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

Answer the following questions. Include two references, cited in APA style.

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 goals:

• The patient should pass a normal soft passage of stool.
• The patient should be relieved from constipation and measures taken to prevent reoccurrence of constipation.

Drug therapy:

• Linaclotide to improve bowel movements.
• Lactulose to soften the stools.
• Lubiprostone to soften the stools and to pass easily.
• Misoprostol to improve bowel movements.
• Plecanatide to increase the fluid in the intestines.

Parameters:

• Bowel movements at least once daily.
• Softening of stools.
• Easy passage of stool.

Patient - education:

• Over counter of drugs may lead to serious harm to the kidney.
• Drugs may also change in serum electrolytes and dehydration.
• Follow a dietary therapy which will be helpful for bowel movements.
• Regular exercises.
• Follow-up if the patient feels any side effects.

Adverse Reactions:

• Linaclotide may cause diarrhea sometimes.
• Lactulose may develop side effects of gas, stomach cramps, stomach upset, and diarrhea.
• Lubiprostone may develop adverse effects of a headache, nausea, vomiting, abdominal pain.

Second-Line Therapy:

• Bulking agents.
• Suppositories
• Enemas.
• dietary fiber supplements.

OTC:

• fiber supplements such as calcium polycarbophil, Psyllium, Wheat dextrin, Methylcellulose fiber.
• Osmotics help to soften the stool. this includes Milk of Magnesia, Magnesium citrate, Polyethylene glycol.
• Stimulants such as bisacodyl, and senna.
• Stool softeners such as Colace and surfak.
• Lubricants such as mineral oil.

Dietary and Lifestyle changes:

• Increased high fiber diet.
• Drinking enough water.
• Regular bowel habits.
• Eat a well-balanced diet.
• Physical activity of patients.

Drug to drug interactions:

Vitamins and herbal products may interact with lubiprostone.