Drugs Affecting the             Gastrointestinal System                   Antidiarrheals and LaxativesCopyright © 2002, 19...
Diarrhea  • Abnormal frequent passage of loose stools       or  • Abnormal passage of stools with increased    frequency, ...
Diarrhea  Acute Diarrhea  • Sudden onset in a previously healthy person  • Lasts from 3 days to 2 weeks  • Self-limiting  ...
Diarrhea  Chronic Diarrhea  • Lasts for over 3 to 4 weeks  • Associated with recurring passage of    diarrheal stools, fev...
Causes of Diarrhea  Acute Diarrhea                                       Chronic Diarrhea  Bacteria                       ...
Antidiarrheals: Mechanism of Action  Adsorbents  • Coat the walls of the GI tract  • Bind to the causative bacteria or tox...
Antidiarrheals: Mechanism of Action  Anticholinergics  • Decrease intestinal muscle tone and peristalsis of GI    tract  •...
Antidiarrheals: Mechanism of Action  Intestinal Flora Modifiers  • Bacterial cultures of Lactobacillus organisms    work b...
Antidiarrheals: Mechanism of Action  Opiates  • Decrease bowel motility and relieve rectal spasms  • Decrease transit time...
Antidiarrheal Agents: Side Effects  Anticholinergics  • Urinary retention, hesitancy, impotence  • Headache, dizziness, co...
Antidiarrheal Agents: Side Effects  Opiates  • Drowsiness, sedation, dizziness, lethargy  • Nausea, vomiting, anorexia, co...
Antidiarrheal Agents: Interactions  • Adsorbents decrease the absorption of many    agents, including digoxin, clindamycin...
Antidiarrheal Agents:  Nursing Implications  • Obtain thorough history of bowel patterns,    general state of health, and ...
Antidiarrheal Agents:  Nursing Implications  • Use adsorbents carefully in elderly patients    or those with decreased ble...
Antidiarrheal Agents:  Nursing Implications  • Teach patients to take medications exactly    as prescribed and to be aware...
Antidiarrheal Agents:  Nursing Implications  • Teach patients to notify their physician    immediately if symptoms persist...
LAXATIVESCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
Constipation  • Abnormally infrequent and difficult passage    of feces through the lower GI tract.  • Symptom, not a dise...
Causes of Constipation  Metabolic and endocrine disorders  • Diabetes, hypothyroidism, pregnancy  Neurogenic  • Autonomic ...
Causes of Constipation  Lifestyle  • Poor bowel movement habits: voluntary refusal to    defecate resulting in constipatio...
Laxatives:  Mechanisms of Action  • Bulk-forming  • Emollient  • Hyperosmotic  • Saline  • StimulantCopyright © 2002, 1998...
Laxatives: Mechanism of Action  Bulk-Forming  • High fiber  • Absorbs water to increase bulk  • Distends bowel to initiate...
Laxatives: Mechanism of Action  Emollient  • Stool softeners and lubricants  • Promote more water and fat in the stools  •...
Laxatives: Mechanism of Action  Hyperosmotic  • Increase fecal water content  • Result: bowel distention, increased perist...
Laxatives: Mechanism of Action  Saline  • Increase osmotic pressure within the intestinal tract,    causing more water to ...
Laxatives: Mechanism of Action  Stimulant  • Increases peristalsis via intestinal nerve stimulation         Examples: cast...
Laxatives: Therapeutic Uses  Laxative Group                                    Use  Bulk-forming                          ...
Laxatives: Therapeutic Uses  Laxative Group                                  Use  Hyperosmotic                            ...
Laxatives: Therapeutic Uses  Laxative Group                                  Use  Stimulant                               ...
Laxatives: Therapeutic Uses  Laxative Group                                  Use  Bulk-forming                            ...
Laxatives: Therapeutic Uses  Laxative Group                                  Use  Saline                                  ...
Laxatives: Side Effects  • All laxatives can cause electrolyte    imbalances!!!Copyright © 2002, 1998, Elsevier Science (U...
Laxatives: Nursing Implications  • Obtain a thorough history of presenting    symptoms, elimination patterns, and    aller...
Laxatives: Nursing Implications  • A healthy, high-fiber diet and increased    fluid intake should be encouraged as an    ...
Laxatives: Nursing Implications  • Patients should take all laxative tablets with    6 to 8 ounces of water.  • Patients s...
Laxatives: Nursing Implications  • Bisacodyl and cascara sagrada should be    given with water due to interactions with   ...
Laxatives: Nursing Implications  • Monitor for therapeutic effect.Copyright © 2002, 1998, Elsevier Science (USA). All righ...
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Anti diarrheals and laxatives

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Anti diarrheals and laxatives

  1. 1. Drugs Affecting the Gastrointestinal System Antidiarrheals and LaxativesCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  2. 2. Diarrhea • Abnormal frequent passage of loose stools or • Abnormal passage of stools with increased frequency, fluidity, and weight, or with increased stool water excretionCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  3. 3. Diarrhea Acute Diarrhea • Sudden onset in a previously healthy person • Lasts from 3 days to 2 weeks • Self-limiting • Resolves without sequelaeCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  4. 4. Diarrhea Chronic Diarrhea • Lasts for over 3 to 4 weeks • Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weaknessCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  5. 5. Causes of Diarrhea Acute Diarrhea Chronic Diarrhea Bacteria Tumors Viral Diabetes Drug-induced Addison’s disease hyperthyroidism Nutritional Irritable bowel syndrome ProtozoalCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  6. 6. Antidiarrheals: Mechanism of Action Adsorbents • Coat the walls of the GI tract • Bind to the causative bacteria or toxin, which are then eliminated through the stool Examples: bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, activated charcoal, attapulgite (Kaopectate)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  7. 7. Antidiarrheals: Mechanism of Action Anticholinergics • Decrease intestinal muscle tone and peristalsis of GI tract • Result: slowing the movement of fecal matter through the GI tract Examples: belladonna alkaloids (Donnatal), atropine, hyoscyamineCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  8. 8. Antidiarrheals: Mechanism of Action Intestinal Flora Modifiers • Bacterial cultures of Lactobacillus organisms work by: – Supplying missing bacteria to the GI tract – Suppressing the growth of diarrhea-causing bacteria Examples: Lactobacillus acidophilus (Lactinex)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  9. 9. Antidiarrheals: Mechanism of Action Opiates • Decrease bowel motility and relieve rectal spasms • Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed Examples: paregoric, opium tincture, codeine, loperamide, diphenoxylateCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  10. 10. Antidiarrheal Agents: Side Effects Anticholinergics • Urinary retention, hesitancy, impotence • Headache, dizziness, confusion, anxiety, drowsiness • Dry skin, rash, flushing • Blurred vision, photophobia, increased intraocular pressureCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  11. 11. Antidiarrheal Agents: Side Effects Opiates • Drowsiness, sedation, dizziness, lethargy • Nausea, vomiting, anorexia, constipation • Respiratory depression • Bradycardia, palpitations, hypotension • Urinary retention • Flushing, rash, urticariaCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  12. 12. Antidiarrheal Agents: Interactions • Adsorbents decrease the absorption of many agents, including digoxin, clindamycin, quinidine, and hypoglycemic agents • Adsorbents cause increased bleeding times when given with anticoagulants • Antacids can decrease effects of anticholinergic antidiarrheal agentsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  13. 13. Antidiarrheal Agents: Nursing Implications • Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies. • DO NOT give bismuth subsalicylate to children under age 16 or teenagers with chicken pox because of the risk of Reye’s syndrome.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  14. 14. Antidiarrheal Agents: Nursing Implications • Use adsorbents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, or confusion. • Anticholinergics should not be administered to patients with a history of glaucoma, BPH, urinary retention, recent bladder surgery, cardiac problems, or myasthenia gravis.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  15. 15. Antidiarrheal Agents: Nursing Implications • Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes. • Assess fluid volume status; intake and output; and mucous membranes before, during, and after initiation of treatment.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  16. 16. Antidiarrheal Agents: Nursing Implications • Teach patients to notify their physician immediately if symptoms persist. Monitor for therapeutic effect.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  17. 17. LAXATIVESCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  18. 18. Constipation • Abnormally infrequent and difficult passage of feces through the lower GI tract. • Symptom, not a disease • Disorder of movement through the colon and/or rectum • Can be caused by a variety of diseases or drugsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  19. 19. Causes of Constipation Metabolic and endocrine disorders • Diabetes, hypothyroidism, pregnancy Neurogenic • Autonomic neuropathy, multiple sclerosis, spinal cord lesions, Parkinson’s disease, CVA Adverse drug effects • Analgesics, anticholinergics, iron supplements, opiates, aluminum antacids, calcium antacidsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  20. 20. Causes of Constipation Lifestyle • Poor bowel movement habits: voluntary refusal to defecate resulting in constipation • Diet: poor fluid intake and/or low-residue (roughage) diet, or excessive consumption of dairy products • Physical inactivity • Psychological factors: stress, anxiety, hypochondriaCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  21. 21. Laxatives: Mechanisms of Action • Bulk-forming • Emollient • Hyperosmotic • Saline • StimulantCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  22. 22. Laxatives: Mechanism of Action Bulk-Forming • High fiber • Absorbs water to increase bulk • Distends bowel to initiate reflex bowel activity Examples: psyllium (Metamucil), methylcellulose (Citrucel), polycarbophilCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  23. 23. Laxatives: Mechanism of Action Emollient • Stool softeners and lubricants • Promote more water and fat in the stools • Lubricate the fecal material and intestinal walls Examples: Stool softeners: docusate salts (Colace, Surfak) Lubricants: mineral oilCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  24. 24. Laxatives: Mechanism of Action Hyperosmotic • Increase fecal water content • Result: bowel distention, increased peristalsis, and evacuation Examples: polyethylene glycol (GoLYTELY), sorbitol, glycerin, lactulose (Chronulac)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  25. 25. Laxatives: Mechanism of Action Saline • Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines • Result: bowel distention, increased peristalsis, and evacuation Examples: magnesium sulfate (Epsom salts) magnesium hydroxide (MOM), magnesium citrate sodium phosphate (Fleet Phospho-Soda)Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  26. 26. Laxatives: Mechanism of Action Stimulant • Increases peristalsis via intestinal nerve stimulation Examples: castor oil, senna, cascara, bisacodylCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  27. 27. Laxatives: Therapeutic Uses Laxative Group Use Bulk-forming Acute and chronic constipation Irritable bowel syndrome Diverticulosis Emollient Acute and chronic constipation Softening of fecal impaction Facilitation of BMs in anorectal conditionsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  28. 28. Laxatives: Therapeutic Uses Laxative Group Use Hyperosmotic Chronic constipation Diagnostic and surgical preps Saline Constipation Diagnostic and surgical preps Removal of helminths and parasitesCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  29. 29. Laxatives: Therapeutic Uses Laxative Group Use Stimulant Acute constipation Diagnostic and surgical bowel prepsCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  30. 30. Laxatives: Therapeutic Uses Laxative Group Use Bulk-forming Impaction and fluid overload Emollient Skin rashes Decreased absorption of vitamins Hyperosmotic Abdominal bloating, rectal irritationCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  31. 31. Laxatives: Therapeutic Uses Laxative Group Use Saline Magnesium toxicity (with renal insufficiency), cramping, diarrhea, increased thirst Stimulant Nutrient malabsorption, skin rashes, gastric irritation, rectal irritationCopyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  32. 32. Laxatives: Side Effects • All laxatives can cause electrolyte imbalances!!!Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  33. 33. Laxatives: Nursing Implications • Obtain a thorough history of presenting symptoms, elimination patterns, and allergies. • Assess fluid and electrolytes before initiating therapy. • Patients should not take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  34. 34. Laxatives: Nursing Implications • A healthy, high-fiber diet and increased fluid intake should be encouraged as an alternative to laxative use. • Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. • All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric-coated.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  35. 35. Laxatives: Nursing Implications • Patients should take all laxative tablets with 6 to 8 ounces of water. • Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 ounces) of water.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  36. 36. Laxatives: Nursing Implications • Bisacodyl and cascara sagrada should be given with water due to interactions with milk, antacids, and H2 blockers. • Patients should contact their physician if they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
  37. 37. Laxatives: Nursing Implications • Monitor for therapeutic effect.Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
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