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Opioid constipation management — GPhC CRA MCQ

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ModerateGastrointestinal TherapeuticsOpioid constipation managementGPhC CRA

A palliative-care patient taking regular oxycodone has not opened their bowels for four days. They have no colicky pain, vomiting or features of obstruction. Which initial plan is most appropriate?

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Correct answer: E — Start regular stimulant treatment and add an osmotic laxative if required

Start regular stimulant treatment and add an osmotic laxative if required: Opioid constipation usually needs active regular prophylaxis and treatment; a stimulant is standard, with an osmotic agent added according to stool consistency and response. Use bulk-forming ispaghula alone with a lower daily fluid intake: Bulk agents can worsen impaction when intake is poor and fluid restriction is counterproductive. Observe for another four days while continuing the current opioid regimen: Tolerance to the constipating effect is unreliable and prolonged delay increases impaction risk. Pause oxycodone and reassess bowel function before introducing any laxative: Abrupt analgesic withdrawal causes uncontrolled pain and does not constitute safe constipation management. Use loperamide after each loose stool until normal frequency returns: Loperamide further slows bowel transit and is inappropriate for current constipation.

Reference: BNF: oxycodone hydrochloride: https://bnf.nice.org.uk/drugs/oxycodone-hydrochloride/; BNF: macrogol 3350: https://bnf.nice.org.uk/drugs/macrogol-3350/