2. Name of Institution
• Acidifiers: Ammonium chloride and Dil. HCl
• Antacid: Ideal properties of antacids, combinations of antacids, Sodium
Bicarbonate*, Aluminum hydroxide gel, Magnesium hydroxide mixture
• Cathartics: Magnesium sulphate, Sodium orthophosphate, Kaolin and Bentonite
• Antimicrobials: Mechanism, classification, Potassium permanganate, Boric acid,
Hydrogen peroxide*, Chlorinated lime*, Iodine and its preparations
Gastrointestinal agents
3. Name of Institution
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 drugs
4. Name of Institution
LAXATIVES –
CATHARTICS –
PURGATIVES
• Increase fluid content in feces
• Uses
• Chronic constipation
• Older
• Trichobezars
• Evacuate colon
• Radiographs
• Pelvic fractures
• Perianal
• Most gentle to harsh
• Laxatives (soften) < Cathartics (evacuate) < Purgatives
(evacuate)
5. Name of Institution
• Types of Laxatives
include:
– Emollients
• Mineral oil
• Cod liver oil
• White petrolatum
• Glycerin
• Docusate sodium succinate
(Colace)
– Bulk-forming
• Types of Cathartics
include:
– Osmotic
• Hypertonic salts
– Milk of magnesia
– Epsom salts
• Lactulose
– Stimulant/ Irritant
• Castor oil
LAXATIVES –
CATHARTICS - PURGATIVES
7. Name of Institution
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)
Polycarbophil (FiberCon)
8. Name of Institution
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 oil
Saline
Increase osmotic pressure within the intestinal tract, causing more water to
enter the intestines
Result: bowel distention, increased peristalsis, and evacuation
9. Name of Institution
Laxatives:
Mechanism of Action
Hyperosmotic
Increase fecal water content
Result: bowel distention, increased peristalsis, and
evacuation
Examples:
polyethylene glycol (GoLYTELY)
sorbitol (increases fluid movement into intestine)
glycerin
lactulose (Chronulac)
11. Name of Institution
Laxatives:
Mechanism of Action
Stimulant
Increases peristalsis via intestinal nerve stimulation
Examples:
castor oil (Granulex)
senna (Senokot)
cascara
12. Name of Institution
Laxatives:
Indications
Laxative Group
Bulk forming
Emollient
Use
Acute and chronic constipation
Irritable bowel syndrome
Diverticulosis
Acute and chronic constipation
Softening of fecal impaction;
facilitation of BMs in
anorectal conditions
13. Name of Institution
Laxatives: Indications
Laxative Group
Hyperosmotic
Saline
Stimulant
Use
Chronic constipation
Diagnostic and surgical preps
Constipation
Diagnostic and surgical preps
Removal of helminths and parasites
Acute constipation
Diagnostic and surgical bowel preps
14. Name of Institution
Laxatives: Side Effects
Bulk forming
Impaction
Fluid overload
Emollient
Skin rashes
Decreased absorption of vitamins
Hyperosmotic
Abdominal bloating
Rectal irritation
All laxatives can cause
electrolyte
imbalances!
16. Name of Institution
Laxatives: 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
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)
17. Name of Institution
Laxatives: 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
Bisacodyl and cascara sagrada should be given with water due to
interactions with milk, antacids, and H2 blockers
Patients should contact their provider if they experience severe abdominal
pain, muscle weakness, cramps, and/ or dizziness, which may indicate fluid
or electrolyte loss
Monitor for therapeutic effect
18. Name of Institution
Magnesium Sulphate
• Synonyms: Epsom salt
• Formula: MgSO4.7H2O or MgO4S
• Molecular Weight:120.361 g/mol (Anhydrous), 246.67 g/mol
• Magnesium is a naturally occurring mineral that is important for many
systems in the body especially the muscles and nerves.
• An injectable solution of magnesium sulfate is used to treat magnesium
deficiency and refractory arrhythmias in patients who are critically ill.
• Magnesium sulfate is used as a laxative to relieve occasional
constipation.
• A dose of 1-2 mEq/kg of magnesium sulfate produced plasma
concentrations of 8.5-12.2 mEq/L, and can increase heart rate,
inotropy, and cardiac output.
19. Name of Institution
Method of Preparation
Incompatibility: Addition of alcohol may cause precipitation of Magnesim Sulphate
Alkali hydroxide or alkali carbonate forms basic hydroxide and carbonates
20. Name of Institution
Sodium Orthophosphate
• Synonyms: Sodium Acid Phosphate (sodium biphosphate),
• Molecular formula: NaH2 PO4.2H2O
• Molecular weight: 156.01
• I.P limit: It contains not less than 98.0% and not more than 100.5% of
NaH2PO4 calculated with reference to the dried substance.
• Properties: Colorless, odorless, crystalline powder with saline acidic taste.
Freely soluble in water and practically in soluble in alcohol. Slightly
deliquescent.
• Preparation:
• It is prepared by adding phosphoric acid to hot concentrated solution of
disodium phosphate until liquid ceases to give precipitate with barium
chloride. The solution is then concentrated to the crystallization point.
• By reaction with phosphoric acid with calculated quantity of sodium
hydroxide.
21. Name of Institution
Disodium Hydrogen Phosphate
(Phosphor soda)
• Molecular formula: Na2HPO4.12H2O
• Molecular weight: 358.14
• I.P limit: It contains not less than 98.0% and not more than 101% of
NaH2PO4 calculated with reference to the dried substance.
• Properties: Colorless, odorless, crystalline powder. Soluble in water and
practically in soluble in alcohol. Very efflorescent.
• Preparation:
– It is prepared by reaction of orthophosphoric acid calculated quantity of sodium
hydroxide.
– From bone ashes or mineral phosphorite, which is treated with sulphuric acid
22. Name of Institution
Kaolin
• Kaolin is characterized as
• Light kaolin
• Light kaolin natural
• Heavy kaolin (China clay)
• Light Kaolin
• IP Preparation: It differs from the heavy variety mainly in the degree of purity and in
particle size.
– It is prepared from heavy kaolin by elutriation, Reducing gritty and coarse particles.
– It should not contain any dispersing agent.
• Properties: It is a light white powder, unctuous (Ointment like, soft) to touch.
Standards: Besides identification test limits prescribed are: arsenic, heavy metals,
chloride, soluble matter, loss on drying and on ignition. Furher it has to be tested for
coarse particles and fine particles.
• Uses: Used IN cathartics. Light kaolin is mainly used as adsorbent for toxic substances
from the gastro-intestinal tract and to provide bulk by swelling with water in conditions
of diarrhoea. It may also be used in poultices. dusting powders, toilet powders and as
filtering aid . Storage: It should be stored in a well-closed container.
23. Name of Institution
Heavy Kaolin
• IP Occurrence: This is a purified form of a natural clay having an approximate
composition Al2O3.2SiO2.2H2O.
• Natural kaolin is contaminated with carbonates of calcium and magnesium and ferric
oxide. These can be easily removed by treatment with hydrochloric acid, followed by
filtration, washing and drying
• Properties: It is a soft whitish powder, odorless and almost tasteless. It is insoluble in
water, organic solvents, mineral acids and alkali solutions.
• Standards: The pharmacopoeia prescribes identification and limits for: acidity or
alkalinity, arsenic, heavy metals, chloride, sulphate, substances soluble in mineral
acids, organic impurities and loss on ignition tests are also included for determining
adsorption power and swelling power.
• Uses: Heavy kaolin is used in the preparation of poultices. As it is liable to be
contaminated with spore bearing bacille and other bacteria.
• Storage: It should be stored in a well-closed container.
24. Name of Institution
Bentonite
• The term bentonite is applied commercially to any plastic, colloidal, and
swelling clay regardless of its geological origin.
• Such clays are ordinarily composed largely of minerals of the montmorillonite
group.
• Bentonite derived from ash falls tends to be in beds of uniform thickness
(from a few millimetres to 15 m) and extensive over large areas.
• Bentonite from ash falls and other sources occurs worldwide in strata spanning
a broad range of ages, but is most abundant in Cretaceous or younger rocks.
• Bentonite is a rock or a clay base industrial material. It is therefore a mixture
of minerals.
25. Name of Institution
Bentonite
• Bentonite feels greasy and soap-like to the touch.
• Freshly exposed bentonite is white to pale green or blue and, with
exposure, darkens in time to yellow, red, or brown.
• The special properties of bentonite are an ability to form thixotrophic gels
with water, an ability to absorb large quantities of water with an
accompanying increase in volume of as much as 12–15 times its dry bulk,
and a high cation exchange capacity.
• Physical and chemical properties Bentonite is used as filler in
pharmaceuticals, and due to its absorption/adsorption functions, it allows
paste formation. Such applications include industrial protective creams,
calamine lotion, wet compresses, and antiirritants for eczema.
• In medicine, bentonite is used as an antidote in heavy metal poisoning.
Personal care products such as mud packs, sunburn paint, baby and
facepowders, and face creams may all contain bentonite.
