Bulk Forming Laxatives and Their Use

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Questions and Answers

What is a potential benefit of using bulk forming laxatives aside from providing relief from constipation?

  • They may lower cholesterol levels. (correct)
  • They can help increase appetite.
  • They provide immediate bowel movements.
  • They enhance drug absorption.

Which patient group should exercise caution when using bulk forming laxatives due to the risk of obstruction?

  • Children under 6 and those on opioids. (correct)
  • Individuals with no prior history of gastrointestinal issues.
  • Patients over 65 years old.
  • Young adults with a high-fiber diet.

What safety consideration must be taken into account when administering bulk forming laxatives?

  • They are safe for all patients with swallowing difficulties.
  • They should be taken with high-calorie beverages.
  • They must be taken with adequate fluids to avoid choking. (correct)
  • They can be used indefinitely without concern.

Why are bulk forming laxatives not recommended for patients on fluid-restricted diets?

<p>They can cause esophageal or intestinal obstruction. (C)</p> Signup and view all the answers

What adverse effect is commonly associated with the use of bulk forming laxatives, particularly when not enough fluid is consumed?

<p>Abdominal cramping and flatulence. (D)</p> Signup and view all the answers

Which of the following bulking agents is most likely to dissolve in intestinal fluid to facilitate bowel movements?

<p>Psyllium (A)</p> Signup and view all the answers

What is the primary reason for the FDA's mandate on labeling laxatives?

<p>To recommend short-term use without health care practitioner oversight (B)</p> Signup and view all the answers

In bowel training, which time period is suggested to take advantage of the gastrocolic reflex?

<p>Immediately after waking up (A), 30 minutes after consuming a meal (D)</p> Signup and view all the answers

Which type of laxative is known to act by lubricating the stool without being absorbed systemically?

<p>Lubricant (B)</p> Signup and view all the answers

What is the recommended daily fluid intake for adults to aid in bowel health?

<p>2 liters (C)</p> Signup and view all the answers

What is the primary mechanism by which hyperosmotic agents like PEG-3350 work?

<p>They draw water into the rectum to facilitate bowel movement. (D)</p> Signup and view all the answers

Which of the following is NOT a recommended indication for using emollient laxatives like docusate?

<p>Regular use for chronic constipation. (C)</p> Signup and view all the answers

What is a significant consideration when using mineral oil as a lubricant laxative?

<p>It may interfere with the absorption of ADEK vitamins. (A)</p> Signup and view all the answers

What is the maximum duration PEG-3350 can be used without a healthcare provider's recommendation?

<p>7 days. (D)</p> Signup and view all the answers

What is a common side effect associated with the use of hyperosmotic agents?

<p>Bloating and discomfort. (B)</p> Signup and view all the answers

In which of the following situations is using docusate sodium NOT preferred?

<p>As a primary laxative for severe constipation. (A)</p> Signup and view all the answers

What is the recommended dosing of MiraLAX® for adults?

<p>1 capful/packet (17 g) dissolved in 4-8 oz of beverage. (B)</p> Signup and view all the answers

What is the typical onset time for glycerin when administered rectally?

<p>15-30 minutes. (B)</p> Signup and view all the answers

Which patient population should NOT be treated with saline laxatives due to safety concerns?

<p>Pregnant women (A)</p> Signup and view all the answers

What is the primary mechanism of action for saline laxatives?

<p>Drawing water into intestines or colon by osmosis (D)</p> Signup and view all the answers

What is a common side effect of saline laxatives that patients should be warned about?

<p>Abdominal cramping (D)</p> Signup and view all the answers

Which saline laxative is suitable for the acute evacuation of the bowel in preparation for a medical exam?

<p>Dibasic sodium phosphate (A)</p> Signup and view all the answers

Which condition is contraindicated for the rectal administration of saline laxatives?

<p>Megacolon (D)</p> Signup and view all the answers

Which of the following is a potential consequence of using sodium phosphate laxatives?

<p>Hyperphosphatemia (C)</p> Signup and view all the answers

What is the recommended time frame for the onset of magnesium hydroxide when taken orally?

<p>30 minutes to 6 hours (C)</p> Signup and view all the answers

How should saline laxatives be administered for optimal effectiveness?

<p>On an empty stomach with 8 oz of water (D)</p> Signup and view all the answers

What is the minimum frequency of bowel movements that is considered constipation in adults?

<p>3 BMs per week (B)</p> Signup and view all the answers

Which of the following demographic groups is most likely to develop constipation?

<p>Older adults (D)</p> Signup and view all the answers

Which lifestyle factor is NOT typically associated with causing constipation?

<p>Diet rich in fruits and vegetables (C)</p> Signup and view all the answers

What is a psychological factor that may contribute to constipation?

<p>Eating disorders (C)</p> Signup and view all the answers

Which condition is an exclusion for self-care treatment of constipation?

<p>Blood in stool (C)</p> Signup and view all the answers

Which of the following medications is NOT commonly associated with causing constipation?

<p>Beta-blockers (A)</p> Signup and view all the answers

What is the recommended fiber intake for adult men to help prevent constipation?

<p>38 grams per day (A)</p> Signup and view all the answers

What is a common reason patients seek self-treatment for constipation?

<p>Nature of the symptom being common (D)</p> Signup and view all the answers

Which of the following is NOT an exclusion criteria for self-care in constipation management?

<p>BMI over 30 (C)</p> Signup and view all the answers

Which non-pharmacological measure is recommended for alleviating constipation?

<p>Increasing fiber-rich foods (D)</p> Signup and view all the answers

What is the recommended management for magnesium citrate when taking fluoroquinolone and tetracycline antibiotics?

<p>Avoid oral magnesium citrate for 1-3 hours before taking the antibiotics (C)</p> Signup and view all the answers

Which laxative is specifically noted to be effective for opioid-induced constipation?

<p>Stimulant laxatives (A)</p> Signup and view all the answers

What is a major adverse effect of using stimulant laxatives?

<p>Decreased fluid and electrolyte levels (D)</p> Signup and view all the answers

In managing laxative overuse, what is a recommended approach?

<p>Monitor hydration levels and increase fiber intake (C)</p> Signup and view all the answers

What is a key concern associated with the use of oral sodium phosphate products?

<p>Acute phosphate nephropathy linked to usage (B)</p> Signup and view all the answers

Which of the following is NOT a consideration when selecting laxatives for older adults?

<p>The use of mineral oil (C)</p> Signup and view all the answers

What is the appropriate action for a patient taking bisacodyl in relation to antacids?

<p>Take bisacodyl 1 hour prior to antacids (C)</p> Signup and view all the answers

Which laxatives are recommended as first-line treatments for children aged 6-12 years?

<p>Docusate sodium and magnesium hydroxide (B)</p> Signup and view all the answers

What is the advised maximum dosage for oral sodium phosphate products in a 24 hour period?

<p>1 dose (C)</p> Signup and view all the answers

When is it appropriate to provide dietary and behavior modification for pediatric patients with constipation?

<p>As the initial approach for all ages (D)</p> Signup and view all the answers

Which laxative type requires separation in dosing for certain medications like captopril and cefdinir?

<p>Magnesium hydroxide (B)</p> Signup and view all the answers

What common misconception might lead to laxative overuse?

<p>Fear of constipation leading to chronic use (D)</p> Signup and view all the answers

Which laxative type should be used cautiously in patients due to the risk of fluid loss?

<p>Stimulant laxatives (A)</p> Signup and view all the answers

Flashcards

Bulk-Forming Laxatives

Bulk-forming laxatives, like methylcellulose, psyllium, and calcium polycarbophil, are recommended for constipation because they work by adding bulk to the stool, making it easier to pass. They're absorbed minimally by the body and are considered safe for long-term use.

How do bulk-forming laxatives work?

Bulk-forming laxatives are like natural sponges, absorbing water and swelling in the intestines.

How much water should you drink with bulk-forming laxatives?

Bulk-forming laxatives are usually taken with a full glass of water (8 ounces) to ensure they work properly and avoid potential side effects like constipation or blockage.

Other types of laxatives include...

Emollients, lubricants, saline laxatives, hyperosmotic laxatives, and stimulants are other types of laxatives that work in different ways to relieve constipation.

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Long-term laxative use

It is essential to consult a healthcare practitioner when considering long-term use of laxatives, especially if you experience chronic constipation or have any underlying medical conditions.

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Constipation

A condition characterized by infrequent bowel movements, typically defined as less than 3 bowel movements per week in adults, and difficulty passing hard, dry stools.

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Extrinsic Factors (Constipation)

Factors outside of the body that can contribute to constipation, such as a low-fiber diet, lack of fluids, and sedentary lifestyle.

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Systemic Factors (Constipation)

Conditions within the body that can cause constipation. Examples include thyroid disorders, diabetes, irritable bowel syndrome (IBS), and neurological disorders.

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Structural Factors (Constipation)

A type of constipation caused by physical abnormalities within the digestive tract, such as injury, inflammation, or structural problems.

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Constipation-Inducing Medication

A medication that can lead to constipation, such as antacids, analgesics, and anticholinergics.

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Fiber Intake Recommendation

The American Dietetic Association recommends a daily intake of 14 grams of fiber per 1000 calories.

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Gradual Fiber Increase

A gradual increase in fiber intake over a period of 1-2 weeks is recommended to avoid digestive discomfort.

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Exclusions to Self-Care (Constipation)

Symptoms that may indicate a more serious underlying condition and require medical attention, not self-care. These symptoms include severe abdominal pain, unexplained flatulence, fever, and blood in the stool.

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Non-Pharmacological Treatment (Constipation)

Non-pharmacological measures to treat constipation, including increasing fruit, vegetables, and whole grains in the diet, and adopting a more active lifestyle.

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Treatment Goals (Constipation)

The goal of constipation treatment is to relieve symptoms, restore normal bowel function, prevent future occurrences, and ensure safe and effective laxative use.

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What are bulk-forming laxatives?

Bulk-forming laxatives work by absorbing water in the gut, creating a larger, softer stool that is easier to pass. They are often used for short-term relief of constipation and can be helpful in promoting regular bowel movements.

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What are some common side effects of bulk-forming laxatives?

Bulk-forming laxatives are generally safe, but some common side effects include abdominal cramping and flatulence, particularly if not enough fluids are consumed. Choking is also a concern if the laxative is taken without sufficient water.

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How do bulk-forming laxatives interact with other medications?

Bulk-forming laxatives can hinder the absorption of certain medications, such as warfarin, digoxin, and salicylates. It's important to separate the intake of these medications and bulk-forming laxatives by at least two hours.

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When should bulk-forming laxatives be avoided?

Bulk-forming laxatives are not suitable for individuals who are on fluid-restricted diets, such as those with renal failure or congestive heart failure. They may also cause esophageal or intestinal obstruction, especially in children under 6 and those on opioids.

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Are there any specific considerations for calcium polycarbophil?

Calcium polycarbophil, a specific type of bulk-forming laxative, should be limited to 150 mg in individuals who are susceptible to hypercalcemia (high calcium levels) such as those with renal disease.

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Hyperosmotic Laxatives

A type of laxative that works by drawing water into the rectum, softening the stool and promoting a bowel movement. They work by creating an osmotic gradient, where the concentration of water in the rectum is lower than inside the body, leading to water moving into the rectum to balance it.

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Examples of Hyperosmotic Laxatives

Examples of hyperosmotic laxatives include glycerin and polyethylene glycol (PEG) 3350.

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MiraLAX®

A type of hyperosmotic laxative that is available over the counter (OTC) and is often used for occasional constipation.

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Emollient Laxatives

A laxative that works by softening the stool and making it easier to pass. They work by reducing the surface tension of the stool, allowing more water to penetrate the stool and soften it.

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Examples of Emollient Laxatives

Examples of emollient laxatives include docusate sodium and docusate calcium.

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Lubricant Laxatives

A type of laxative that works by lubricating the intestines to prevent absorption of water by the stool. This makes the stool easier to pass.

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Example of Lubricant Laxative

An example of a lubricant laxative is mineral oil.

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Interaction between Mineral Oil and Docusate

Mineral oil and docusate should not be co-administered as they can interact with each other, reducing the effectiveness of both medications.

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Saline Laxative

A type of laxative that works by drawing water into the intestines, increasing pressure and promoting bowel movement. Examples include magnesium citrate, magnesium hydroxide, and sodium phosphate.

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Indications for Saline Laxatives

These laxatives are generally safe for occasional constipation relief, but not recommended for long-term use.

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Safety Considerations with Saline Laxatives

These laxatives can cause side effects such as abdominal cramping, nausea, vomiting and dehydration. They can also lead to electrolyte imbalances, especially if used improperly.

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Hypermagnesia (Elevated Magnesium Levels)

Saline laxatives can lead to an increase in magnesium levels in the blood, especially in people with kidney problems, newborns, and older adults. Be cautious with magnesium-containing laxatives in these groups.

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Sodium Phosphate Safety

Sodium phosphate laxatives can cause high phosphate levels, low calcium levels, and high sodium levels in the blood. Exercise caution in patients with kidney problems, heart conditions, restricted sodium/fluid diets, or those taking medications that affect electrolytes.

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Contraindications for Saline Laxatives

Saline laxatives should be avoided in patients with certain conditions such as megacolon, gastrointestinal obstruction, imperforate anus, or colostomy. These conditions can be worsened by the increased pressure and fluid in the intestines.

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Saline Laxative Administration

Take saline laxatives on an empty stomach with a full 8 oz. glass of water to enhance effectiveness and minimize side effects.

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Mechanism of Action of Saline Laxatives

Saline laxatives work by increasing fluid in the intestines, which causes pressure and stimulates bowel movements.

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Drug Interactions with Magnesium-Based Laxatives

Magnesium citrate and magnesium hydroxide can interact with various medications, reducing their absorption or effectiveness. This includes fluoroquinolones, tetracycline antibiotics, captopril, cefdinir, bisphosphonates, gabapentin, iron salts, phenytoin, nitrofurantoin, phenothiazines, rosuvastatin, ketoconazole, itraconazole, and levothyroxine.

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FDA Warnings on Oral Sodium Phosphate

Oral sodium phosphate products are used for bowel cleansing, but they have been linked to acute phosphate nephropathy. The FDA issued a boxed warning and recommends nonprescription oral sodium phosphate products not be used for bowel cleansing.

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How Do Stimulant Laxatives Work?

Stimulant laxatives like bisacodyl and senna work by increasing peristaltic activity in the intestines, either by local irritation of the mucosa or by acting on the intestinal smooth muscle. They also increase water and electrolyte secretion, helping to soften and move stool.

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Indications for Stimulant Laxatives

Bisacodyl and senna are used as a component of bowel preparation for endoscopic examinations, to prevent or treat opioid-induced constipation (often combined with docusate), and as a second-line option for simple occasional constipation, but they can have adverse effects.

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Safety Considerations for Stimulants

Stimulant laxatives can cause severe cramping, electrolyte and fluid imbalances, enteric loss of protein, and hypermobility. Long-term use can lead to laxative abuse.

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Laxative Overuse: Causes and Symptoms

Laxative overuse can occur due to misconceptions about bowel movements, fear of constipation, or underlying conditions like anorexia nervosa. Symptoms include diarrhea, vomiting, fluid and electrolyte imbalance, and dehydration.

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Treating Opioid-Induced Constipation

Opioid-induced constipation is commonly treated with stimulant laxatives, often combined with docusate. PEG-3350 can be used for prevention or treatment, and saline laxatives can be used periodically for acute evacuation. Bulk-forming laxatives are generally not suitable.

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Selecting Laxatives

When choosing a laxative, consider your specific needs, lifestyle, and potential side effects. Bulk-forming laxatives and PEG-3350 are often good first choices for simple constipation.

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Pediatric Laxative Approach

For children under 2, consult a healthcare provider before using any laxatives. For children ages 2-6, docusate sodium or magnesium hydroxide are often recommended first. For children ages 6-12, methylcellulose, calcium polycarbophil, psyllium powder, magnesium hydroxide, or docusate sodium are preferred.

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Older Adult Laxative Approach

For older adults, dietary and behavior modification should be the first steps, followed by education about normal bowel habits. Bulk-forming laxatives are often a good first choice, but be aware of fluid restrictions and other medical conditions. PEG-3350 is also a good option, as is docusate for hemorrhoids. Avoid mineral oil and use saline laxatives with caution.

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Counseling Issues for Laxative Use

Always include lifestyle considerations like diet, hydration, and exercise when discussing laxatives. Don't take laxatives for more than a week without a healthcare provider's supervision, except for fiber or functional fiber supplements. Be alert for co-morbid conditions and potential drug interactions. Remember that the onset of action varies depending on the laxative.

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Taking Bisacodyl with Other Medications

Bisacodyl, a stimulant laxative, should be taken one hour before antacids or milk to avoid interfering with its enteric coating. It's important to avoid H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). Do not crush or break enteric-coated bisacodyl.

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Senna and Urine Color

Senna, a stimulant laxative, can color urine pink, red, violet, or brown. This is a normal side effect and nothing to worry about.

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Bulk-Forming Laxatives: Long-Term Use

Bulk-forming laxatives like methylcellulose, psyllium, and calcium polycarbophil are generally considered safe for long-term use. They add bulk to stool, making it easier to pass.

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Avoiding Mineral Oil as a Laxative

Mineral oil, a lubricant laxative, should be avoided if possible due to potential risks of aspiration, malnutrition, and prolonged absorption.

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Study Notes

Self-Care Constipation

  • Defined as infrequent bowel movements (<3 per week) in adults, often characterized by hard, dry stools.
  • Patients may experience straining, small stools or feelings of incomplete bowel elimination.
  • Constipation is a common complaint (2-28% of general population).
  • Older adults and women are more susceptible. Older adults are 5x more likely, women 3x more likely than men.

Constipation Statistics

  • A common reason for self-treatment, with 2.5 million physician visits annually.

Etiology (Causes)

  • Lifestyle/Extrinsic factors: Low fiber diet, low fluid intake, sedentary lifestyle, suppressing the urge to defecate.
  • Structural factors: Colorectal or anorectal injury, inflammation, pelvic floor disorders, structural abnormalities.
  • Systemic factors: Thyroid disorders, diabetes, IBS, neurological disorders, autonomic neuropathy, cerebrovascular accidents, multiple sclerosis, dementia, Parkinsonism, post-surgical causes.
  • Psychological factors: Depression, eating disorders, and situational stress.
  • Medications: Calcium or aluminum antacids, narcotic analgesics, anticholinergics, others

Medications Causing Constipation

  • Analgesics
  • Antacids
  • Anticholinergics
  • Anticonvulsants
  • Antidepressants
  • Antihistamines
  • Antimotility
  • Antimuscarinics
  • Benzodiazepines
  • Calcium Channel Blockers
  • Calcium supplements
  • Diuretics
  • Hematinics
  • Hyperlipidemia agents
  • Hypotensives
  • Muscle relaxers
  • Opiates
  • Parkinsonism agents
  • Polystyrene sodium sulfonate
  • Psychotherapeutic drugs
  • Sedative hypnotics
  • Serotonin agonists
  • Sucralfate

Treatment Goals

  • Relieve constipation and re-establish normal bowel function.
  • Establish dietary and exercise habits to prevent recurrences.
  • Promote safe and effective laxative use.

Exclusions to Self-Care

  • Marked abdominal pain, significant distention, or cramping.
  • Unexplained flatulence
  • Fever
  • Nausea or vomiting
  • Daily laxative use
  • Unexplained change in bowel habits, especially with weight loss.
  • Blood in stool or dark tarry stool.
  • Presence of chronic conditions like IBS, paraplegia/quadriplegia, or colostomy.
  • Marked change in stool character (e.g., pencil thin).
  • Sudden change in bowel habits persisting for 2 weeks or recurring over 3 months.
  • Inflammatory bowel disease.
  • Anorexia.
  • Age under 2 years old

Non-Pharmacological Measures

  • Increased intake of fruits, vegetables, and whole grains. The American Dietetic Association recommends 14 g/1000 kcal of fiber per day. (25 g/day for women, 38 g/day for men).
  • Gradual increase in fiber intake over 1-2 weeks.
  • Limit foods low in fiber like cheese, meats and processed foods.
  • Supplement fiber intake where necessary to maintain 14 grams per 1000kcal of food.
  • Bulk-forming laxatives like methylcellulose, polycarbophil, and psyllium.
  • Dietary supplements such as inulin, powdered cellulose, wheat dextrin, partially hydrolyzed guar gum.
  • Increase daily fluid intake (8 glasses of 8oz fluid generally recommended; extra fluid for pregnant and lactating women).
  • Encourage physical activity and regular bowel habits (e.g., "bowel training").

Goals of Pharmacologic Therapy

  • Be nonirritating and nontoxic, acting only on the descending and sigmoid colon.
  • Produce a normally formed stool within a few hours.
  • FDA labeling emphasizes short-term use (<1 week) without a healthcare provider's oversight.

Types of Laxative Agents

  • Bulk forming
  • Emollient
  • Lubricant
  • Saline
  • Hyperosmotic
  • Stimulants

Bulk Forming Laxatives

  • Examples: Methylcellulose, polycarbophil, psyllium (e.g., Citrucel®, FiberCon®, Metamucil®)
  • Mechanism: Dissolve or swell in intestinal fluid, facilitating passage.
  • Not systemically absorbed.

Indications for Bulk Forming Laxatives

  • Indicated to aid for short-term constipation relief, esp. low-fiber diets, postpartum women, older adults, patients with colostomies/IBS/diseases.
  • Can aid as a preventive measure to avoid straining.

Safety Considerations with Bulk Forming Laxatives

  • Common adverse effects are abdominal cramping and flatulence; adequate fluid intake is crucial.
  • Choking may occur if not taken with enough water.
  • Bind/hinder absorption of certain drugs (space 2 hours between drug/laxative ingestion)
  • Not appropriate for patients with restricted diets (e.g., renal failure, congestive heart failure).
  • Children under 6 and patients using opioids at increased risk.
  • Calcium polycarbophil usage limited to 150mg in patients with renal disease susceptible to hypercalcemia.

Hyperosmotic Laxatives

  • Examples: Glycerin or Polyethylene Glycol (PEG)- 3350 (e.g., Fleet Glycerin Suppository, Fleet Babylax, MiraLAX).
  • Mechanism: Draws water into the rectum to facilitate bowel movement.
  • Not systemically absorbed, few side effects.
  • PEG-3350 has emerged as a first-line option in adults.

Safety Considerations with Hyperosmotics

  • Poorly absorbed, little drug interactions.
  • Bloating, discomfort, cramping and flatulence may occur.
  • Dosing varies based on age and type of administration (oral or suppository).

Indications for Hyperosmotics

  • Short-term relief from occasional constipation. Indicated for low fiber diets, postpartum women, older adults, patients with colostomies/IBS.

Saline Laxatives

  • Examples: Magnesium citrate, magnesium hydroxide, dibasic sodium phosphate/monobasic sodium phosphate, or magnesium sulfate (e.g. Fleet Ready-to-Use Enema®, Phillips’ MOM®, Epsom salts).
  • Mechanism: Elevate intraluminal pressure to promote peristalsis via osmosis.
  • Oral regimen requires taking on an empty stomach; rectal administration has a shorter onset time.

Indications for Saline Laxatives

  • Occasional constipation relief. Used for bowel preparation for colonoscopies.
  • Not for long-term constipation management.

Safety Considerations with Saline Laxatives

  • Abdominal cramping, nausea, vomiting, and dehydration may occur.
  • Electrolyte imbalance and fluid loss are potential complications.
  • Do not use in patients with sodium, magnesium, or phosphorus restrictions.
  • Use cautiously in those with conditions like renal impairment, newborns, and older adults.

Stimulant Laxatives

  • Examples: Bisacodyl, Senna (e.g., Correctol, Dulcolax, Ex-Lax, Senokot).
  • Mechanism: Stimulate intestinal motility/peristalsis.
  • Oral and rectal administration is common.

Indications for Stimulant Laxatives

  • Used prior to endoscopic examinations for complete bowel evacuation.
  • Prevent/treat opioid-induced constipation, but often as a 2nd line approach after bulk-forming or hyperosmotic approaches.
  • Occasionally used for simple, occasional constipation.

Safety Considerations with Stimulants

  • Potential for side effects such as cramping, electrolyte imbalances, and enteric protein loss.
  • Use cautiously for patients with pre-existing conditions, and take appropriate precautions for drug interactions.

Laxative Overuse

  • Misconceptions about bowel movements, fear of constipation, underlying conditions such as anorexia nervosa are contributing factors.
  • Clinical features include diarrhea, vomiting, fluid/electrolyte imbalance and dehydration.
  • Wean patients off laxatives, and encourage dietary habits for fiber and fluid intake, as well as physical activity to address underlying issues.

Opioid-Induced Constipation

  • Stimulant laxatives are commonly recommended (with or without docusate).
  • Docusate alone may be ineffective.
  • PEG-3350/saline laxatives may be used periodically to encourage evacuation if needed.
  • Bulk-forming laxatives may not be appropriate.

Selecting Laxatives

  • Review patient's history and current conditions to appropriately determine the best laxative and approach.
  • Start with lifestyle management recommendations and adjustments; if necessary, consider bulk forming/PEG-3350 as the first-line choice.
  • Consider side effects, interactions and pre-existing conditions (e.g. mineral oil avoidance).

Pediatric Approach

  • Dietary and behavioral modification should be prioritized for children under 2 years old.
  • Children 2-6 years old: consider docusate sodium, or magnesium hydroxide as first-line treatments.
  • Children ages 6–12 years old: methylcellulose, calcium polycarbophil, psyllium powder, magnesium hydroxide, and other similar laxatives that can also be offered as first line treatments.

Older Adult Approach

  • Dietary and behavioral modification should be prioritized for older adults, with education on healthy bowel habits being essential.
  • Bulk-forming laxatives may be an initial approach, though careful consideration of additional conditions is paramount (especially fluid restrictions and co-morbidities).
  • PEG-3350 and docusate are also beneficial first-line options.
  • Mineral oil and other similar laxatives should be approached with caution.

Counseling Issues

  • Lifestyle considerations are always essential aspects to managing and preventing constipation.
  • Laxatives are not generally intended for long-term use (longer than a week) unless directed by a healthcare professional.
  • Consideration of any and all potential co-morbidities and drug interactions are necessary.
  • Treatment vs. prevention should be considered for appropriate therapeutic management.
  • Onset of the action of different drugs varies based on different active ingredients.

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