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  2. 2. CLASSIFICATION Bulk forming Stool softener Stimulant purgatives Osmotic purgative
  3. 3. <ul><li>Bulk forming </li></ul><ul><li>High fiber </li></ul><ul><li>Absorbs water to increase bulk </li></ul><ul><li>Distends bowel to initiate reflex bowel activity </li></ul><ul><li>Examples: </li></ul><ul><ul><li>psyllium ( Metamucil ) </li></ul></ul><ul><ul><li>methylcellulose ( Citrucel ) </li></ul></ul><ul><ul><li>polycarbophil </li></ul></ul>
  4. 4. <ul><li>Stool Softeners </li></ul><ul><li>Anionic detergents </li></ul><ul><li>Promote more water and fat in the stools </li></ul><ul><li>Lubricate the fecal material and intestinal walls </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Docusates ( DOSS ) </li></ul></ul><ul><ul><li>Liquid paraffin </li></ul></ul>
  5. 5. <ul><li>Stimulant Purgative </li></ul><ul><li>Increases peristalsis via intestinal nerve stimulation </li></ul><ul><li>Irritate intestinal mucosa </li></ul><ul><li>Examples: </li></ul><ul><ul><li>castor oil </li></ul></ul><ul><ul><li>senna </li></ul></ul><ul><ul><li>cascara </li></ul></ul><ul><ul><li>bisacodyl </li></ul></ul>
  6. 6. <ul><li>Osmotic Purgatives </li></ul><ul><li>Not absorbed in the intestine </li></ul><ul><li>Retain water osmotically </li></ul><ul><li>Examples: </li></ul><ul><ul><li>magnesium sulfate (Epsom salts) </li></ul></ul><ul><ul><li>magnesium hydroxide ( MOM ) </li></ul></ul><ul><ul><li>magnesium citrate </li></ul></ul><ul><ul><li>sodium phosphate ( Fleet Phospho-Soda ) </li></ul></ul>
  7. 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. 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. 10. Causes of Diarrhoea Acute Diarrhoea Bacterial Viral Drug induced Nutritional Protozoal Chronic Diarrhoea Tumors Diabetes Addison’s disease Hyperthyroidism Irritable bowel syndrome
  11. 11. Treatment -T/t of fluid depletion and acidosis -Maintenance of nutrition -Drug therapy
  12. 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. 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. 14. DRUGS USED <ul><li>Specific antimicrobial drugs </li></ul><ul><li>Non-specific antidiarrhoeal drugs </li></ul><ul><li>Absorbants </li></ul><ul><li>Antisecretory/anticholinergics </li></ul><ul><li>Antimotility/opioids </li></ul>
  15. 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. 16. SIDE EFFECTS Constipation, dark stools Confusion, twitching Hearing loss, tinnitus, metallic taste, blue gums
  17. 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. 18. SIDE EFFECTS Urinary retention, impotence Headache, dizziness, confusion, anxiety,drowsiness, Dry skin, rash, flushing Blurred vision, photophobia, increased intraocular pressure.
  19. 19. <ul><li>Intestinal flora modifiers </li></ul><ul><li>Bacterial cultures of Lactobacillus organisms work by: </li></ul><ul><ul><li>Supplying missing bacteria to the GI tract </li></ul></ul><ul><ul><li>Suppressing the growth of diarrhea-causing bacteria </li></ul></ul><ul><li>Example: L. acidophilus (Lactinex) </li></ul>
  20. 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. 21. SIDE EFFECTS Opiates Drowsiness, sedation, dizziness, lethargy Nausea, vomiting, anorexia, constipation Respiratory depression Bradycardia, palpitations, hypotension Urinary retention Flushing, Rash, urticaria