Constipation: The Daily PANCE Blueprint
A 40-year-old patient with a history of hyperlipidemia, chronic pain, hypertension, and hypothyroidism presents to your clinic complaining of chronic constipation. She currently takes hydrocodone/acetaminophen, levothyroxine, lisinopril, atorvastatin, and furosemide. Which of her following medications is most likely contributing to her constipation?
A. Atorvastatin
B. Hydrocodone/acetaminophen
C. Levothyroxine
D. Furosemide
E. Lisinopril
Answer and topic summary
The answer is B. Hydrocodone/acetaminophen
Constipation is a common complaint and can be caused by many things. Workup should involve evaluation and ruling out secondary etiologies, such as underlying disorders (hypothyroidism, diabetes, depression, etc) and medications (antihistamines, opioids, iron supplements, antacids, CCBs, etc). In general, initial management includes dietary changes (more fiber), bulk-forming laxatives (psyllium, methylcellulose, etc), increasing water intake, exercise, etc. Those who do not respond may require other agents like stool softeners (docusate), osmotic agents (magnesium citrate, sorbitol, polyethylene glycol), and stimulant laxatives (like bisacodyl or senna). There are also other agents, but at this point, the patient will likely need to be referred to a gastroenterologist.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ Blueprint GI and Nutrition ⇒ ⇒
Also covered on the Emergency Medicine, Family Medicine, Pediatric, and General Surgery PAEA EOR topic rotation list
