colon (harsh bowel movements)
- Cramping and fluid loss
Contraindications:
- Pregnancy (preterm labor)
- Geriatrics should use stimulants sparingly (fluid loss)
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DR:
- < 3 bowel movements per WEEK
Can Lead To:
- hypertension
- cardiac arrthymias
- possible rectal prolapse
Facts:
- affects 2-27% of US population
- most estimates: 15 % (underestimated)
- only 25% seek tx
- HIGHEST RISK :forbidden:
Treatment Goals
- relieve constipation/return to normal bowel movement
- est dietary & exercise habits (prevention)
- safe & effective use of laxatives
- avoid overuse of laxatives (dependence)
- Bowel Evacuation:
- Sodium Phosphates (Visicol)
- 40 tablets
- evening before colonoscopy
- 3 tabs with 8 oz of clear liquids q 15 minutes for a total of 20 tablets. (last dose will be 2 tablets)
- day of procedure: save as above
- caution: acute phosphate nephropathy
- water BM 1 hour after
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