SlideShare a Scribd company logo
DR D Y PATIL COLLEGE OF
PHARMACY, AKURDI
CONSTIPATION
GUIDED BY: PROF SHIRODE SIR
CREATED BY: GAURI P GAWANDE
SUBJECT: ADVANCED PHARMACOLOGY-
II
M PHARM 1ST YR
CONTENTS
1) Introduction
2) Non-therapeutic
Measure to treat
Constipation
3) Order of Effectiveness
4) Laxatives & Purgatives
5) Purgative abuse
2
5
INTRODUCTION:
Constipation is defined as delayed passage of faeces through the intestine
with defecation process remaining normal. Evacuation is often associated with
straining and is usually incomplete.
Constipation refers to bowel movement that are infrequent or hard to pass.
The stool is often hard and dry.
Dyschezia:
Dyschezia means derangement of defecation process which may result due
to:
1) Pain arising from haemorrhoids/ fissure
2) Presence of hard dehydrated faecal matter in rectum
3) Sudden cessation of a habitual use of Purgative
 Normal defecation clear only Descending Colon
Purgative entire Colon
6
Non-therapeutic Measure to treat Constipation:
1) Fibrous count in daily diet
2) Daily fluid intake
3) in physical activity
4) Not neglecting nature’s call
5) Selecting alternative drugs which cause lesser constipation as
SE
Ex: Morphine, anti-cholinergics, Al/Ca gp of Antacids
6) Treating vit B1 deficiency, Hypothyroidism, DM which lead
Constipation
 If all these measures fails then Laxative & Purgatives are used.
7
 Order of Effectiveness:
Aperient (to get rid of) < Laxative (to loosen) < Emollient (to smooth &
soften) < Evaculant (to empty) < Purgative (to clean) < Cathartic ( to
utterly clean)
 Laxative: In higher dose act as Purgative
→Result in elimination of soft semi-solid stool
 Purgative: In smaller dose act as Laxative, In higher Cathartic
→Provide mor watery evacuation
8
9
LAXATIVES: Mild activity & faecal softens
 Used:
1) To treat Constipation
2) To avoid undue straining at defaecation in case having hernia, haemorrhoids/ CVD
3) Before/ after any anorectal Surgery
4) In bedridden patients
1) Bulk-forming Laxatives:
Wheat bran, Psyllium huck, Ispaghula husk, Semisynthetic cellulose & polycarbophils synthetic fibres
Site & MOA:
These are luminally active, hydophilic, Indigestible vegetable fibres
Stimulate peristalsis & defecation reflexes by ng faecal bulk
due to their H₂O absobing & retaining capacity
Dosage & latency period:
Adequate amt of water must be taken
Effect within 1-3 days
Bran or husk powder sprinkled over stewed fud
SE:
-Not absorbed
-Bacterial digestion of vegetable fibres within the Colon may lead to bloating & cause abdominal discomfort
10
 Dietary fibre is unabsorbable cell wall and other constituents of vegetable food- cellulose, lignins, gums ,
pectins, glycoproteins and other polysaccharides.
 Bran is a residual product of flour industry which consist of 40% dietary fibre.
 Incresaed uptake of dietary fibres causes prevention of functional constipation used for treatment of simple
constipation.
11
 Psyllium husk derived from the seed of Plantago herb.
 Psyllium husk contains a hydrophilic mucilloid that undergoes significant fermentation in the
COLON shows the Laxative action.
12
2) OSMOTIC LAXATIVES:
Lactulose(10g/15ml), Sorbitol
“Non-toxic and suitable for long term use”
Site & MOA: Luminally active
Non-absorbable indigestible disaccharide(sugar)
es faecal bulk by Hydrophilic action & due to Osmotic action
Dosage & Latency period:
10g BD/TDS with plenty of water to produce 2/3 soft stools /day
Latency period: 1-3 days
SE:
1) Flatulence(fart) 3) Some people feel nauseated due to periculiar sweet
taste
2) Cramps may occur in few
3) Stool Softener( liquid Paraffin):
Site & MOA: Luminally active, pharmacologically inert mineral oil
Faecal lubricant, stool softener as it retard water absorption from food
Dosage & Latency period: -15-30ml/day at bed time
- 1-3 days
Note: Not palatable but can be given in emulsified form/ with juices
SE:
1) Frequent use deficiency of fat soluble Vit (A,D,E,K)
13
4) Surfactant Laxatives:
Dioctyl Na sulfosuccinate(Docusate Na)
Site & MOA: Luminally active agent & anionic surfactant which softens the stool by ing surface tension of
fluids in bowel
- Act as Wetting agent for bowel by emulsifying Colonic contents & mixing of water into faeces
Dosage & Latency period:
- 100-400mg orally/ day
- 1-3 days
SE:
1) Nausea as bitter in taste
2) Cramps & abdominal pain
3) Hepatotoxicity if prolonged use
4) Absorption of “Paraffin” hence should
5) not given together
14
PURGATIVES:
Used for Complete Colonic Cleansing prior to GI endoscopy
Needed for bed ridden patients
Needed for neurologically impaired patients
1) Osmotic Purgatives: (lead to watery evacuation)
 Solutes that are not absorbed in the intestine retain water osmotically and distend the bowel increasing
peristalsis indirectly.
 Mg sulphate, Na sulphate, MgOH(Milk of Magnesia), Na phosphate, PEG
Site & MOA:
- Act on small as well as large intestine
- Faecal absorption by retaining water by Osmotic effect thus increasing intestinal secretion &
peristalsis
SE: 1)Vomiting as need to ingested with enough water
2) Mg salts on long term use renal insufficiency
15
2) Irritant/Stimulant Purgatives:
 They are powerful purgatives: often produce griping. Secretion is enhanced by activation of cAMP in crypt
cells as well as by increased PG synthesis.
 Larger doses of stimulant purgatives can cause excess purgation resulting in fluid and electrolyte
imbalance. Hypokalaemia can occur on regular intake. Routine and long-term use must be discouraged,
because it can produce colonic atony.
i) Anthraquinones/Emodins: Senna(most common), Cascara, Aloe
ii) Diphenylmethanes/Organic Irritants: Phenolphthalein, Bisacodyl, Sod bicosulphate
iii) 5-HT4 agonist: Prucalopride
iv) Fixed oil: Castor oil, Croton oil
 Diphenylmethane Derivatives:
It is the only diphenylmethane derivative available in the U.S. It is marketed as entericcoated and regular
tablets and as a suppository for rectal administration.
 Phenolphthalein is a litmus-like indicator which is in use as purgative from the beginning of the 20th
century. It turns urine pink if alkaline. Shows protracted action due to its enterohepatic
 Bisacodyl more popular. They are partly absorbed and re-excreted in bile. Bisacodyl is activated in the
intestine by deacetylation. The primary site of action of diphenyl methane is in the colon where they irritate
the mucosa, produce mild inflammation and increase secretion
16
Allergic reactions:
1) Skin rashes
2) Fixed drug eruption
3) Stevens-Johnson syndrome have been reported.
4) Morphological alterations in the colonic mucosa have been observed; the mucosa becomes more leaky.
17
i) ANTHRAQUINILONES(Emodins):
Senna obtained from Leaves and pods of certain Cassia sp.
Cascara sargada powdered bark of buck-thorn tree which contain Anthraquinolone glycosides
SE:
1) Cramps, excessive purging
2) Skin rashes, fixed dose eruption
3) Regular use4 foe 4-12 months
cause colonic atony &
mucosal pigmentation
18
ii) 5-HT4 agonist: Prucalopride
 When other laxatives fail to provide adequate relief in chronic constipation in women then Prucalopride is
used (marketed in country like Europe, UK and Canada).
 Prucalopride is shown to have low affinity for 5-HT1B/ID receptor, & cardiac K+ channels. It is therefore, no
cardiovascular risk.
SE:
1) Headache
2) dizziness
3) fatigue
4) abdominal pain and diarrhea
19
iii) Fixed oil: Castor oil (oldest purgatives)
 Castor oil is a bland vegetable oil obtained from the seeds of Ricinus communis. It mainlymcontains
triglyceride of ricinoleic acid which is a polar long chain fatty acid. Ricinoleic acid, being polar, is poorly
absorbed.
 The primary action is now shown to be decreased intestinal absorption of water and electrolytes, and
enhanced secretion by a detergent like action on the mucosa.
20
Purgative abuse:
 Some individuals are obsessed with using purgatives regularly. This may be the
reflection of a psychological problem. Others use a purgative casually, obtain
thorough bowel evacuation, and by the time the colon fills up for a proper
motion (2-3 days) they get convinced that they are constipated and start taking
the drug regularly.
 Chronic use of purgatives must be discouraged. Once the purgative habit
forms, it is difficult to break.
 Dangers of purgative abuse are:
1. Flairing of intestinal pathology, rupture of inflamed appendix. 2. Fluid and
electrolyte imbalance, especially hypokalaemia.
3. Malabsorption syndrome.
4. Protein losing enteropathy.
5. Spastic colitis.
THANK
YOU

More Related Content

Similar to Gauri Gawande(9) Constipation Final.pptx

Drugs Used for treatment of Constipation & Diarrhoea
Drugs Used for treatment of Constipation & DiarrhoeaDrugs Used for treatment of Constipation & Diarrhoea
Drugs Used for treatment of Constipation & Diarrhoea
anujrims
 
8 Drugs acting on Digestive system.pptx
8 Drugs acting on Digestive system.pptx8 Drugs acting on Digestive system.pptx
8 Drugs acting on Digestive system.pptx
Nisha Mhaske
 
Drugs used in treatment of constipation
Drugs used in treatment of constipationDrugs used in treatment of constipation
Drugs used in treatment of constipation
SnehalChakorkar
 
Drugs for constipation
Drugs for constipationDrugs for constipation
Drugs for constipation
Ashishkumar Baheti
 
Drugs for diarrhoea & constipation
Drugs for diarrhoea & constipationDrugs for diarrhoea & constipation
Drugs for diarrhoea & constipation
BADAR UDDIN UMAR
 
DRUGS USED IN GI SYSTEM.pptx
DRUGS USED IN GI SYSTEM.pptxDRUGS USED IN GI SYSTEM.pptx
DRUGS USED IN GI SYSTEM.pptx
RamshijaAboobacker
 
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam KAntidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
LVSimhachalam
 
treatment of constipation
treatment of constipationtreatment of constipation
treatment of constipation
Vishnu Vardhan
 
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
KuldeepKumar56017
 
Drugs used in constipation & diarrhoea
Drugs used in constipation & diarrhoeaDrugs used in constipation & diarrhoea
Drugs used in constipation & diarrhoea
Shri guru ram rai institute of technology and science
 
Laxatives purgatives
Laxatives purgativesLaxatives purgatives
Laxatives purgatives
Ravish Yadav
 
laxatives
laxativeslaxatives
laxatives
BikashAdhikari26
 
Anti Diarrheals, Pharmacology Baqir Naqvi.pptx
Anti Diarrheals, Pharmacology  Baqir Naqvi.pptxAnti Diarrheals, Pharmacology  Baqir Naqvi.pptx
Anti Diarrheals, Pharmacology Baqir Naqvi.pptx
Dr. Baqir Raza Naqvi
 
3. drug affecting git motility rt h
3. drug affecting git motility rt h3. drug affecting git motility rt h
3. drug affecting git motility rt h
IAU Dent
 
Suppository - Types & Formulation
Suppository - Types & FormulationSuppository - Types & Formulation
Suppository - Types & Formulation
Zobayer Hossain
 
Slide32 git part2
Slide32  git part2Slide32  git part2
Slide32 git part2
Tala Khaled
 
Antidiarrhoeals
AntidiarrhoealsAntidiarrhoeals
Laxative and antidiarrheal agents
Laxative and antidiarrheal agentsLaxative and antidiarrheal agents
Laxative and antidiarrheal agents
Rahul B S
 
Purgatives & Laxatives, by Baqir Naqvi.pptx
Purgatives & Laxatives, by Baqir Naqvi.pptxPurgatives & Laxatives, by Baqir Naqvi.pptx
Purgatives & Laxatives, by Baqir Naqvi.pptx
Dr. Baqir Raza Naqvi
 
Laxatives and Purgatives
Laxatives and PurgativesLaxatives and Purgatives
Laxatives and Purgatives
Koppala RVS Chaitanya
 

Similar to Gauri Gawande(9) Constipation Final.pptx (20)

Drugs Used for treatment of Constipation & Diarrhoea
Drugs Used for treatment of Constipation & DiarrhoeaDrugs Used for treatment of Constipation & Diarrhoea
Drugs Used for treatment of Constipation & Diarrhoea
 
8 Drugs acting on Digestive system.pptx
8 Drugs acting on Digestive system.pptx8 Drugs acting on Digestive system.pptx
8 Drugs acting on Digestive system.pptx
 
Drugs used in treatment of constipation
Drugs used in treatment of constipationDrugs used in treatment of constipation
Drugs used in treatment of constipation
 
Drugs for constipation
Drugs for constipationDrugs for constipation
Drugs for constipation
 
Drugs for diarrhoea & constipation
Drugs for diarrhoea & constipationDrugs for diarrhoea & constipation
Drugs for diarrhoea & constipation
 
DRUGS USED IN GI SYSTEM.pptx
DRUGS USED IN GI SYSTEM.pptxDRUGS USED IN GI SYSTEM.pptx
DRUGS USED IN GI SYSTEM.pptx
 
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam KAntidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
Antidiarrheal agents and Drugs for Constipation ppt - By Dr L V Simhachalam K
 
treatment of constipation
treatment of constipationtreatment of constipation
treatment of constipation
 
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
Antiemetics, Anti-Diarrheals and Drugs for Constipation and irritable bowel s...
 
Drugs used in constipation & diarrhoea
Drugs used in constipation & diarrhoeaDrugs used in constipation & diarrhoea
Drugs used in constipation & diarrhoea
 
Laxatives purgatives
Laxatives purgativesLaxatives purgatives
Laxatives purgatives
 
laxatives
laxativeslaxatives
laxatives
 
Anti Diarrheals, Pharmacology Baqir Naqvi.pptx
Anti Diarrheals, Pharmacology  Baqir Naqvi.pptxAnti Diarrheals, Pharmacology  Baqir Naqvi.pptx
Anti Diarrheals, Pharmacology Baqir Naqvi.pptx
 
3. drug affecting git motility rt h
3. drug affecting git motility rt h3. drug affecting git motility rt h
3. drug affecting git motility rt h
 
Suppository - Types & Formulation
Suppository - Types & FormulationSuppository - Types & Formulation
Suppository - Types & Formulation
 
Slide32 git part2
Slide32  git part2Slide32  git part2
Slide32 git part2
 
Antidiarrhoeals
AntidiarrhoealsAntidiarrhoeals
Antidiarrhoeals
 
Laxative and antidiarrheal agents
Laxative and antidiarrheal agentsLaxative and antidiarrheal agents
Laxative and antidiarrheal agents
 
Purgatives & Laxatives, by Baqir Naqvi.pptx
Purgatives & Laxatives, by Baqir Naqvi.pptxPurgatives & Laxatives, by Baqir Naqvi.pptx
Purgatives & Laxatives, by Baqir Naqvi.pptx
 
Laxatives and Purgatives
Laxatives and PurgativesLaxatives and Purgatives
Laxatives and Purgatives
 

Recently uploaded

All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
Aswan University Hospital
 
Public Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public HealthPublic Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public Health
phuakl
 
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptxDistrict Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptx
CommunityMedicine46
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Kanhu Charan
 
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptxpharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
AdugnaWari
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
RAJU B N
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
MuskanShingari
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
Gokuldas Hospital
 
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdfOphthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
MuhammadMuneer49
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
FFragrant
 
Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
NX Healthcare
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
shruti jagirdar
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Get New Sim
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
TigistuMelak
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Kunj Vihari
 
5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods
Dr. Deepika's Homeopathy - Gaur City
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
KerlynIgnacio
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
Jyoti Bhaghasra
 

Recently uploaded (20)

All about shoulder Joint ..
All about shoulder Joint .. All about shoulder Joint ..
All about shoulder Joint ..
 
Public Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public HealthPublic Health Lecture 4 Social Sciences and Public Health
Public Health Lecture 4 Social Sciences and Public Health
 
District Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptxDistrict Residency Programme (DRP) for PGs in India.pptx
District Residency Programme (DRP) for PGs in India.pptx
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
 
pharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptxpharmacy exam preparation for undergradute students.pptx
pharmacy exam preparation for undergradute students.pptx
 
Helminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing studentsHelminthiasis or Worm infestation in Children for Nursing students
Helminthiasis or Worm infestation in Children for Nursing students
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
 
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdfOphthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
 
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
Demystifying Fallopian Tube Blockage- Grading the Differences and Implication...
 
Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
 
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
 
13. PROM premature rupture of membranes
13.  PROM premature rupture of membranes13.  PROM premature rupture of membranes
13. PROM premature rupture of membranes
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
 
5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods
 
pharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdfpharmacology for dummies free pdf download.pdf
pharmacology for dummies free pdf download.pdf
 
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
 
Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1 Foundation of Yoga, YCB Level-3, Unit-1
Foundation of Yoga, YCB Level-3, Unit-1
 

Gauri Gawande(9) Constipation Final.pptx

  • 1. DR D Y PATIL COLLEGE OF PHARMACY, AKURDI CONSTIPATION GUIDED BY: PROF SHIRODE SIR CREATED BY: GAURI P GAWANDE SUBJECT: ADVANCED PHARMACOLOGY- II M PHARM 1ST YR
  • 2. CONTENTS 1) Introduction 2) Non-therapeutic Measure to treat Constipation 3) Order of Effectiveness 4) Laxatives & Purgatives 5) Purgative abuse 2
  • 3.
  • 4.
  • 5. 5 INTRODUCTION: Constipation is defined as delayed passage of faeces through the intestine with defecation process remaining normal. Evacuation is often associated with straining and is usually incomplete. Constipation refers to bowel movement that are infrequent or hard to pass. The stool is often hard and dry. Dyschezia: Dyschezia means derangement of defecation process which may result due to: 1) Pain arising from haemorrhoids/ fissure 2) Presence of hard dehydrated faecal matter in rectum 3) Sudden cessation of a habitual use of Purgative  Normal defecation clear only Descending Colon Purgative entire Colon
  • 6. 6 Non-therapeutic Measure to treat Constipation: 1) Fibrous count in daily diet 2) Daily fluid intake 3) in physical activity 4) Not neglecting nature’s call 5) Selecting alternative drugs which cause lesser constipation as SE Ex: Morphine, anti-cholinergics, Al/Ca gp of Antacids 6) Treating vit B1 deficiency, Hypothyroidism, DM which lead Constipation  If all these measures fails then Laxative & Purgatives are used.
  • 7. 7  Order of Effectiveness: Aperient (to get rid of) < Laxative (to loosen) < Emollient (to smooth & soften) < Evaculant (to empty) < Purgative (to clean) < Cathartic ( to utterly clean)  Laxative: In higher dose act as Purgative →Result in elimination of soft semi-solid stool  Purgative: In smaller dose act as Laxative, In higher Cathartic →Provide mor watery evacuation
  • 8. 8
  • 9. 9 LAXATIVES: Mild activity & faecal softens  Used: 1) To treat Constipation 2) To avoid undue straining at defaecation in case having hernia, haemorrhoids/ CVD 3) Before/ after any anorectal Surgery 4) In bedridden patients 1) Bulk-forming Laxatives: Wheat bran, Psyllium huck, Ispaghula husk, Semisynthetic cellulose & polycarbophils synthetic fibres Site & MOA: These are luminally active, hydophilic, Indigestible vegetable fibres Stimulate peristalsis & defecation reflexes by ng faecal bulk due to their H₂O absobing & retaining capacity Dosage & latency period: Adequate amt of water must be taken Effect within 1-3 days Bran or husk powder sprinkled over stewed fud SE: -Not absorbed -Bacterial digestion of vegetable fibres within the Colon may lead to bloating & cause abdominal discomfort
  • 10. 10  Dietary fibre is unabsorbable cell wall and other constituents of vegetable food- cellulose, lignins, gums , pectins, glycoproteins and other polysaccharides.  Bran is a residual product of flour industry which consist of 40% dietary fibre.  Incresaed uptake of dietary fibres causes prevention of functional constipation used for treatment of simple constipation.
  • 11. 11  Psyllium husk derived from the seed of Plantago herb.  Psyllium husk contains a hydrophilic mucilloid that undergoes significant fermentation in the COLON shows the Laxative action.
  • 12. 12 2) OSMOTIC LAXATIVES: Lactulose(10g/15ml), Sorbitol “Non-toxic and suitable for long term use” Site & MOA: Luminally active Non-absorbable indigestible disaccharide(sugar) es faecal bulk by Hydrophilic action & due to Osmotic action Dosage & Latency period: 10g BD/TDS with plenty of water to produce 2/3 soft stools /day Latency period: 1-3 days SE: 1) Flatulence(fart) 3) Some people feel nauseated due to periculiar sweet taste 2) Cramps may occur in few 3) Stool Softener( liquid Paraffin): Site & MOA: Luminally active, pharmacologically inert mineral oil Faecal lubricant, stool softener as it retard water absorption from food Dosage & Latency period: -15-30ml/day at bed time - 1-3 days Note: Not palatable but can be given in emulsified form/ with juices SE: 1) Frequent use deficiency of fat soluble Vit (A,D,E,K)
  • 13. 13 4) Surfactant Laxatives: Dioctyl Na sulfosuccinate(Docusate Na) Site & MOA: Luminally active agent & anionic surfactant which softens the stool by ing surface tension of fluids in bowel - Act as Wetting agent for bowel by emulsifying Colonic contents & mixing of water into faeces Dosage & Latency period: - 100-400mg orally/ day - 1-3 days SE: 1) Nausea as bitter in taste 2) Cramps & abdominal pain 3) Hepatotoxicity if prolonged use 4) Absorption of “Paraffin” hence should 5) not given together
  • 14. 14 PURGATIVES: Used for Complete Colonic Cleansing prior to GI endoscopy Needed for bed ridden patients Needed for neurologically impaired patients 1) Osmotic Purgatives: (lead to watery evacuation)  Solutes that are not absorbed in the intestine retain water osmotically and distend the bowel increasing peristalsis indirectly.  Mg sulphate, Na sulphate, MgOH(Milk of Magnesia), Na phosphate, PEG Site & MOA: - Act on small as well as large intestine - Faecal absorption by retaining water by Osmotic effect thus increasing intestinal secretion & peristalsis SE: 1)Vomiting as need to ingested with enough water 2) Mg salts on long term use renal insufficiency
  • 15. 15 2) Irritant/Stimulant Purgatives:  They are powerful purgatives: often produce griping. Secretion is enhanced by activation of cAMP in crypt cells as well as by increased PG synthesis.  Larger doses of stimulant purgatives can cause excess purgation resulting in fluid and electrolyte imbalance. Hypokalaemia can occur on regular intake. Routine and long-term use must be discouraged, because it can produce colonic atony. i) Anthraquinones/Emodins: Senna(most common), Cascara, Aloe ii) Diphenylmethanes/Organic Irritants: Phenolphthalein, Bisacodyl, Sod bicosulphate iii) 5-HT4 agonist: Prucalopride iv) Fixed oil: Castor oil, Croton oil  Diphenylmethane Derivatives: It is the only diphenylmethane derivative available in the U.S. It is marketed as entericcoated and regular tablets and as a suppository for rectal administration.  Phenolphthalein is a litmus-like indicator which is in use as purgative from the beginning of the 20th century. It turns urine pink if alkaline. Shows protracted action due to its enterohepatic  Bisacodyl more popular. They are partly absorbed and re-excreted in bile. Bisacodyl is activated in the intestine by deacetylation. The primary site of action of diphenyl methane is in the colon where they irritate the mucosa, produce mild inflammation and increase secretion
  • 16. 16 Allergic reactions: 1) Skin rashes 2) Fixed drug eruption 3) Stevens-Johnson syndrome have been reported. 4) Morphological alterations in the colonic mucosa have been observed; the mucosa becomes more leaky.
  • 17. 17 i) ANTHRAQUINILONES(Emodins): Senna obtained from Leaves and pods of certain Cassia sp. Cascara sargada powdered bark of buck-thorn tree which contain Anthraquinolone glycosides SE: 1) Cramps, excessive purging 2) Skin rashes, fixed dose eruption 3) Regular use4 foe 4-12 months cause colonic atony & mucosal pigmentation
  • 18. 18 ii) 5-HT4 agonist: Prucalopride  When other laxatives fail to provide adequate relief in chronic constipation in women then Prucalopride is used (marketed in country like Europe, UK and Canada).  Prucalopride is shown to have low affinity for 5-HT1B/ID receptor, & cardiac K+ channels. It is therefore, no cardiovascular risk. SE: 1) Headache 2) dizziness 3) fatigue 4) abdominal pain and diarrhea
  • 19. 19 iii) Fixed oil: Castor oil (oldest purgatives)  Castor oil is a bland vegetable oil obtained from the seeds of Ricinus communis. It mainlymcontains triglyceride of ricinoleic acid which is a polar long chain fatty acid. Ricinoleic acid, being polar, is poorly absorbed.  The primary action is now shown to be decreased intestinal absorption of water and electrolytes, and enhanced secretion by a detergent like action on the mucosa.
  • 20. 20 Purgative abuse:  Some individuals are obsessed with using purgatives regularly. This may be the reflection of a psychological problem. Others use a purgative casually, obtain thorough bowel evacuation, and by the time the colon fills up for a proper motion (2-3 days) they get convinced that they are constipated and start taking the drug regularly.  Chronic use of purgatives must be discouraged. Once the purgative habit forms, it is difficult to break.  Dangers of purgative abuse are: 1. Flairing of intestinal pathology, rupture of inflamed appendix. 2. Fluid and electrolyte imbalance, especially hypokalaemia. 3. Malabsorption syndrome. 4. Protein losing enteropathy. 5. Spastic colitis.