1. Question №. 14
 My brother suffers from chronic constipation.
®
He starts taking Purgaton tablets on
regular basis. First the condition improved
but now the case is worse.
 What do you think?
Faculty of Pharmacy - Alexandria University
(Egypt)

2. ®
Purgaton tablet
Contain senna glycosides (anthraquinone)
 With extended use
cause lazy bowel
syndrome (atonic colon)
 Bowel unable to
move without
chemical stimulation.
Faculty of Pharmacy - Alexandria University
(Egypt)

3. Life style modifications
 Increased intake of water, and fiber (either
dietary or as supplements).
 The routine use of laxatives is
discouraged, as having bowel movements
may come to be dependent upon their use.
Faculty of Pharmacy - Alexandria University
(Egypt)

4. Life style modifications
 Enemas can be used to provide a form of
mechanical stimulation. However, enemas
are generally
 Useful only for stool in the rectum, not in
the intestinal tract.
Faculty of Pharmacy - Alexandria University
(Egypt)

5. Question №. 15
 Abilaxine® tab are effective in reliving
constipation . Comment on their
administration immediately after meals or
with Epicogel® suspension.
Faculty of Pharmacy - Alexandria University
(Egypt)

6. Bisacodyl
 Abilaxine ® is containing Bisacodyl formed
as an enteric coated tablet .
 All biscodyl containing product shouldn't
be taken within an hour of ingesting food
or antacid (as epicogel) or milk.
 Should be avoided in patient tacking H2
blocker.
Faculty of Pharmacy - Alexandria University
(Egypt)

7. Question №. 16
My sister is pregnant; can she take castor oil
or Minalax® tablets for constipation?
What is docusate?
Mention its medicinal syndromes.
 Can she take castor oil or Minalax® tablets
for constipation?
 No she cannot take castor oil because of its danger
Faculty of Pharmacy - Alexandria University
(Egypt)

8. What is the danger of Castor oil in this case?
1. Premature labor due to premature
uterine contractions.
2. Death due to amniotic air
embolism.
3. Impaired health of the infant.
Faculty of Pharmacy - Alexandria University
(Egypt)

9. But, she can take Minalax
tablets because :-
1- It is emollient laxative (stool
softener) which is safe.
2- It acts as surfactant by allowing
absorption of water into the
stool so;
It makes the softened stool easier
to pass.
Faculty of Pharmacy - Alexandria University
(Egypt)

10. B) What is docusate?
1. It is emollient laxative (stool softener).
2. They act as surfactant by allowing absorption of
water into the stool so; it makes the softened stool
easier to pass).
Faculty of Pharmacy - Alexandria University
(Egypt)

11. C) Mention its medicinal syndromes?
1. For patients who must avoid straining to pass
hard stools. as those recently have a myocardial
infarction or rectal surgery.
2. Safe for pregnant.
Faculty of Pharmacy - Alexandria University
(Egypt)

12. Question №. 17
I prefer taking paraffin as laxative.
What is your advice?
How about using it concomitantly
with Minalax® tablets in severe
constipation?
Faculty of Pharmacy - Alexandria University
(Egypt)

13. A:- My advice:-
1. It should be taken on an empty stomach.
(Because of its possible aspiration into the
lungs, lipid pneumonitis may occur).
2. Patients shouldn’t take it at bed time or
recline after administration.
Faculty of Pharmacy - Alexandria University
(Egypt)

14. B) How about using it concomitantly with
Minalax® tablets in severe constipation?
 Minalax® may increase the systemic absorption of
paraffin leading to hepatotoxicity.
Faculty of Pharmacy - Alexandria University
(Egypt)

15. Question №. 18
I am suffering from chronic constipation and
usually strain during defecation. Can this lead to
hemorrhoids? And are there are any other causes?
(Define hemorrhoids and mention its etiology and
epidemiology).
A) Can this lead to hemorrhoids?
- Yes, hemorrhoids will occur.
Faculty of Pharmacy - Alexandria University
(Egypt)

16. B) Define hemorrhoids
 Hemorrhoids refers to a condition in which the
veins around the anus or lower rectum are
swollen, inflamed and abnormally large.
Faculty of Pharmacy - Alexandria University
(Egypt)

17. B. Etiology
1- Hereditary.
2-Acquired factors:
 Straining during defecation push
the hemorrhoid veins downward
with increased venous
pressure, they dilate and become
engorged.
Faculty of Pharmacy - Alexandria University
(Egypt)

18.  Over time the fibers that anchor the hemorrhoidal veins
to their underlying muscular coats stretch which result
in prolapsed.
 Occupations that require heavy lifting can transform
asymptomatic hemorrhoids into a problem.
Faculty of Pharmacy - Alexandria University
(Egypt)

19. C) Epidemiology
 The risk of developing hemorrhoids increases with
advanced age and pregnancy.■
Faculty of Pharmacy - Alexandria University
(Egypt)

20.  Is a condition in which the veins around the anus or
lower rectum are swollen and inflamed
 Risk of developing hemorrhoid increase with
advanced age and pregnancy.
 It may internal or external or mixed.

21. Question №. 19
 I am feeling discomfort in the anal area, a
friend suggested I am suffering from
Hemorrhoids; I want to know if my
symptoms can be caused by any other
condition and what are the other
symptoms of hemorrhoids?
Faculty of Pharmacy - Alexandria University
(Egypt)

22. Other conditions that mimic
hemorrhoids in symptoms
1. Anal abscessses : staphylococcus infection.
2. Anal fissures : unnatural crack or tear in the
skin of the anal canal.
3. Anal fistula : abnormal connection between the
epithelial surface of the anal canal and the
perianal skin.
4. Inflammatory bowel diseases
5. Polyps : begnin tumor of the large intestine
6. Colorectal cancer
Faculty of Pharmacy - Alexandria University
(Egypt)

23. Other Symptoms of Hemorrhoid
1. Painless bleeding [ bright red blood on
the stool] .
2. Prolapse . 5. Swelling .
3. Discomfort . 6. Burning .
4. Pruritis . 7. Sleeping .
Faculty of Pharmacy - Alexandria University
(Egypt)