QuestionPrescription
QuestionComment
what about docusate?
61748
QuestionComment
Its a softener 
61807
User
subscriber
Craniofacial 
User
subscriber
Intravenous Power
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3632
Treating constipation with osmotic or stimulant laxatives
Topic
129
Elderly medicine
## Drug choice feedback

This gentleman has constipation. He only wants a stimulant or osmotic laxative - the laxatives that fall inside this group are lactulose, macrogol, bisacodyl, senna and sodium picosulfate. The bulk forming laxatives include ispaghula husk and poo-softener laxatives include docusate.

## Dose/Route/Frequency/Duration feedback

The following prescriptions are appropriate to treat this man's constipation:

- Lactulose 15ml PO BD
- Macrogol 2 sachets PO OD
- Bisacodyl 5-10mg PO OD
- Senna 7.5-15mg PO ON
- Sodium picosulfate 5-10mg PO ON
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PrescriptionAnswer
PrescribeAnswerData
15 mg
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senna 7.5 mg tablets
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7 days
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nightly
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oral (PO)
PrescriptionAnswer
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5 mg
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bisacodyl 5 mg tablets
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7 days
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daily (OD)
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oral (PO)
PrescriptionAnswer
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5 mg
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sodium picosulfate 5 mg/5 mL oral solution
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7 days
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nightly
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oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 sachet
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macrogol '3350' 13.8g oral powder sachets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
7.5 mg
PrescribeAnswerData
senna 7.5 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
nightly
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
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15 mL
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lactulose 10 g/15 mL oral solution
PrescribeAnswerData
7 days
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twice daily (BD)
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oral (PO)
PrescriptionAnswer
PrescribeAnswerData
2 sachets
PrescribeAnswerData
macrogol '3350' 13.8g oral powder sachets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 68-year-old gentleman attends his GP complaining of constipation.



## PH
Osteoarthritis, hypercholesterolaemia

## DH
Ibuprofen 400mg PO QDS, lansoprazole 30mg PO OD, atorvastatin 20 mg PO OD

## FHx

No family history of lower gastrointestinal cancer

## On examination

He is alert and oriented. Abdomen is soft and non tender, with no palpable organomegaly.

Temperature 36.7°C, HR 70, RR 14, BP 127/82mmHg O<sub>2</sub> 99% RA, GCS 15, Weight 94kg

## Investigations

FBC: Hb 149, WCC 6.1, Plt 271

Colonoscopy performed 4 weeks ago: no abnormalities detected.

## Prescribing Request

Write a prescription for one drug that is most appropriate to treat this patient's constipation. He would prefer you to prescribe an osmotic or stimulant laxative - not a bulk-forming or poo-softener laxative. He does not want to take any medication rectally.