Constipation & Diarrhea F12 (1)

Fiber binds water in the gi tract reduces colonic

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Fiber binds water in the GI tract Reduces colonic transit time stool bulk and frequency Examples of high-fiber foods: Beans Whole grains (granola, bread, pasta) 1 slice of whole grain bread: ~1.5g of fiber Bran cereals Fresh fruits 1 apple: ~2.5-5g of fiber Vegetables (asparagus, brussels sprouts, cabbage, carrots, cauliflower, string beans)
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Diet Avoid foods that cause constipation Processed cheeses Ice cream Can also use fiber supplements
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Lifestyle Changes Water/fluids 1.5 to 2 liters/day Except for patients who have fluid restrictions Daily exercise 30 minutes of aerobic exercise per day Dedicated bathroom time Try to establish “regularity” Do not ignore the urge
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Non Prescription Medications Type of laxatives: Bulk forming Emollient Lubricant Saline Hyperosmotic Stimulant
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Bulk Forming Laxatives Examples: Methylcellulose (Citrucel®) Calcium polycarbophil (FiberCon®) Psyllium (Konsyl®, Metamucil®) MOA: stool bulk, retention of stool water, and rate of transit Not systemically absorbed Onset of action = 12-72 hr
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Bulk Forming Laxatives Adverse effects Bloating Flatulence Can cause intestinal or esophageal obstruction if not taken with sufficient water Drug interactions May bind to other drugs Should separate from other medications by 1-2 hr Sugar-free products available Diabetics
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Bulk Forming Laxatives Place in therapy 1 st line NOT used in immobile patients Worsen constipation Must drink large amounts of fluid
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Emollient Laxatives Example: Docusate sodium (Colace®) MOA: Facilitate mixing of aqueous and fatty materials in the intestinal tract (stool softener) Onset of action = 24-72 hr Role in therapy Primarily used to prevent constipation and maintain regularity Useful in hospital when trying to prevent patients from straining during bowel movements (e.g. postoperative, after MI) Not really effective for long-standing constipation
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Emollient Laxatives Adverse effects Cramping Diarrhea Drug interactions Should not be used with mineral oil
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Lubricant Laxatives Example: Mineral oil MOA: Prevent colonic absorption of fecal water Lubricate and soften the stool Onset of action Oral = 6-8 hrs Rectal = 5-15 min Role in therapy Maintain soft stool and avoid straining Emollient laxatives preferred Avoid prolonged use Avoid use in bedridden patients Mineral oil not recommended for use
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Lubricant Laxatives Adverse effects (primarily due to repeated and prolonged use) Lipid pneumonia (if aspirated) Anal leakage/pruritis May impair absorption of fat-soluble vitamins (A, D, E, and K) Drug interactions Can absorption of many medications
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Saline Laxatives Examples: Magnesium citrate Magnesium hydroxide (Milk of Magnesia®) Monobasic/dibasic sodium phosphate (Fleet’s Enema®) MOA Cause osmotic effect Draws water into rectum Bowel movement Onset of action Oral = 30 min - 3 hr Rectal = 2-5 min
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Saline Laxatives
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