1. Kelly is a 33-year-old woman with a 1-year history of chronic constipation. She has tried changing her lifestyle with changes in diet, fluid intake, exercise, and fiber supplementation but has not had an improvement in her symptoms. Which of the following additional symptoms support a diagnosis of constipation-predominant irritable bowel syndrome (IBS-C), and not chronic idiopathic constipation (CIC) for Kelly?

2. A 42-year-old man is diagnosed with chronic idiopathic constipation. He has tried fiber supplementation (psyllium powder 5 g in 8 ounces of water 3 times daily), sennosides 2 tablets at bedtime, and polyethylene glycol 17 g twice daily to relieve his symptoms, along with lifestyle modifications such as increased fluid intake and exercise, with limited success. Which of the following is the most reasonable next treatment step with the highest quality of evidence for this patient?

3. A 29-year-old woman presents to the pharmacy for information regarding a nonprescription laxative. Which of the following options would be the best first step in helping this patient with her constipation?

4. KP is a 39-year-old woman with constipation-predominant IBS (IBS-C). She also has a history of heartburn for which she is prescribed ranitidine 150 mg twice daily, although she is often late for refills on that medication. When you as the pharmacist discuss these late refills with her, she says she has a difficult time remembering her evening dose of medication. KP has recently experienced a reduction in stool frequency despite using psyllium 1 scoop daily and PEG 17 g daily for the past 2 months. She reports that her last bowel movement was 3 days ago. She also complains of abdominal discomfort and bloating. What is the best recommendation for KP at this time?

5. Through the use of a network meta-analysis, which of the following agents was shown to be superior in the treatment of chronic idiopathic constipation (CIC) with regard to complete spontaneous bowel movements (CSBMs) per week?

6. Development of nausea has been most commonly associated with which of the following medications?

7. Which of the following is the correct mechanism of action of lubiprostone?

8. Jerry is a 42-year-old patient with CIC whose physician has recommended a nonprescription laxative. He also has chronic kidney disease (stage 4, glomerular filtration rate 25 mL/min). Which of the following recommendations is accurate to instruct this patient?

9. Stanley is a 62-year-old man with a history of chronic back pain who has been taking hydrocodone 5 mg/acetaminophen 500 mg as 1 tablet every 4 to 6 hours for the past several months. He mentions that he is experiencing constipation, with 4 to 5 days between bowel movements. He indicates his Bristol stool form score is a 1 today. How would you classify Stanley's constipation?

10. A 68-year-old man presents to the pharmacy with complaints of chronic constipation. He and his wife have recently started a ketogenic diet, eating high fat and low carbohydrate foods. He is a retired schoolteacher who exercises 3 to 4 times a week. Which characteristics place him at higher risk for CIC?

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