SCENARIO

A pregnant patient of yours is being treated for severe morning sickness. You previously dispensed promethazine and metoclopramide for her, but these were not effective and she was then prescribed ondansetron. A week later her mother comes in and says that the new medication is working well, but her daughter is now constipated. Her next appointment at the ante-natal clinic is not for a couple of weeks. She asks what you advise.

QUESTIONS

1  What advice would you give, and why?
2  What anti-emetic drugs are used for the treatment of vomiting in pregnancy and how do they act?
3  What are the two types of constipation and what are their causes?
4  What are the symptoms of constipation?
5  What treatments are available? How do they act and what, if any, drawbacks do they have?
6  What are the ‘red flags’ that require referral?
7  What advice could you give to help patients avoid constipation?