TAKE A MOMENT TO MAXIMIZE MOVEMENT - OPIOID INDUCED CONSTIPATION
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OPIOID INDUCED CONSTIPATION –
TAKE A MOMENT TO MAXIMIZE MOVEMENT
KATE MOORE, PHARMD
OPIOID INDUCED CONSTIPATION - TAKE A MOMENT TO MAXIMIZE MOVEMENT
ACTIVITY DESCRIPTION ACCREDITATION
Chronic pain affects approximately one-third of U.S. PHARMACY
adults or as many as 100 million adults and between PharmCon, Inc. is accredited by the
five and 10 percent receive opioid treatment. While Accreditation Council for Pharmacy
opioid analgesics may be an effective treatment, the Education as a provider of continuing
side effects can also seriously impact the quality of pharmacy education.
life of patients. Although a variety of gastro-intestinal
complaints - including nausea, vomiting, and gastric NURSING
reflux - may occur, opioid induced constipation is the PharmCon, Inc. is approved by the California Board of
most common, debilitating side effect of opioid Registered Nursing (Provider Number CEP 13649) and
therapy. As many as 40% of patients report the Florida Board of Nursing (Provider Number 50-
significant problems with constipation that can lead 3515). Activities approved by the CA BRN and the FL
to reduced quality of life and ultimately BN are accepted by most State Boards of Nursing.
discontinuation of treatment to avoid opioid induced
constipation (OIC). Healthcare professionals and CE hours provided by PharmCon, Inc. meet the ANCC criteria
pharmacists in particular should take a pro-active for formally approved continuing education hours. The ACPE
approach to preventing and treating OIC. As the is listed by the AANP as an acceptable, accredited continuing
education organization for applicants seeking renewal
bridge between patients and physicians, pharmacists
through continuing education credit. For additional
are in the position to play an integral part of a multi-
information, please visit
pronged solution to the challenges of OIC. http://www.nursecredentialing.org/RenewalRequirements.aspx
TARGET AUDIENCE Universal Activity No.: 0798-0000-14-189-H01-P&T
The target audience for this activity is pharmacists Credits: 1.0 contact hour (0.1 CEU)
and pharmacy technicians in hospital, community,
and retail pharmacy settings. Release Date: April 16, 2015
Expiration Date: April 16, 2016
LEARNING OBJECTIVES
After completing this activity, the pharmacist will be ACTIVITY TYPE
able to: Knowledge-Based Home Study Webcast
Outline the basic epidemiology and etiology
of opioid induced constipation (OIC). FINANCIAL SUPPORT BY
Describe the current and emerging
AstraZeneca
pharmacological approaches to the
management of OIC (pharmacologic profiles,
efficacy, side effects, & adverse events).
Identify proactive actions pharmacists can
take to preemptively manage or minimize
OIC
After completing this activity, the pharmacy
technicians will be able to:
List signs and symptoms of opioid induced
constipation (OIC)
List common pharmaceuticals to help
manage OIC
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ABOUT THE AUTHOR
Dr. Moore is board certified in ambulatory care and
pharmacotherapy. She completed 2 years of residency
training with a specialty in ambulatory care. She is
currently an assistant professor at Presbyterian College
School of Pharmacy. She serves as a preceptor for both Kate Moore, PharmD
students and pharmacy residents at a large internal Presbyterian College School of Pharmacy
medicine clinic where she provides transition of care
coordination and disease management services. She
FACULTY DISCLOSURE
also serves as an educator for the clinic staff.
It is the policy of PharmCon, Inc. to require the
disclosure of the existence of any significant financial
interest or any other relationship a faculty member or
a sponsor has with the manufacturer of any
commercial product(s) and/or service(s) discussed in
an educational activity. Kate Moore reports no
actual or potential conflict of interest in relation to
this activity.
Peer review of the material in this CE activity was
conducted to assess and resolve potential conflict of
interest. Reviewers unanimously found that the
activity is fair balanced and lacks commercial bias.
Please Note: PharmCon, Inc. does not view the existence of
relationships as an implication of bias or that the value of
the material is decreased. The content of the activity was
planned to be balanced and objective. Occasionally,
authors may express opinions that represent their own
viewpoint. Participants have an implied responsibility to use
the newly acquired information to enhance patient
outcomes and their own professional development. The
information presented in this activity is not meant to serve
as a guideline for patient or pharmacy management.
Conclusions drawn by participants should be derived from
objective analysis of scientific data presented from this
monograph and other unrelated sources.
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ACTIVITY TEST
1. Which of the following is responsible for opioid induced constipation?
a. Mu-opioid receptor
b. Delta-opioid receptor
c. Type 2 chloride channel
d. Kappa-opioid receptor
2. Which of the following is a risk factor for OIC?
a. Race
b. Use of laxatives
c. Opioid dose
d. Duration of opioid therapy
3. Which of the following non-pharmacologic treatments is recommended for OIC?
a. Increased fluids
b. Increased physical actibity
c. Increased fiber
d. All of the above
4. Which conventional therapy regimen would be most effective for OIC?
a. Docusate 100mg twice daily
b. Senna 1mg at bedtime
c. Metamucil 2 tablets daily
5. Which of the following therapies works via the Type 2 Chloride Channels in the GI tract?
a. methylnaltrexone
b. naloxegol
c. lubiprostone
d. polyethylene glycol
156. How does methylnaltrexone relieve OIC?
a. By antagonizing the mu-opioid receptor in the CNS
b. By antagonizing the mu-opioid receptor in the GI tract
c. By stimulating the type 2 chloride channels in the GI tract
d. By facilitating the mixture of fat and stool in the GI tract
7. Which of the following agents would need to be dose adjusted in a patient with renal
dysfunction (CrCl =30)
a. lactulose
b. methylnaltrexone
c. naloxegol
d. lubiprostone
8. Which of the following is NOT currently available as an oral therapy for OIC?
a. methylnaltrexone
b. naloxegol
c. lubiprostone
d. Senna
9. Which agent would NOT be the best agent to use for OIC in a patient being treated with
methadone for chronic pain?
a. naloxegol
b. lubiprostone
c. methylnaltrexone
d. alvimopan
10. 10. Which of the following would be the most positive impact a pharmacist could have on
reducing OIC?
a. Recommend a peripherally acting mu opioid receptor antagonist for all patients
b. Encourage patients to quit taking their opioid if they develop constipation
c. Ensure all patients are on prophylactic laxative +/- stool softener with all chronic opioid
prescription
Please submit your final responses on freeCE.com. Thank you.
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