Constipation

Opioid induced constipation

Laxatives

Remote Consultation Skills

You are the pharmacist working in a community pharmacy. You are conducting a remote consultation via MS Teams / Zoom (or simulated video call in person) with a 78-year-old female who reports constipation.

Assess the patient's symptoms, develop an appropriate treatment plan, and provide relevant medical or lifestyle advice as needed.

IMPORTANT:
This is a remote video consultation.

You have 10 minutes.

You have access to the BNF if needed.

You are:

Mrs Margaret Jones (Mar-gret Jones)
78 years old
Calling via MS Teams / Zoom

Opening statement: “Hello… I hope you can hear me okay through my iPad. I’m calling because I haven’t been able to go to the toilet properly for a few days.”

Identity Confirmation

Name: Margaret Jones
DOB: 14/02/1947
Address: 22 Oakfield Road, Leicester

Past Medical History:

• Osteoarthritis in the right hip
• Recent gallbladder removal - discharged from the hospital 3 days ago, the same day as the operation, healing fine
• Mild high blood pressure

Medication History:

• Amlodipine 5 mg once a day
• Paracetamol when needed for pain
• Codeine 30mg 4 times a day since the operation, supply is enough for 7 days in total
• *If asked*: No laxatives tried yet

Allergies:

• None known

Symptoms 

• “I haven’t had a proper bowel movement for 3 days.”
• “Before this, I usually went every day.”
• "My stools are hard and difficult to pass.”
• “I feel bloated and uncomfortable.”
• NO OTHER SYMPTOMS

Lifestyle Factors: 

• "I drink 3 cups of tea a day but very little water"
• "I eat fruit and vegetables every day - I get my 5 a day"
• "I don't move around much"

If the student diagnoses opioid-induced constipation:

Respond: “Oh… is this because of the codeine? I didn’t realise that. I'm not even in that much pain, I can just take less.”

If the student recommends laxatives:

Respond positively:
“Okay, I’m happy to try what you suggest.”

Referral Criteria for Constipation: 

1. NICE. 2024.Constipation – adults: Management. Clinical Knowledge Summaries.Available at: https://cks.nice.org.uk/topics/constipation/management/adults/Accessed: 17 November 2025.
2. General Pharmaceutical Council. 2025. Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet.Accessed: 17 November 2025.