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WorksheetsConstipation and Constipation/Diarrhea Drugs
Total questions: 60
Worksheet time: 30mins
Which definition best matches the official definition of constipation?
Any stool passage that is painful or requires straining
Fewer than 1 bowel movement per day for ≥1 week
Fewer than 3 bowel movements per week associated with straining and difficult passage of hard, dry stools
Fewer than 5 bowel movements per week regardless of stool texture
Constipation is considered chronic when symptoms last:
≥ 2 weeks
≥ 1 month
≥ 3 months
≥ 6 months
In the constipation pathophysiology, which structure is the site that stores fecal matter until defecation?
Cecum
Sigmoid colon
Rectum
Duodenum
The Valsalva maneuver refers to:
Inhaling deeply and bearing down while keeping the mouth closed
Exhaling without letting air escape through the nose or mouth to help stool passage
Drinking water and increasing fiber simultaneously
Biofeedback-guided pelvic floor contraction
Constipation is reported as most frequent in:
Men with IBS
Children only
Elderly adults, women, pregnant/postpartum
Athletes with high fiber diets
Which of the following is NOT a symptom of constipation?
Anorexia
Bloating
Flatulence
Psychosocial distress
Jaundice
Primary/idiopathic constipation may include:
IBS only
Normal transit, slow transit, pelvic floor dysfunction/disordered defecation
Only slow transit constipation
Only drug-induced constipation
Secondary constipation causes fall into which 3 broad categories?
Genetics, infection, dehydration
Lifestyle factors, drugs, medical disorders
Surgery, autoimmune disease, cancer
Trauma, food allergy, bowel obstruction
Which drug is NOT associated with causing constipation?
Antihistamines
Clonidine
Verapamil
Sucralfate
Metformin
Which medical condition is NOT associated with constipation?
Hypothyroidism
Diabetes Mellites
Heart Failure
Hypercalcemia
Gout
The Bristol Stool Form Scale (BSFS) is described as:
A diagnostic tool for colon cancer
A classification of stool based on consistency, mostly used in clinical trials
A grading system for hemorrhoids
A tool only used for pediatric constipation
Which correctly lists the 3 F’s for lifestyle modification?
Fiber, Fluoride, Fitness
Fiber, Fluid, Fitness
Fluids, Food, Fitness
Fiber, Fasting, Fitness
what is recommended daily fiber intake?
5–10 g/day
10–15 g/day
20–30 g/day
50–60 g/day
Fiber should be increased:
Immediately to target dose in 24 hours
Slowly over 1–2 weeks
Only by supplementation
Only if stool is watery
Fiber should be avoided in which scenario?
IBS-C
Fecal impaction
Pregnancy
Elderly
What is the daily recommended fluid intake?
1 liter/day in adults
Eight 8-oz glasses water/day
Only drink when thirsty
Avoid water to prevent diarrhea
Patients should attempt bowel movements when the gastrocolic reflex is strongest:
At bedtime
During exercise
First thing in the morning and ~30 minutes after meals
Only after laxative use
Which is a self-treatment exclusion for constipation?
Symptoms lasting 2 days
Bloating only
Symptoms lasting >2 weeks or recurring over ≥3 months
Flatulence after fiber
How long should you try nondrug measure before looking at pharmacologic options in constipation?
24 hours
3 days
1 week
1 month
Without PCP supervision, laxatives should generally be used:
Indefinitely
Short term (< 1 week)
For ≥ 4 weeks
Only as PRN forever
Most laxatives should NOT be taken within how long of other medications?
15 minutes
30 minutes
1 hour
2 hours
Which class is described as treatment of choice in pregnancy?
Stimulant laxatives
Bulk-forming agents
Saline laxatives
Mineral oil
Saline laxatives are contraindicated in:
Hypertension only
Ileostomy/colostomy, dehydration, renal impairment, CHF
Diabetes only
Pregnancy only
OIC occurs primarily due to activation of:
κ receptors
δ receptors
μ receptors
CB1 receptors
Which statement is correct?
OIC improves over time without treatment
OIC does not improve over time without treatment; prophylaxis is required for around-the-clock opioids
OIC resolves after 1 week
OIC is unrelated to water absorption
AGA recommends in OIC first line:
PAMORA
Traditional laxatives
Lubiprostone only
Guanylate cyclase agonist first
Adequate trial for refractory OIC requires:
PRN senna for 3 days
1 laxative class for 7 days
Scheduled regimen (not PRN) of ≥2 laxative classes for ≥2–3 weeks
PEG only once
PAMORAs work by:
Blocking CNS μ receptors → analgesia reversal
Blocking μ receptors in gut only; do not cross BBB → minimal withdrawal risk but monitor
Activating chloride secretion into colon
Increasing stool surface tension
Naloxegol must be taken:
With fatty meal
At bedtime only
On an empty stomach at least 1 hr before or 2 hrs after first meal
With grapefruit juice
Alvimopan is available only through a restricted program for short-term use:
5 doses
10 doses
15 doses
20 doses
A patient reports having bowel movements every 3 days. Which additional symptom BEST fits the definition/characterization of constipation?
Increased appetite after bowel movements
Excessive straining with hard stools and sense of incomplete evacuation
Bowel movements >3 times per day
Bloody stools with fever
Which drug class listed below is specifically implicated as a cause of constipation?
Beta blockers
Anticholinergics
SSRIs
NSAIDs
A medication is described as having a “stronger action resulting in more fluid evacuation.” This is BEST classified as:
Bulk-forming laxative
Laxative/aperient
Purgative/cathartic
Stool softener
Psyllium improves constipation primarily through which mechanism?
Direct stimulation of μ-opioid receptors
Absorbs water → forms bulky gelatinous mass
Inhibits acetylcholinesterase in the gut
Decreases intestinal bacterial mass
Which statement BEST describes docusate?
A lubricant that blocks intestinal fat absorption
An anionic detergent/surfactant that emulsifies colonic
A nonabsorbable solute that releases CCK via phosphate ions
A stimulant that causes melanosis coli due to anthrol formation
A patient takes liquid paraffin chronically and develops deficiency symptoms. Which adverse effect explains this?
Increased mucosal cyclic GMP leading to fluid secretion
Interference with absorption of fat-soluble substances and vitamins
Cardiac arrhythmias due to QT prolongation
Binding of phosphate to calcium causing hypocalcemia
A stimulant laxative is inactive until intestinal deacetylation, acts mainly in the colon via mucosal irritation, and prolonged use (>10 days) may cause atonic nonfunctional colon. Which drug matches?
Lactulose
Bisacodyl
Lubiprostone
Methylnaltrexone
Magnesium hydroxide/citrate increases intestinal motility in part by:
Stimulating cyclic AMP in mucosa
Increasing acetylcholine release
Stimulate cholecystokinin release
Activating chloride channels in intestinal epithelium
Sodium phosphate laxatives should NOT be used in CHF or renal disease primarily because:
They cause melanosis coli
They can increase phosphate which binds calcium
They precipitate opioid withdrawal
They cause Reye’s syndrome
Senna produces laxative effects after:
Intestinal esterases activate it into diphenyl methane
Colon bacteria liberate the active anthrol
Direct activation of CFTR channels
Inhibition of prostaglandin synthesis
Which long-term adverse effect is associated with prolonged stimulant purgative use and is described as reversible?
Blackening of stool
Melanosis coli
Torsade de points
Severe hypocalcemia
Castor oil produces laxative effects when intestinal lipases convert triglycerides into:
Glycerol and ricinoleic acid
Diphenyl methane and acetic acid
Lactose and fructose
Naloxone and PEG polymer
Lactulose reduces ammonia in hepatic encephalopathy primarily by:
Increasing stool pH so NH3 converts to NH4+
Lowering stool pH so NH3 converts to NH4+
Binding ammonia directly via salicylate
Blocking ammonia synthesis via CYP3A4 inhibition
Polyethylene glycol (PEG) solution is CONTRAINDICATED in:
Diabetes mellitus
Toxic megacolon
Pregnancy
Hypothyroidism
μ-opioid receptor activation causes constipation by:
Increasing motility and secretion while decreasing water absorption
Reducing motility and secretion while increasing water absorption
Increasing prostaglandins → increased chloride secretion
Blocking CFTR channels
Naloxegol is contraindicated when taken with strong CYP3A4 inhibitors such as:
Azole compounds and macrolides
Penicillins and cephalosporins
Tetracyclines and sulfonamides
Fluoroquinolones and aminoglycosides
Linaclotide is BEST described chemically as:
A PEG-conjugated naloxone derivative
A bicyclic fatty acid prostone derivative
A small synthetic heterodetic cyclic peptide
An anthraquinone glycoside activated by colon bacteria
Linaclotide increases secretion/accelerated transit via:
Increased cyclic AMP → intestinal secretion
Increased cGMP → increased Cl⁻ and HCO3⁻ secretion
Increased prostaglandins in intestinal mucosa
Direct inhibition of p-gp efflux transporters
A patient has loose, watery stools for 20 days. How is this classified?
Acute
Persistent
Chronic
Dysentery
Which scenario is most consistent with avoiding loperamide based on provided contraindication details?
Adult with traveler’s diarrhea prophylaxis
Adult with diarrhea caused by C. difficile infection
Adult with constipation predominant IBS
Adult with chronic idiopathic constipation
Diphenoxylate is combined with atropine primarily to:
Prevent cardiac arrhythmias
Increase its effect on CFTR chloride secretion
Discourage abuse
Reduce tinnitus
Bismuth subsalicylate decreases stool frequency primarily by:
Increasing PG synthesis and increasing chloride secretion
Decreasing PG synthesis in intestinal mucosa → reducing chloride secretion
Antagonizing μ-opioid receptors
Increasing cGMP via GC-C activation
A teenager given bismuth subsalicylate develops neurotoxicity associated with salicylates. This is linked to:
Paralytic ileus
Reye’s syndrome
Hypokalemia
MI risk
Docusate increases intestinal secretion partly by:
Increasing mucosal cyclic AMP
Blocking GC-C receptors
Activating δ-opioid receptors
Increasing CCK release
A constipation medication is an anthraquinone glycoside and is converted by colon bacteria to an active form. Which is it?
Senna
Lubiprostone
PEG
Psyllium
Bisacodyl is pharmacologically inactive until it undergoes which structural conversion?
Hydrolysis to glycerol and fatty acid
Deacetylation in the intestine
Reduction to anthrol form by bacteria
PEG conjugation
The active metabolite of bisacodyl that produces stimulant laxative effects is classified as:
Diphenyl methane
Anthrol
Prostone
Salicylate
Lactulose is best described structurally as:
Semisynthetic disaccharide
Synthetic opioid chemically related to pethidine
Small cyclic peptide
Bicyclic fatty acid derivative
Polyethylene glycol acts as an osmotic purgative because it is:
Highly lipid soluble → increases absorption
Inert, nonabsorbable surfactant with high osmotic pressure
Converted by bacteria into anthrol
Metabolized by CYP3A4
Lubiprostone is structurally best categorized as:
Anthraquinone glycoside
Bicyclic fatty acid prostone derivative
Synthetic opioid related to codeine
PEG-conjugated naloxone derivative
