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  • 2. CLASSIFICATION Bulk forming Stool softener Stimulant purgatives Osmotic purgative
  • 3.
    • Bulk forming
    • High fiber
    • Absorbs water to increase bulk
    • Distends bowel to initiate reflex bowel activity
    • Examples:
      • psyllium ( Metamucil )
      • methylcellulose ( Citrucel )
      • polycarbophil
  • 4.
    • Stool Softeners
    • Anionic detergents
    • Promote more water and fat in the stools
    • Lubricate the fecal material and intestinal walls
    • Examples:
      • Docusates ( DOSS )
      • Liquid paraffin
  • 5.
    • Stimulant Purgative
    • Increases peristalsis via intestinal nerve stimulation
    • Irritate intestinal mucosa
    • Examples:
      • castor oil
      • senna
      • cascara
      • bisacodyl
  • 6.
    • Osmotic Purgatives
    • Not absorbed in the intestine
    • Retain water osmotically
    • Examples:
      • magnesium sulfate (Epsom salts)
      • magnesium hydroxide ( MOM )
      • magnesium citrate
      • sodium phosphate ( Fleet Phospho-Soda )
  • 7. USES Functional constipation Bedridden patients To avoid straining at stools After anthelmintics Food/Drug Poisoning Preparation of bowel for surgery, colonoscopy, abdominal x-ray
  • 9. Acute Diarrhoea Sudden onset in a previously healthy person Lasts from 3 days to 2 weeks Self-limiting Chronic Diarrhoea Lasts for more than 3 weeks Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness
  • 10. Causes of Diarrhoea Acute Diarrhoea Bacterial Viral Drug induced Nutritional Protozoal Chronic Diarrhoea Tumors Diabetes Addison’s disease Hyperthyroidism Irritable bowel syndrome
  • 11. Treatment -T/t of fluid depletion and acidosis -Maintenance of nutrition -Drug therapy
  • 12. Composition of i.v fluid Nacl 85mM=5g KCl 13mM=1g NaHCO 3 48mM=4g In 1L of water or 5%glucose solution
  • 13. Composition of ORS Nacl 60mM=3.5g KCl 20mM=1.5g Trisodium citrate 30mM=2.9g Glucose 110mM=20g To be dissolved in 1L of water
  • 14. DRUGS USED
    • Specific antimicrobial drugs
    • Non-specific antidiarrhoeal drugs
    • Absorbants
    • Antisecretory/anticholinergics
    • Antimotility/opioids
  • 15. Absorbants Coat the walls of the GI tract Bind to the causative bacteria or toxin, which is then eliminated through the stool Examples: bismuth subsalicylate ( Pepto-Bismol ), kaolin-pectin, activated charcoal, attapulgite ( Kaopectate )
  • 16. SIDE EFFECTS Constipation, dark stools Confusion, twitching Hearing loss, tinnitus, metallic taste, blue gums
  • 17. Antisecretory Decrease intestinal muscle tone and peristalsis of GI tract Result: slowing the movement of fecal matter through the GI tract Examples: atropine,bismuth subsalicylate,sulfasalazine,mesalazine, octreotide
  • 18. SIDE EFFECTS Urinary retention, impotence Headache, dizziness, confusion, anxiety,drowsiness, Dry skin, rash, flushing Blurred vision, photophobia, increased intraocular pressure.
  • 19.
    • Intestinal flora modifiers
    • Bacterial cultures of Lactobacillus organisms work by:
      • Supplying missing bacteria to the GI tract
      • Suppressing the growth of diarrhea-causing bacteria
    • Example: L. acidophilus (Lactinex)
  • 20. Antimotility/Opioids Decrease bowel motility and relieve rectal spasms Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed Examples: codeine, loperamide, diphenoxylate-atropine
  • 21. SIDE EFFECTS Opiates Drowsiness, sedation, dizziness, lethargy Nausea, vomiting, anorexia, constipation Respiratory depression Bradycardia, palpitations, hypotension Urinary retention Flushing, Rash, urticaria
  • 22.  
  • 23.