Home' Australian Pharmacist : Australian Pharmacist December2016 Contents Australian Pharmacist December 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
1. Which of the following statements
regarding constipation in older
people is the MOST appropriate?
a) Constipation has been found to affect
less than 10% of the elderly population.
b) A person who defecates less than once
daily fits the diagnosis of functional
c) Constipation in older people often
occurs from multiple factors.
d) Constipation has minimal impact on the
quality of life in older people.
2. With which of the following
drug-induced electrolyte and
endocrine abnormalities is
constipation MOST likely to occur?
a) Amiodarone-induced thyrotoxicosis.
c) Hyperkalaemia resulting from
the combination of ramipril and
d) Hypomagnesaemia resulting from
3. Which of the following statements
regarding the non-pharmacological
management of constipation is the
a) A rapid increase in dietary fibre intake
is recommended to reduce the risk of
adverse effects occurring.
b) Establishing a regular toileting time in
the morning within the first 2 hours
after wakening or after breakfast may
improve bowel motion regularity.
c) There is substantial high-quality
evidence supporting increased fluid
intake and physical activity to effectively
d) Increasing fluid intake is safe to
recommend for all patients, regardless
of their other comorbidities.
4. Which of the following statements
regarding laxative use for chronic
constipation in older people is the
a) Bisacodyl is more appropriate to
recommend to relieve opioid-
induced constipation than a psyllium
b) A 3-month trial of prucalopride is usually
required to assess its effectiveness.
c) Macrogol is most effective for chronic
constipation when administered in large
doses every few days.
d) As fluid intake should be limited with
their use, bulk-forming laxatives are
particularly useful in patients with
chronic renal failure on fluid restriction.
Some medicines used in the
management of Parkinson’s disease such
as anticholinergics may also be associated
with constipation, although dopaminergic
medicines and catechol-O -methyl
transferase inhibitors do not appear to
cause or aggravate constipation.
The initial treatment for constipation in
Parkinson’s disease is the same as that
for constipation associated with other
causes, including an increase in fibre
and fluid intake.
19 Although David had
already tried such measures with little
relief, he was encouraged to continue
with these measures as they were likely to
augment laxative therapy. He was advised
to commence Movicol (macrogol 3350,
an osmotic laxative), at an initial dose of
one sachet daily. Macrogol was chosen as
it has been demonstrated to be effective
in treating constipation in people with
Parkinson’s disease, whereas other laxatives
such as lactulose and sorbitol have not been
formally assessed in Parkinson’s disease.
David was provided with the Constipation
PSA Self Care Fact Card, and was also
referred to his doctor for follow-up, to
exclude other causes of constipation
that may occur with Parkinson’s disease,
such as defecatory dysfunction due to
pelvic floor dyssynergia.
1. Drossman DA, Sandler RS, McKee DC, et al. Bowel
patterns among subjects not seeking health care. Use
of a questionnaire to identify a population with bowel
dysfunction. Gastroenterology 1982;83(3):529–34.
2. Expert Group for Gastrointestinal. Gastrointestinal, version 6.
In: eTG complete. Melbourne: Therapeutic Guidelines; 2016.
3. Vazquez Roque M, Bouras EP. Epidemiology and
management of chronic constipation in elderly patients.
Clin Interv Aging 2015;10:919–30.
4. Longstreth GF, Thompson WG, Chey WD, et al. Functional
bowel disorders. Gastroenterology 2006;130(5):1480–91.
5. Guidelines - Rome III diagnostic criteria for functional
gastrointestinal disorders. Journal of gastrointestinal and
liver diseases: J Gastrointestin Liver Dis 2006;15(3):307–312.
6. Soenen S, Rayner CK, Jones KL, et al. The ageing gastrointestinal
tract. Curr Opin Clin Nutr Metab Care. 2016;19(1):12–18.
7. Rao SS, Go JT. Update on the management of constipation in the
elderly: new treatment options. Clin Interv Aging 2010;5:163–171 .
8. Andrews CN, Storr M. The pathophysiology of chronic
constipation. Can J Gastroenterol 2011;25 (Suppl B):16B–21B.
9. Gandell D, Straus SE, Bundookwala M, et al. Treatment of
constipation in older people. CMAJ 2013;185(8):663–70.
10. Paré P, Bridges R, Champion MC, et al. Recommendations
on chronic constipation (including constipation
associated with irritable bowel syndrome) treatment. Can J
Gastroenterol 2007;21(Suppl B):3B–22B.
KEY LEARNING POINTS
• Constipation is highly prevalent in older people due to a multitude of contributing
factors, including medicines.
It may have a profoundly detrimental effect on a person’s quality of life, and
pharmacists are well positioned to identify possible causes, provide referral where
required, and suggest management strategies to improve symptoms.
Appropriate management strategies may require both lifestyle and pharmacological
moieties to ensure optimal patient outcomes.
11. UpToDate. Causes of secondary constipation.
2016. At: www.uptodate.com/contents/
12. Tvistholm N, Munch L, Danielsen AK. Constipation is casting
a shadow over everyday life - a systematic review on older
people’s experience of living with constipation. Journal of
clinical nursing 2016. DOI: 10.1111/jocn.13422
13. Whitehead W, Wald A, Diamant N, et al. Functional disorders
of the anus and rectum. Gut 1999;45(Suppl 2):II55–9 .
14. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2016.
15. Constipation. Porter RS, ed. In: The Merck Manual (online).
New Jersey: Merck and Co; 2016. At: www.merckmanuals.
16. Selby W, Corte C. Managing constipation in adults. Aust
Prescr 2010;33:116–9 .
17. Lewis SJ. Heaton KW. Stool form scale as a useful
guide to intestinal transit time. Scand J Gastroenterol
18. Kim J-S, Sung H-Y. Gastrointestinal autonomic dysfunction
in patients with parkinson’s disease. J Mov Disord
19. Rossi M, Merello M, Perez-Lloret S. Management
of constipation in parkinson’s disease. Expert Opin
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