Question

C.J. is a 71-year-old woman who presents for follow-up. She complains of hard, dry stools over the past week. She remembers reading an educational brochure she picked up in her pharmacy that suggested increasing her fiber and fluid intake, but this has not alleviated her problem. C.J.’s past medical conditions include hypertension and chronic renal insufficiency. She had a stroke 1 year ago with little or no residual. Her medications include verapamil SR 240 mg daily, lisinopril 10 mg orally once daily, calcium carbonate 1,250 mg orally twice daily, and aspirin 325 mg orally once daily.

Diagnosis: Constipation

List specific goals of treatment for this patient.

What drug therapy would you prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Discuss specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause you to change therapy.

What would be the choice for second-line therapy?

What OTC or alternative medications would be appropriate for this patient?

What dietary and lifestyle changes should be recommended for this patient?

Describe one or two drug–drug or drug–food interactions for this patient.

Answer 1

Specific goal for the patient is:

To assist the patient in taking an adequate amount of dietary fiber (20g)

To assist the patient for physical activity and exercise.

A drug that can be prescribed for this patient is docusate sodium(colace). As it avoids straining, it pulls in the water to intestine soften the stool and helps in easy defecation.

Educate the patient not to take this medicine along with liquid paraffin. And the tablet should be taken one hour before taking any other medication.

Adverse effects of the medication are:

Abdominal cramps,local irritation ,nausea, anorexia etc

The second line of treatment for constipation would be saline osmotic laxatives, lactulose or bisacodyl.

Lactulose is the drug that metabolizes bacteria present in small and large intestine. Lactulose forms lactic, acetic and formic acid this leads to water secretion in the intestine and thus soften the stool.

Lactulose interacts with atomoxetine, and interacts with antiarrhythmic drugs and cardiac glycosides.

Laxatives interact with mineral oil and bisodocyl enteric coated tablet can interact with milk if taken within an hour of drinking milk.