Podcast
Questions and Answers
What is one of the criteria for the diagnosis of chronic idiopathic constipation (CIC)?
What is one of the criteria for the diagnosis of chronic idiopathic constipation (CIC)?
- Sudden weight loss
- Straining during defecation (correct)
- Increased appetite
- Presence of blood in stool
Which of the following is NOT a symptom used to diagnose chronic idiopathic constipation (CIC)?
Which of the following is NOT a symptom used to diagnose chronic idiopathic constipation (CIC)?
- Frequent bowel movements (correct)
- Sensation of anorectal obstruction
- Manual maneuvers to facilitate defecation
- Less than 3 spontaneous bowel movements per week
Which type of laxatives causes soft or semi-fluid stools within 6-12 hours?
Which type of laxatives causes soft or semi-fluid stools within 6-12 hours?
- Magnesium citrate (correct)
- Docusate
- Polyethylene glycol
- Methylcellulose
What is the main mechanism of action of lactulose as an osmotic laxative?
What is the main mechanism of action of lactulose as an osmotic laxative?
Which agent is classified as an intestinal secretagogue for treating chronic idiopathic constipation?
Which agent is classified as an intestinal secretagogue for treating chronic idiopathic constipation?
What lifestyle modifications are recommended for initial management of chronic idiopathic constipation?
What lifestyle modifications are recommended for initial management of chronic idiopathic constipation?
Which medication can result in watery evacuation within 1-6 hours?
Which medication can result in watery evacuation within 1-6 hours?
Which agent is classified as a prokinetic agent used in the treatment of chronic idiopathic constipation?
Which agent is classified as a prokinetic agent used in the treatment of chronic idiopathic constipation?
'Increase stool frequency' is a pharmacological effect associated with which medication?
'Increase stool frequency' is a pharmacological effect associated with which medication?
What is the recommended first-line treatment for mild chronic idiopathic constipation (CIC) according to the text?
What is the recommended first-line treatment for mild chronic idiopathic constipation (CIC) according to the text?
What side effect should be monitored if osmotic laxatives are used for longer than 6 months, especially in elderly patients?
What side effect should be monitored if osmotic laxatives are used for longer than 6 months, especially in elderly patients?
What can be considered as rescue therapy in combination with other pharmacological medications for chronic idiopathic constipation?
What can be considered as rescue therapy in combination with other pharmacological medications for chronic idiopathic constipation?
What is the recommended course of action if fiber is not effective at all for chronic idiopathic constipation?
What is the recommended course of action if fiber is not effective at all for chronic idiopathic constipation?
What is the suggested duration of treatment with agents approved for chronic idiopathic constipation (CIC) according to the text?
What is the suggested duration of treatment with agents approved for chronic idiopathic constipation (CIC) according to the text?
What should be avoided when a patient cannot move, drink plenty of fluids, or has difficulty swallowing in relation to laxative use?
What should be avoided when a patient cannot move, drink plenty of fluids, or has difficulty swallowing in relation to laxative use?
What is the mechanism of action of Prucalopride (Motegrity)?
What is the mechanism of action of Prucalopride (Motegrity)?
Which of the following is a contraindication for using Prucalopride (Motegrity)?
Which of the following is a contraindication for using Prucalopride (Motegrity)?
How frequently should Prucalopride (Motegrity) be administered?
How frequently should Prucalopride (Motegrity) be administered?
Which of the following gastrointestinal symptoms is a potential side effect of Prucalopride (Motegrity)?
Which of the following gastrointestinal symptoms is a potential side effect of Prucalopride (Motegrity)?
What should be considered when dosing Prucalopride (Motegrity) for a patient with a creatinine clearance (CrCL) less than 30 mL/min?
What should be considered when dosing Prucalopride (Motegrity) for a patient with a creatinine clearance (CrCL) less than 30 mL/min?
What outcome is expected during 12-week studies with Prucalopride (Motegrity)?
What outcome is expected during 12-week studies with Prucalopride (Motegrity)?
Which condition is NOT a contraindication for using Prucalopride (Motegrity)?
Which condition is NOT a contraindication for using Prucalopride (Motegrity)?
What should a patient do if the symptoms of CIC have not improved with fiber and Miralax?
What should a patient do if the symptoms of CIC have not improved with fiber and Miralax?
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Study Notes
Treatment of Chronic Idiopathic Constipation (CIC)
- Goals of treatment: relieve symptoms and re-establish normal bowel habits
- First-line treatment: fiber (2-4 weeks)
- Avoid bulk laxatives in patients who cannot move, drink plenty of fluids, or have difficulty swallowing
- If fiber is partially effective or not effective, switch or add an osmotic laxative (Miralax, lactulose, magnesium oxide) for 2-4 weeks
- Stimulant laxatives (bisacodyl, senna) are good for occasional use or rescue therapy in combination with other medications
- Can be used long-term if the regimen is effective
Osmotic Laxatives
- Lactulose: non-absorbable disaccharide that reaches the large bowel, metabolized by colonic bacteria to monosaccharides, increasing stool frequency
- Administration: oral solution, mix with fruit juice, water, or milk
- Miralax: polyethylene glycol, dissolves in 120 mL water, typically administered once daily
Prokinetic Agent: Prucalopride (Motegrity)
- Mechanism of action: selective serotonin type 4 receptor agonist, stimulating colonic peristalsis, increasing bowel motility
- Efficacy: ≥ 3 BMs per week, on average, in 12-week studies
- Administration: orally once daily, with or without food
- Side effects: headache, abdominal pain, nausea, diarrhea
- Contraindications: tear in the stomach or intestinal wall, bowel obstruction, Crohn's disease, ulcerative colitis
Diagnosis of Chronic Idiopathic Constipation (CIC)
- Symptoms for ≥ 6 months
- ≥ 2 of the following symptoms for > 25% of defecations during the past 3 months:
- Straining
- Lumpy/hard stools
- Sensation of incomplete evacuation
- Sensation of anorectal obstruction/blockage
- Manual maneuvers to facilitate
- Less than 3 spontaneous BM/week
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