laxatives
TRANSCRIPT
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