laxatives

LAXATIVESLAXATIVES

(APERIENTS, PURGATIVES, CATHARTICS)(APERIENTS, PURGATIVES, CATHARTICS)

CLASSIFICATIONCLASSIFICATION

Bulk formingBulk forming

Stool softenerStool softener

Stimulant purgativesStimulant purgatives

Osmotic purgativeOsmotic purgative

Bulk formingBulk formingHigh fiberHigh fiber

Absorbs water to increase bulkAbsorbs water to increase bulk

Distends bowel to initiate reflex bowel activityDistends bowel to initiate reflex bowel activity

Examples: Examples: psyllium (psyllium (MetamucilMetamucil))

methylcellulose (methylcellulose (CitrucelCitrucel))

polycarbophilpolycarbophil

Stool SoftenersStool SoftenersAnionic detergentsAnionic detergents

Promote more water and fat in the stoolsPromote more water and fat in the stools

Lubricate the fecal material and intestinal wallsLubricate the fecal material and intestinal walls

Examples:Examples: Docusates (Docusates (DOSSDOSS))

Liquid paraffinLiquid paraffin

Stimulant PurgativeStimulant PurgativeIncreases peristalsis via intestinal nerve stimulationIncreases peristalsis via intestinal nerve stimulation

Irritate intestinal mucosaIrritate intestinal mucosa

Examples:Examples:castor oilcastor oil

sennasenna

cascaracascara

bisacodylbisacodyl

Osmotic PurgativesOsmotic PurgativesNot absorbed in the intestineNot absorbed in the intestine

Retain water osmoticallyRetain water osmotically

Examples:Examples:magnesium sulfate (Epsom salts)magnesium sulfate (Epsom salts)

magnesium hydroxide (magnesium hydroxide (MOMMOM))

magnesium citratemagnesium citrate

sodium phosphate (sodium phosphate (Fleet Phospho-SodaFleet Phospho-Soda))

USESUSES Functional constipationFunctional constipation

Bedridden patientsBedridden patients To avoid straining at stoolsTo avoid straining at stools

After anthelminticsAfter anthelmintics Food/Drug PoisoningFood/Drug Poisoning

Preparation of bowel for surgery, colonoscopy, Preparation of bowel for surgery, colonoscopy, abdominal x-rayabdominal x-ray

DIARRHOEADIARRHOEA

Acute DiarrhoeaAcute DiarrhoeaSudden onset in a previously healthy personSudden onset in a previously healthy person

Lasts from 3 days to 2 weeksLasts from 3 days to 2 weeks

Self-limitingSelf-limiting

Chronic DiarrhoeaChronic DiarrhoeaLasts for more than 3 weeksLasts for more than 3 weeks

Associated with recurring passage of diarrheal Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, stools, fever, loss of appetite, nausea,

vomiting, weight loss, and chronic weaknessvomiting, weight loss, and chronic weakness

Causes of DiarrhoeaCauses of DiarrhoeaAcute DiarrhoeaAcute Diarrhoea

BacterialBacterial

ViralViral

Drug inducedDrug induced

Nutritional Nutritional

ProtozoalProtozoal

Chronic DiarrhoeaChronic Diarrhoea

TumorsTumors

DiabetesDiabetes

Addison’s diseaseAddison’s disease

HyperthyroidismHyperthyroidism

Irritable bowel syndromeIrritable bowel syndrome

TreatmentTreatment

-T/t of fluid depletion and acidosis-T/t of fluid depletion and acidosis

-Maintenance of nutrition-Maintenance of nutrition

-Drug therapy-Drug therapy

Composition of i.v fluidComposition of i.v fluid

Nacl 85mM=5g Nacl 85mM=5g

KCl 13mM=1g KCl 13mM=1g

NaHCONaHCO3 3 48mM=4g48mM=4g

In 1L of water or 5%glucose solution In 1L of water or 5%glucose solution

Composition of ORSComposition of ORS

Nacl 60mM=3.5gNacl 60mM=3.5gKCl 20mM=1.5gKCl 20mM=1.5g

Trisodium citrate 30mM=2.9gTrisodium citrate 30mM=2.9gGlucose 110mM=20gGlucose 110mM=20gTo be dissolved in 1L of waterTo be dissolved in 1L of water

DRUGS USEDDRUGS USED

Specific antimicrobial drugsSpecific antimicrobial drugs

Non-specific antidiarrhoeal drugsNon-specific antidiarrhoeal drugsAbsorbantsAbsorbants

Antisecretory/anticholinergicsAntisecretory/anticholinergicsAntimotility/opioidsAntimotility/opioids

AbsorbantsAbsorbantsCoat the walls of the GI tractCoat the walls of the GI tract

Bind to the causative bacteria or toxin, Bind to the causative bacteria or toxin, which is then eliminated through the stoolwhich is then eliminated through the stool

Examples: bismuth subsalicylate (Examples: bismuth subsalicylate (Pepto-Pepto-BismolBismol), kaolin-pectin, activated charcoal, ), kaolin-pectin, activated charcoal,

attapulgite (attapulgite (KaopectateKaopectate))

SIDE EFFECTSSIDE EFFECTS

Constipation, dark stoolsConstipation, dark stools

Confusion, twitchingConfusion, twitching

Hearing loss,Hearing loss,

tinnitus, metallic taste,tinnitus, metallic taste,

blue gumsblue gums

AntisecretoryAntisecretoryDecrease intestinal muscle tone and Decrease intestinal muscle tone and

peristalsis of GI tractperistalsis of GI tract

Result: slowing the movement of fecal Result: slowing the movement of fecal matter through the GI tractmatter through the GI tract

Examples: atropine,bismuth Examples: atropine,bismuth subsalicylate,sulfasalazine,mesalazine,subsalicylate,sulfasalazine,mesalazine,

octreotideoctreotide

SIDE EFFECTSSIDE EFFECTS

Urinary retention, impotenceUrinary retention, impotenceHeadache, dizziness, confusion, Headache, dizziness, confusion,

anxiety,drowsiness, Dry skin, rash, flushinganxiety,drowsiness, Dry skin, rash, flushingBlurred vision, photophobia, increased Blurred vision, photophobia, increased

intraocular pressure.intraocular pressure.

Intestinal flora modifiersIntestinal flora modifiersBacterial cultures of Bacterial cultures of LactobacillusLactobacillus

organisms work by:organisms work by: Supplying missing bacteria to the GI Supplying missing bacteria to the GI

tracttract Suppressing the growth of diarrhea-Suppressing the growth of diarrhea-

causing bacteriacausing bacteria

Example: Example: L. acidophilusL. acidophilus (Lactinex) (Lactinex)

Antimotility/OpioidsAntimotility/OpioidsDecrease bowel motility and relieve Decrease bowel motility and relieve

rectal spasmsrectal spasmsDecrease transit time through the bowel, Decrease transit time through the bowel,

allowing more time for water and allowing more time for water and electrolytes to be absorbedelectrolytes to be absorbed

Examples: codeine, loperamide, Examples: codeine, loperamide, diphenoxylate-atropinediphenoxylate-atropine

SIDE EFFECTSSIDE EFFECTS

OpiatesOpiatesDrowsiness, sedation, dizziness, lethargyDrowsiness, sedation, dizziness, lethargy

Nausea, vomiting, anorexia, constipationNausea, vomiting, anorexia, constipation

Respiratory depressionRespiratory depression

Bradycardia, palpitations, hypotensionBradycardia, palpitations, hypotension

Urinary retentionUrinary retention

Flushing,Flushing,

Rash, urticariaRash, urticaria