COMPARISON CHART FOR CONSTIPATION MEDs Class of agent, Examples Mechanism of Contraindications, Administration & Onset of Action Action Precautions & SE Instructions Bulk-forming Agents: -Retain H2O in -NOT FOR pt w/ -Do not take within 2 Psyllium (Metamucil & stool & increase esophageal strictures, hrs of other Rx or Prodiem) stool bulk which GI ulcerations, effect of other Rx is Methylcellulose (Citrucel) stimulates stenosis or possible reduced Polycarbophil (Fiber-Con) intestinal motility obstruction -Do not prepare Sterculia gum (Normacol) -Use sugar-free mixture in advance Benefiber (wheat dextrin) version for diabetics -Take w/ 250ml H2O Onset: 12-72 hrs SE: flatulence, or juice diarrhea, bloating, -Increase fluids abdominal pain Hyper-osmotic Agents: -Pulls fluid into -*diabetics ? -Use water-soluble Lactulose GI tract by -Avoid antacids w/ lubricant to Sorbitol 70% solution osmosis & this lactulose administer supp & Onset: (24-48 hrs) increases pressure SE: flatulence, have pt turn & Glycerin suppository which stimulates cramps, bloating, remain on L side. Onset: (15-30min) GI motility diarrhea PEG powder can be Polyethylene glycol 3350 (Supp-local irritant) mixed w/ H2O, juice, (Miralax, PEG) (0.5-1hr) tea, coffee or soda Lubricants: -Coats & softens -DO NOT administer -use with extreme Mineral oil the stool & w/ stool softeners d/t caution d/t risk of Onset: 6-8 hrs prevents increased absorption aspiration pneumonia reabsorption of of mineral oil -Use only for short H2O into colon -Decreased periods absorption of fat -DO NOT give at soluble Vits (ADEK) bedtime, to prevent SE: rectal seepage, aspiration irritation Osmotic-Saline Agents: -Draw H2O into -Caution in elderly & -Caution in pts at risk Magnesium Hydroxide stool by osmosis, renal pts since Mg is of dehydration (MoM) increasing eliminated by -MoM has antacid Magnesium Citrate pressure & kidneys: increased properties so give 2 (Citro-Mag) stimulating Mg can cause CNS hrs apart from: Onset: 0.5-3 hrs intestinal motility depression, muscle ketoconazole, weakness, decreased itraconazole, BP & ECG changes tetracyclines & SE: diarrhea, quinolones abdominal pain Stool Softeners: -Decrease surface -Insignificant Na for -Take w/ lots of H2O Ducosate Na (Colace) tension & allow Na–restricted diets to improve Ducosate Ca (Surfak) fat & H2O into (HTN, CHF) effectiveness Onset: 12-72 hrs stools to soften SE: stomach upset -do not give w/ them mineral oil T. Broda, RN[EC], BScN, NP-PHC, CDDN Solution-s Class of agent & Mechanism of Contraindications, Administration Examples action Precautions & SE Instructions Stimulants: -Increase -DO NOT give to -Bisacodyl: do not Senna (Senekot) intestinal motility pregnant women as take with milk Bisacodyl (Dulcolax) by direct action may induce -Bisacodyl (EC) tabs Cascara sagrada on the smooth contractions should not be chewed Onset: 6-12 hrs muscle of the -Do not give to pt w/ or crushed to prevent Bisacodyl supp intestine appendicitis d/t risk contractions in Onset: 0.5-1hr -May also of rupture stomach & small stimulate SE: flatulence, intestine secretion of H2O griping, diarrhea, -Bisacodyl must be & electrolytes excessive diarrhea given 1-2 hrs apart into colon may lead to from antacids, H2- -Bisacodyl causes electrolyte loss & antagonists & PPI’s, contractions of dehydration as they will dissolve entire colon. (EC) (Senna & Cascara- EC => cramping! discolor urine: red, pink, brown, black) **Long term use may lead to cathartic colon, but may be necessary for pts on opiods long-term Enemas : -Various SE: mechanical -NOT for < 2 yrs (onset: 5-15 min) mechanisms of trauma to rectal 1. Tap H2O: action wall 1. Warm H2O 500 ml PR 1. H2O 2. Avoid 2. Na+ Phosphate intoxication prolonged (Fleet): 120ml PR & hypoNa+ retention 3. Mineral oil: 2. hypophospha 100-250ml PR temia & hypocalcemia 3. incontinence *Lactulose: indicated in Patient Self-Care, 2nd ed. (2010, p.269) that it CAN be used by diabetics but taste is ++ sweet & is NOT for pts who should not take galactose BUT bottle of Lactulose clearly indicates diabetic patients should consult MD before using (because it contains lactose & galactose). SE: side effects T. Broda, RN[EC], BScN, NP-PHC, CDDN Solution-s .