Term
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Definition
difficult passage of stool, or a decrease in # of bowel movements (BMs);
Common in:
- elderly (>65 yrs old)
- pregnancy |
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Term
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Definition
| 3x daily to 3x per week (pt-dependent) |
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Term
| Risk Factors for Constipation |
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Definition
insufficient dietary fiber intake;
inadequate fluid intake;
lack of physical activity;
poor bowel habits (ignoring urge, hurried BMs) |
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Term
| Conditions that can cause Constipation |
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Definition
GI disorders: IBS, diverticulitis, hemorrhoids;
Metabolic/Endocrine: hypOthyroidism, hypERcaclcemia, DM;
Pregnancy (progesterone);
Neurogenic: brain trauma, CVA, Parkinson's;
Postponing urge to defecate |
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Term
| Drugs that cause Constipation |
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Definition
Opiates;
Anticholinergics (antihistamines, TCAs);
Antacids containgin CaCO3 or AlOH (Tums, Mylanta, Maalox);
Non-dihydropyridine CCBs (verapamil, diltiazem);
Clonidine;
Fe preps; |
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Term
| Patient's Perception of Constipation |
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Definition
Infrequent BM;
Straining to have BM;
Passing hard, dry stool;
Insufficient size stools;
Feeling of fullness;
Mild pain on passing stool;
Loss of appetite; |
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Term
| What a Pharmacist should Ask |
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Definition
Frequency?
Duration of constipation?
Exercise routine?
Appetite?
Dietary fiber consumption?
Presence of other Sx?
Current meds?
Meds used to relieve constipation & their effectiveness? |
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Term
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Definition
Treat specific cause/Remove cause if possible;
Relieve Sx;
Restore normal bowel fcn;
Avoid overuse of laxatives; |
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Term
| Non-Pharm Tx for Constipation |
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Definition
Increase amount of fiber in diet: 25-30 g fiber/day;
Increase fluid intake;
Increase exercise;
Utilize bowel training to increase regularity; |
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Term
| psyllium (Metamucil), methylcellulose (Citrucel), calcium polycarbophil (FiberCon), barley malt extract (Maltsupex) |
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Definition
Bulk-forming laxatives;
**Uses: Prevention & Treatment - most safe to use**
Seperate administration time w/ other meds by 2 hrs;
Administration: mix w/ 8-10 oz H2O, followed by additional 8-10 oz H2O;
All PO; |
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Term
| docusate sodium (Colace), docusate calcium (Surfak) |
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Definition
Emollient (stool softeners);
MoA: anionic surfactant;
**Uses: PREVENTION in pts who should avoid straining (i.e. after abd/rectal surgery, labor, MI);
**Use along w/ STIMULANT for long-term tx of opiate-induced constipation;
**DRUG INTERACTIONS: mineral oil - don't give together** |
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Term
| mineral oil (Fleets Mineral Oil) |
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Definition
lubricant laxative;
MoA: "greases the stool";
Uses: NOT preferred due to ADRs; Routine Use is NOT recommended, but can be used when AVOIDING straining is required;
ADRs:
- anal leakage
- decreased absorption of fate soluble vitamins (A,D,E,K) --> take 2 hrs apart;
Avoid in pregnancy;
Risk of Aspiration Pneumonia;
Interactions: emollient laxatives (docusate);
Precautions:
- bedridden pts
- pts w/ difficulty swallowing
- rectal bleeding
- appendicitis;
Administration: emuslified products may taste better --> chill/mix w/ juice or ice cream; |
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Term
| magnesium hydroxide (Milk of Magnesia), sodium phosphates (Fleet Phospho-Soda, OsmoPrep, Visicol), magnesium citrate (Citroma) |
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Definition
saline laxatives;
MoA: nonadsorbable ions pull water into GI lumen & increase volume & pressure which increases bowel motility;
**Use: ACUTE evacuation of bowel before a procedure**
ADRs:
- excessive dehydration
- hypermagnesemia, hyperphosphatemia;
Interactions: Separate administration from medications;
Administer: Drink w/ full glass of H2O;
Precautions: AVOID in renal impairment, HF, sodium-restricted diets, pregnancy, & children <5 yrs old; |
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Term
| lactulose, glycerin, polyethylene glycol (PEG) w/ electrolytes [Colyte, GoLYTELY], PEG w/o electrolytes [MiraLax], sorbitol |
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Definition
hyperosmotic laxatives;
MoA: creates an osmotic effect & draws water into GI tract, stimulating BM
**NOT USED FOR PREVENTION**
ADRs:
- flatulence
- cramps
- diarrhea
- electrolyte imbalances |
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Term
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Definition
hyperosmotic laxative - only available in liquid form;
Use: TREATMENT;
Comments: Monitor for electrolyte imbalances in elderly;
Onset: 1-3 days; |
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Term
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Definition
hyperosmotic laxative - OTC - rectal use only;
Uses: Treatment;
Onset: 1-6 hrs |
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Term
| polyethylene glycol (PEG) w/ electrolytes [Colyte, GoLYTELY] - RX |
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Definition
Hyperosmotic laxatives: Rx;
Use: ACUTE EVACUATIONS PRIOR TO PROCEDURE;
Reconstitute w/ H2O; Drink 8 oz. every 8 10 min until 4 L consumed & fecal discharge is clear;
May decrease absorption of other meds;
Onset: 4 hrs; |
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Term
| PEG w/o electrolytes (Miralax) - Rx |
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Definition
Hyperosmotic laxative;
Use: TREATMENT;
Dissolve in 8 oz of fluid;
**NOT used for acute bowel evacuation prior to procedure**
Onset: 1-3 days |
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Term
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Definition
Hyperosmotic laxative;
Use: TREATMENT;
Less expensive than lactulose;
Onset: 0.5-1 hr |
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Term
| senna or sennosides (Senokot, Ex-Lax) |
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Definition
stimulant laxatives - anthraquinone class;
Uses: TREATMENT of Constipation --> caused by OPIATES (Tx of CHOICE) or resistant to stool softeners & bulk-forming laxatives;
Onset: 6-12 hrs;
May change urine color;
ADRs: abdominal cramping, diarrhea, electrolyte & fluid deficiencies, melanosis coli;
Interactions: PPIs, H2RAs (separate by 1-2 hrs);
Precautions: Should NOT be used >1 wk; |
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Term
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Definition
stimulant laxative - diphenylmethane class;
Uses: ACUTE evacuations before GI procedure, TREATMENT of constipation caused by OPIATES (**TReatment of Choice);
Onset: PO - 6-12 hrs, Rectal - 1-6 hrs;
ADRs:
- abdominal cramping, diarrhea;
- electrolyte & fluid deficiencies;
Interactions: PPI, H2RA (separate by 2 hrs); |
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Term
| castor oil (Purge Liquid) |
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Definition
very potent stimulant laxative;
Use: Treatment of Constipation to stool softeners & bulk-forming laxatives;
Onset: 2-6 hrs, PO;
ADRs:
- abdominal cramping, diarrhea;
- electrolyte abnormalities; |
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Term
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Definition
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Term
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Definition
Perdiem;
Tx of opiate-induced constipation; |
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Term
| Nondrug Constipation Counseling Points |
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Definition
High-fiber diet (25-30 g/day);
Increase dietary fiber (wheat grains, fruits, vegetables);
Avoid constipating foods (processed cheese & conc. sweets);
6-8 8oz glasses of fluid/day; |
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Term
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Definition
MoA: acts locally in gut to open Cl channels --> stimulate intestinal fluid secretion & accelerate GI motility;
Uses: Tx of chronic idiopathic constipation in adults;
Dose: 24 mg (1 cap) PO BID with food;
ADRs: HA, diarrhea, nausea;
**Use when all else fails** |
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Term
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Definition
MoA: serotonin receptor agonist --> stimulates GI peristalsis;
Uses: IBS w/ constipation & chronic idiopathic constipation in women (<55 yrs old) in which no alternative therapy exists;
Dose: 1 tab (6 mg) PO BID before meals;
ADRs: abdominal pain, diarrhea; |
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Term
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Definition
Non-pharm therapy is PREFERRED;
Avoid enemas;
If <5 yrs old, glycerin suppositories preferred;
Use stimulant laxatives ONLY w/ MD supervision;
Barley malt extract (Maltsupex) is safe in infants <1 month; |
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Term
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Definition
| Emollient laxatives alone are not sufficient --> PREFERRED: stimulant + emollient (i.e. senna + docusate [Senokot-S]) |
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Term
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Definition
Consider lifestyle changes or adjustments in constipating meds;
PREFERRED: bulk-forming laxatives;
AVOID mineral oil & saline laxatives; |
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Term
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Definition
1st Line: bulk-forming laxatives;
2nd Line: emollient, senna, or bisacodyl may be used;
AVOID castor oil --> premature labor;
AVOID osmotic & saline laxatives --> electrolyte abnormalities;
AVOID mineral oil --> decreased vitamin absorption; |
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Term
| Heart Failure (HF) & Renal Insufficiency |
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Definition
Avoid Na-containing laxatives (Na overload, H2O retention);
AVOID Mg & phosphate-containing laxatives in RENAL INSUFFICIENCY |
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Term
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Definition
Long-term: vomiting, abdominal pain, weakness, thirst, BONE PAIN (osteomalacia);
Serious: electrolyte imbalance, hypoalbuminemia, colitis;
Most common in middle-aged women; |
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Term
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Definition
| abnormally large, bulging, symptomatic clusters of hemorrhoidal vessels, tissues, and mucous membranes located in lower rectum or anus |
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Term
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Definition
| located above the dentate line |
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Term
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Definition
located below the dentate line in the anal canal;
Freq. visible as bluish lumps at external or distal boundary of anal canal; |
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Term
| Risk Factors for Hemorrhoids |
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Definition
Pregnancy;
Prolonged sitting or standing;
Lack of dietary fiber;
Chronic constipation;
Diarrhea;
Heavy lifting with straining;
Straining at defecation;
Age (elderly);
Hereditary; |
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Term
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Definition
Self-Treatable: pruritus, discomfort, irritation, burning, inflammation, swelling;
Requires Med Referral: moderate-severe pain, bleeding, prolapse, thrombosis; |
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Term
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Definition
| If minor Sx do NOT respond to 7 days of self-treatment, refer to MD |
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Term
| Nonpharm Tx for Hemorrhoids |
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Definition
Avoid foods that aggravate Sx (spicy foods, caffeine);
Avoid lifting heavy objects;
Increase dietary fiber & exercise;
Encourage proper bowel habits: avoid sitting on toilet >10 min, do not avoid urge to defecate, avoid excessive scrubbing of area, sitz baths;
Surgery for large, prolapsed hemorrhoids; |
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Term
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Definition
local anesthetics;
Indications: EXTERNAL USE ONLY - temporary relief of external anal Sx;
ADRs:
- contact dermatitis (burning & itching)
Precaution: do not use if skin abraded; |
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Term
| ephedrine sulfate, epinephrine HCl, phenylephrine HCl |
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Definition
MoA: vasoconstriction of aterioles, reduces swelling;
Indications: EXTERNAL USE for swelling, discomfort, irritation, itching; INTERNAL USE: ephedrine & phenylephrine;
ADRs:
- tremor, nervousness
- increase in BP & HR;
Precautions:
- harmful ADRs in pts w/: HTN, cardiac dx, DM, hyperthyroidism, BPH; |
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Term
| aluminum hydroxide gel, glycerin, zinc oxide, calamine, kaolin |
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Definition
protectants;
MoA: forms physical barrier on skin forming protective coating;
Indications:
- used internally & externally; Glycerin: ONLY EXTERNALLY;
- temporary relief of itching, burning, irritation, discomfort;
Administration: remove previously used greasy ointment before applying |
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Term
| witch hazel, calamine, zinc oxide |
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Definition
astringents;
MoA: locally coagulates proteins;
Indications: external & internal use - temporary relief of burning, itching, irritation;
ADRs: minimal |
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Term
| aluminum chlorhydroxy allantoinate (alcoxa), resorcinol |
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Definition
Indications: External use only - helps relieve discomfort & itching;
ADRs: if r is absorbed --> methemoglobinemia, exfoliative dermatitis, death - DO NOT APPLY to OPEN WOUND;
Precaution: allergic rxns |
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Term
| menthol, juniper tar, camphor |
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Definition
analgesics/anesthetics/antipruritics;
MoA: "counterirritants" - induce cool, warm, or tingling relief;
Indications: EXTERNAL USE ONLY - temp. relief of burning, discomfort, itching, pain; |
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Term
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Definition
corticosteroid;
MoA: antipruritic (reduces itching);
Indications: External use only for relief of itching; |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| calamine, zinc oxide, AlOH gel, ephedrine sulfate, phenylephrine HCl |
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Definition
| products that can be used INTERNALLY |
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Term
| Pt Education for Application of Creams/Ointments |
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Definition
Use after BM;
Cleanse area w/ mild unscented soap & warm water;
Dry w/ unscented toilet paper or soft cloth;
External: apply a thin layer to perianal & anal canal;
Internal: apply w/ finger or applicator (preferred);
If inserting applicator causes MORE pain, CONTACT MD |
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