RxPrep Constipation & Diarrhea

chronic idiopathic constipation

When constipation persists for several weeks or longer and the cause is unknown, it's termed ________.

IBS-C

Idiopathic constipation associated with chronic or recurrent abdominal discomfort that's relieved by defecation is termed ________.

irritable bowel syndrome with constipation

What does IBS-C stand for?

anal disorders, cerebrovascular events, diabetes, hypothyroidism, IBS, multiple sclerosis, Parkinson disease, spinal cord tumors

What are 8 medical conditions that can cause constipation?

fissures, fistulae, rectal prolapse

What are 3 anal disorders that can cause constipation?

eat high-fiber foods, increase fluid intake, increase physical activity

What are 3 non-drug treatments for constipation?

antacids, anticholinergics, antidiarrheals, clonidine, colesevelam, iron, non-DHP CCBs, opioids, sucralfate

What are 9 drugs/classes that can cause constipation?

aluminum, Ca

________- and ________-containing antacids can cause constipation.

antihistamines, antispasmodics, incontinence drugs, phenothiazines, TCAs

What are 5 anticholinergic classes that can cause constipation?

diphenhydramine

What's an example of an antihistamine that can cause constipation?

baclofen

What's an example of an antispasmodic that can cause constipation?

prochlorperazine

What's an example of a phenothiazine that can cause constipation?

amitriptyline

What's an example of a TCA that can cause constipation?

oxybutynin

What's an example of an incontinence drug that can cause constipation?

verapamil

Which non-DHP CCB is most likely to cause constipation?

OTC

Most medications for the treatment of constipation are available (by prescription only/OTC).

abdominal cramping, diarrhea

What are the 2 most common side effects of drugs used to treat constipation?

a

Which constipation treatment is first-line in most cases?

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

a

Which constipation treatment is the treatment of choice in pregnancy?

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

a

Constipation treatment that absorbs water in the intestine, increasing peristalsis and decreasing stool transit time

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

soluble fiber; psyllium

An example of a bulk-forming drug is ________, such as ________.

c

Constipation treatment that contains large ions or molecules that are poorly absorbed, drawing fluid into the bowel lumen which distends the colon and increases peristalsis

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

PEG

What's an example of an osmotic?

polyethylene glycol

What does PEG stand for?

d

Constipation treatment that directly stimulates neurons in the colon, causing peristaltic activity

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

bisacodyl, senna

What are 2 examples of stimulant laxatives?

d

Patients using chronic opioids, all of which are constipating, often require a(n) ________.

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

stool softener

A(n) ________ can be given with the stimulant laxative if a patient on chronic opioids is having trouble with hard stools.

e

Constipation treatment that's an emollient that reduces the surface tension of the stool oil-water interface, allowing more water and fat to mix with the stool

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

docusate

What's an example of a stool softener?

iron supplements

Stool softeners are frequently used by patients using ________, which make the stool hard and compact.

b

Constipation treatment that coats the bowel and stool with a waterproof film, keeping moisture in the stool and making defecation easier

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

mineral oil

What's an example of a lubricant?

a) bulk-forming drug

e) stool softener

Which of the following are recommended to treat iron-induced constipation or hard stool? (select all that apply)

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

c) osmotic

d) stimulant

Which of the following are recommended to treat opioid-induced constipation? (select all that apply)

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

bisacodyl suppository, glycerin suppository

What are 2 drug options when fast relief is needed for constipation in adults?

glycerin suppository

What is a drug option when fast relief is needed for constipation in children?

7 days

If there's no improvement after treating constipation for ________, refer the patient to a healthcare provider.

bulk-forming drugs

Psyllium, calcium polycarbophil, methylcellulose, and wheat dextrin are examples of ________ used to treat constipation.

Metamucil

What's the brand name for psyllium?

FiberCon

What's the brand name for calcium polycarbophil?

Citrucel

What's the brand name for methylcellulose?

Benefiber

What's the brand name for wheat dextrin?

abdominal cramping, bloating, flatulence

What are 3 side effects of bulk-forming drugs?

adequate fluids

________ are required for use with bulk-forming drugs when treating constipation.

a) calcium polycarbophil

Which bulk-forming drug should be separated from select drugs due to a binding interaction?

a) calcium polycarbophil

b) methylcellulose

c) psyllium

d) wheat dextrin

osmotic laxatives

Magnesium hydroxide, PEG 3350, glycerin, lactulose, sodium phosphates, and sorbitol are examples of ________ used to treat constipation.

Milk of Mangesia

What's the brand name for magnesium hydroxide?

MiraLax

What's the brand name for PEG 3350?

ulose

Common brand names for lactulose end in "-________."

Fleet Enema

What's the brand name for sodium phosphates?

abdominal cramping, electrolyte imbalance

What are 2 side effects of osmotic laxatives?

renal impairment

Magnesium-containing osmotic laxatives should be used with caution in patients with ________.

d

Which osmotic laxative is commonly used for hepatic encephalopathy?

a) glycerin

b) magnesium hydroxide

c) PEG 3350

d) lactulose

e) sodium phosphates

f) sorbitol

stimulant laxatives

Senna and bisacodyl are examples of ________ used to treat constipation.

Ex-Lax, Senokot

What are 2 brand names for senna?

Senna S, Senokot S

What are 2 brand names for senna + docusate?

Dulcolax

What's a brand name for bisacodyl?

abdominal cramping

What's a side effect of stimulant laxatives?

bedtime

At what time of day should a stimulant laxative be taken?

emollient

What's another term for stool softener?

Colace

What's a brand name for docusate sodium?

stool softener

Docusate sodium is an example of a(n) ________ used to treat constipation.

e

Which of the following is preferred to treat constipation when straining should be avoided (e.g., postpartum, post-MI, anal fissures, hemorrhoids)?

a) bulk-forming drug

b) lubricant

c) osmotic

d) stimulant

e) stool softener

lubiprostone

prescription only drug for constipation that acts on chloride channels in the gut, leading to increased fluid and peristalsis

linaclotide

prescription only guanylate cyclase C agonist for constipation that increases chloride and bicarbonate secretion into the lumen of the intestines, increasing the speed of GI transit and reducing abdominal pain

PAMORA

prescription only drug class for constipation that acts on mu-opioid receptors in the GI tract, decreasing constipation

peripherally-acting mu-opioid receptor antagonist

What does PAMORA stand for?

Amitiza

What's the brand name for lubiprostone?

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

Which of the following are indications for lubiprostone? (select all that apply)

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

d) surgery (to decrease risk of post-operative ileus)

nausea

What's a side effect of lubiprostone?

Linzess

What's the brand name for linaclotide?

chloride channel activator

Lubiprostone is an example of a(n) ________ used to treat constipation.

guanylate cyclase C agonists

Linaclotide and plecanatide are examples of ________ used to treat constipation.

a) chronic idiopathic constipation

b) IBS-C

Which of the following are indications for guanylate cyclase C agonists (linaclotide, plecanatide)? (select all that apply)

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

d) surgery (to decrease risk of post-operative ileus)

diarrhea

What's a side effect of guanylate cyclase C agonists?

Entereg

What's a brand name for alvimopan?

PAMORAs

Alvimopan, methylnaltrexone, naloxegol, and naldemedine are examples of ________ used to treat constipation.

d) surgery (to decrease risk of post-operative ileus)

Which of the following is an indication for alvimopan?

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

d) surgery (to decrease risk of post-operative ileus)

15

Alvimopan can be used for a maximum of ________ dose(s) when used for hospitalized surgery patients to decrease the risk of post-operative ileus.

MI

What's the boxed warning associated with alvimopan?

therapeutic doses of opioids for >7 days

What's a contraindication for alvimopan?

Relistor

What's the brand name for methylnaltrexone?

Movantik

What's the brand name for naloxegol?

c) opioid-induced constipation

What's an indication for methylnaltrexone, naloxegol, and naldemedine?

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

d) surgery (to decrease risk of post-operative ileus)

a) chronic idiopathic constipation

What's an indication for prucalopride?

a) chronic idiopathic constipation

b) IBS-C

c) opioid-induced constipation

d) surgery (to decrease risk of post-operative ileus)

5HT4 agonist

Prucalopride is an example of a(n) ________ used to treat constipation.

suicidal ideation

What's a warning associated with prucalopride?

diarrhea

What's a side effect of prucalopride?

electrolyte loss, fluid loss

Although usually safe and well-tolerated, laxatives for whole bowel irrigation can cause ________ and ________.

oral sodium phosphate

What laxative used for whole bowel irrigation can cause critical fluid and electrolyte losses?

CV disease,

loop diuretic use,

NSAID use,

renal insufficiency

Patients in what 4 groups should use extra caution when using laxatives for whole bowel irrigation?

PEG-electrolyte solution,

sodium phosphates,

sodium sulfate/potassium sulfate/magnesium sulfate

What are 3 laxatives used for whole bowel irrigation?

Colyte, GoLytely

What are 2 brand names for PEG-electrolyte solutions used for whole bowel irrigation?

OsmoPrep

What's a brand name for sodium phosphates used for whole bowel irrigation?

Suprep Bowel Prep Kit

What's a brand name for sodium sulfate/potassium sulfate/magnesium sulfate products used for whole bowel irrigation?

nephropathy

What's a boxed warning associated with Osmoprep (sodium phosphate)?

acute phosphate nephropathy,

gastric bypass,

stapling surgery

What are 3 contraindications for OsmoPrep (sodium phosphate)?

c

Bowel prep regimens typically require doses the ________ the colonoscopy to completely evacuate the bowel.

a) evening before

b) morning of

c) both A and B

clear liquid

A(n) ________ diet is required the day prior to colonoscopy.