3 Constipation

Drugs that Cause Constipation

Anticholinergics, Cation-Containing, Neurally Active Agents

Non Opioid Acute Constipation Treatment

Use Bulk Forming Laxative

Add Osmotic or Stimulant if Needed

Diet

Exercise

Increase Fluid Intake

Correct Underlying Cause

Chronic Idiopathic Constipation Treatment

Order of Operation: Bulk Lax and lifestyle changes, Osmotic, Simulant, Clinic Referral, Secretagog

BOS

Opioid Induced Constipation (OIC) Prevention

Automatic long-term laxative bowel regiment

Stimulants and then Polyethylene Glycol

What Laxative is Useless in Opioid Constipation

Bulk Formind Lax

Treatment of OIC

Order of Operation: Stimulant Lax, Polyethylene glycol (osmotic), Add peripheral opioid antagonist

SOO

Bulk Forming Laxatives

Psyllium

Polycarbophil

Methylcellulose

Take 3-5 days

Hyperosmolar Laxatives

Polyethylene Glycol (PEG)

Glycerin (Suppository)

Sorbitol

Lactulose

Magnesium Salts

Stimulant Laxatives

Senna

Bisacodyl

8-12 hrs

Emollient Laxative

Docusate

Only help prevent

Secretagogues

Lubiprostone (Cl Channel activator)

Linaclotide (guanylated cyclase-C receptor)

Plecanatide (guanylated cyclase-C receptor)

What Secretagogues have a BBW and what is it?

Linaclotide and Plecanatide

Dehydration in children less than 6 and 2 yrs

Peripherally Acting Mu Receptor Antagonists

Methylnaltrexone

Naloxegol

Lubiprostone

Naldemedine