This document discusses the treatment of constipation. It begins by defining constipation and listing some common causes such as lifestyle factors, medications, neurological and gastrointestinal disorders. It then describes various classes of laxatives including bulk-forming agents, stimulant laxatives, osmotic laxatives and emollient laxatives. Specific laxatives are discussed within each class along with their mechanisms of action, indications, adverse effects and contraindications. Newer agents for treating constipation like lubiprostone are also mentioned. The document concludes by describing laxative abuse syndrome which can occur with overuse of strong purgatives.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation (failure to pass stools or gas) and fecal impaction, which can progress to bowel obstruction and become life-threatening.
Constipation is a symptom with many causes. These causes are of two types: obstructed defecation and colonic slow transit (or hypo mobility). About 50 percent of people evaluated for constipation at tertiary referral hospitals have obstructed defecation. This type of constipation has mechanical and functional causes. Causes of colonic slow transit constipation include diet, hormonal disorders such as hypothyroidism, side effects of medications, and rarely heavy metal toxicity. Because constipation is a symptom, not a disease, effective treatment of constipation may require first determining the cause. Treatments include changes in dietary habits, laxatives, enemas, biofeedback, and in particular situations surgery may be required.
Constipation is common; in the general population rates of constipation varies from 2–30 percent. In elderly people living in care homes the rate of constipation is 50–75 percent.[4] In the United States expenditures on medications for constipation are greater than US$250 million per year.
The definition of constipation includes the following:
infrequent bowel movements (typically three times or fewer per week)
difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools; straining in this context is a strong effort to push out stool often by holding one's breath and by pushing the respective muscles in the abdominal area hard), or
the sensation of incomplete bowel evacuation.
The Rome III criteria are widely used to diagnose chronic constipation, and are helpful in separating cases of chronic functional constipation from less-serious instances.
Another definition states that less than three bowel movements per week and straining on more than 75% of occasions represents constipation in clinical surveys.
This presentation is to help readers to be equipped with knowledge on predisposing factor to peptic ulcer disease and how it can be managed in the clinical/hospital setup.
short and simple study on the topic of laxative and purgatives which is very usefull for the student , teachers, as well as health cares peoples. this study is done by the student with the help of teachers
This presentation is to help readers to be equipped with knowledge on predisposing factor to peptic ulcer disease and how it can be managed in the clinical/hospital setup.
short and simple study on the topic of laxative and purgatives which is very usefull for the student , teachers, as well as health cares peoples. this study is done by the student with the help of teachers
Constipation in Infants & Children By Dr. Vivek Rege
Pediatric Surgeon & Pediatric Urologist, BhatiaHospital, Saifee Hospital, Fortis Hospitals, B J Wadia Hospital for Children
Constipation is a comdition which causes difficulty in ecretion of feaces, less than three bowel in a week. the drugs that are used to treat constipation are cathartics.
Diarrhoea is a condition of excretion of loose stool and water equal or more than three bowel movement in a day. it is of three types, acute, dysentry, chronic diarrrhoea. may caused by bacteria E.coli, and Rotavirus in children. drugs used to treat are called anti diarrhoeal drugs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. 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
4/20/2015 1:33 PM2
3. Causes of constipation
1. In most cases of chronic constipation, no specific
cause is found (chronic idiopathic constipation)
2. Lifestyle Factors
a) Inadequate fluid intake
b) Decreased food intake
c) Inappropriate bowel habits
d) Immobility
3. Medications
4. Endocrine and Metabolic disorders
a) Hypothyroidism
b) Hypercalcemia
c) Hypokalemia
d) Pheochromocytoma
4/20/2015 1:33 PM3
4. Causes of constipation
5. Neurologic
a) Parkinson's disease
b) Multiple sclerosis
c) Spinal lesions
d) Damage to sacral parasympathetic nerves
e) Autonomic neuropathy (Diabetes mellitus
6. 6. Psychological
a) Depression
b) Eating disorders (e.g., anorexia nervosa)
7. GI disorders:
a) Irritable bowel syndrome
b) Diverticulitis
c) Hemorrhoids and anal fissures
d) Tumors
e) Hernia
f) Hirschsprung’s disease.
8. Pregnancy
4/20/2015 1:33 PM4
6. Mechanism of drug-induced
constipation
1. Drugs with anticholinergic action (e.g.
first generation antihistaminic drugs,
tricyclic antidepressants, benztropine,
phenothiazines,..):
GIT motility is under parasympathetic
(cholinergic) control.
Parasympathetic stimulation →
↑motility
Drugs with anti-cholinergic effect
(whether it is their main action or a
side effect) →↓motility → constipation
4/20/2015 1:33 PM6
7. Mechanism of drug-induced
constipation
2. Opioids:
Opioids cause constipation by:
A) Increasing the smooth muscle tone,
suppressing forward peristalsis, raising
sphincter tone at the ileo-cecal valve
and anal sphincter. This delays passage
of feces through the GIT → increase in
absorption of electrolytes and water in
the small intestine and colon →
constipation
B) Reducing sensitivity to rectal distension.
4/20/2015 1:33 PM7
9. Treatment of constipation
General measures:
Definition: Fiber is that part of food that resists enzymatic
digestion
Effect of fiber: Fiber reaches the colon unchanged.
Colonic bacteria → Fermentation →
Short-chain fatty acids (→ prokinetic effect)
1) Increase the amount of fiber consumed daily fruits,
vegetables, bran and cereals).
Increased bacterial mass (→ increased stool bulk).
Fiber that is not fermented → osmotic effect →increases
stool bulk.
2. Increasing fluid intake.
3. Regulation of bowel habits
4. Regular exercise.
5. Treatment of the cause
6. For drug causes of constipation, a non constipating
alternatives should be used. If no alternatives exist, lower the
dose.
4/20/2015 1:33 PM9
10. Treatment of constipation
If general measures alone are
inadequate or not applicable (e.g.,
because of old age), they may be
supplemented with bulk-forming agents,
osmotic laxatives or stimulant laxatives.
When stimulant laxatives are used, they
should be administered at the lowest
effective dosage and for the shortest
period of time to avoid abuse
4/20/2015 1:33 PM10
11. Definitions
Laxatives Cathartics
Drugs that help
evacuation of
formed fecal
material from the
rectum
Drugs that help
evacuation of
unformed, usually
watery fecal
material from the
entire colon.
4/20/2015 1:33 PM11
12. Drug treatment of constipation
(laxatives)
General indications:
1. Fecal impaction
2. Constipation associated with illness,
surgery, pregnancy or poor diet
3. Drug-induced constipation
4. Conditions where bowel strain is
undesirable
5. Preparation for surgery or investigations
involving the GIT (e.g. sigmoidoscopy)
4/20/2015 1:33 PM12
14. 1- Bulk-forming agents
(active after 12-36h)
Drugs: (taken as granules, powders or tablets)
1. Methylcellulose
2. Bran
3. Psyllium
Mechanism of action of bulk-forming agents:
They increase stool bulk and water content
(make stools bulky (→ stimulate peristalsis)
and soft → easy to pass) (similar to natural
fiber)
4/20/2015 1:33 PM14
15. Bulk-forming agents (cont.)
(active after 12-36h)
Indications:
1. They are the first-line treatment of constipation
2. Conditions where dietary intake of fibers can not be
increased
Precautions:
Adequate fluid intake to avoid intestinal obstruction
Adverse effects of bulk-forming laxatives:
1. Abdominal distension (due to fermentation).
2. Intestinal obstruction when not consumed with sufficient
fluid
Contraindications:
1. Atony of the colon
2. Intestinal obstruction
3. Fecal impaction (should be corrected before
administration of fiber)
4. Immobility
4/20/2015 1:33 PM15
17. Mechanism of action and
classification of stimulant (irritant)
laxatives
They are given in an inactive form → hydrolyzed in the
GIT into active forms → GIT irritation → modify
permeability of the mucosal cells → ↑ fluid and
electrolyte secretion in the GIT → distension →
evacuation of soft (or liquid) bulky stools. They probably
cause direct stimulation of the enteric nerves.
According to the site of GIT irritation they are classified
into:
1. Small bowel irritant (hydrolysed in the small intestine by
the action of lipases): castor oil
2. Large bowel irritants (hydrolyzed by colonic bacteria):
a) Bisacodyl and Sodium picosulfate
b) Senna and Cascara
4/20/2015 1:33 PM17
18. Stimulant (irritant) laxatives
(cont.)
Indications of large bowel irritants:
a) Bisacodyl and Sodium picosulfate
b) Senna and Cascara
1. Prevention of straining at stool following
surgery, myocardial infarction or stroke
2. Painful diseases of the anus, e.g., fissure
or hemorrhoids.
4/20/2015 1:33 PM18
19. Stimulant (irritant) laxatives
(cont.)
1. Bisacodyl and sodium picosulfate:
Dosage forms:
1. Oral (the laxative effects after a dose occurs after 6
– 12 hours; taken at bedtime, it will produce its effect
the next morning)
2. Rectal suppository (for bisacodyl only – the laxative
effect occurs within 30 to 60 min.)
Indications: (also for cascara and senna)
1. Should not be used for more than 10 consecutive days
(due to the possibility of developing atonic colon)
2. Preparation before diagnostic procedures involving the
GIT
4/20/2015 1:33 PM19
20. Stimulant laxatives (cont)
Bisacodyl and sodium picosulfate (cont)
Adverse effects:
1. Abdominal cramps after each dose
2. Over dosage → catharsis and fluid
and electrolyte disturbances.
3. Can damage mucosa and cause
inflammation in the colon.
4. Atonic colon (following years of use)
Contraindications:
1. Intestinal obstruction
4/20/2015 1:33 PM20
21. Stimulant laxatives (cont.)
2. Cascara and Senna
Dosage forms:
Oral (the laxative effects after a dose occurs after 6 – 12 hours;
taken at bedtime, it will produce its effect the next morning)
Adverse effects of long-term use;
Abdominal cramps after each dose
Over dosage → catharsis and fluid and electrolyte
disturbances.
Pigmentation of the colonic mucosa (melanosis coli). (4 – 9
months of use)
Atonic colon (years of use)
Contraindications:
Breast feeding (active compounds are absorbed to a
variable degree from the colon and excreted in breast
milk)
Intestinal obstruction
4/20/2015 1:33 PM21
22. Stimulant laxatives (cont.)
3. Castor Oil:
Dosage form:
Oral in a liquid form (laxative effect occurs after 1 – 3h)
Adverse effects:
1. Unpleasant taste
2. Damage to intestinal epithelium and enteric neurons
Uses:
Strong purgative → evacuation of the bowel before surgery
and diagnostic procedures
Contraindications:
1. Intestinal obstruction
4/20/2015 1:33 PM22
23. 3- Osmotic laxatives
1. Saline laxatives (have cathartic action in large doses)
A. Magnesium salts (sulfate, hydroxide or citrate)
A. Sodium phosphate
Mechanism of action:
1. Poorly absorbed → water retention (osmotic effect) →soft
bulky stools → ↑peristalsis → relief of constipation
2. Magnesium-containing laxatives may stimulate the release of
cholecystokinin, which leads to intraluminal fluid and
electrolyte accumulation and to increased intestinal motility
Uses:
Enema (causes bowel evacuation after 30 min)
Oral forms (cause bowel evacuation after 2-5h)
Both forms are used for intestinal evacuation before abdominal
radiological procedures, sigmoidoscopy or surgery (cathartics)
4/20/2015 1:33 PM23
25. Osmotic laxatives (cont.)
2. Non-digestible sugars and alcohols
1. Lactulose (disaccharide of galactose and
fructose that resists intestinal disaccharidase
activity)
2. Sorbitol (monosaccharide)
Mechanism of action:
Lactulose → metabolized by colonic bacteria into
short chain fatty acids → osmotic effect → stimulate
propulsive activity
Adverse effects:
1. Abdominal distention
2. Diarrhea
4/20/2015 1:33 PM25
26. Osmotic laxatives (cont.)
Uses:
Lactulose: (24-48h)
1. Used for treatment of hepatic
encephalopathy (↓ blood ammonia
by lowering fecal pH →↓growth of
ammonia-producing bacteria and
conversion of ammonia in the colon to
ammonium ion).
2. Constipation in the elderly patient
3. Alternative for acute constipation
Sorbitol:
1. Chronic constipation
4/20/2015 1:33 PM26
27. Osmotic laxatives (cont.)
3. Polyethylene Glycol-Electrolyte Solutions.
Mechanism of action:
Poorly absorbed, and retained in the lumen of the gut
→ osmotic effect → increase water content of stools.
Uses:
1.Cathartic: high doses.
2.Laxative: small oral doses
4/20/2015 1:33 PM27
28. Osmotic laxatives (cont.)
4. Glycerin
Dosage form:
Suppository (laxative effect > 30 min.)
Mechanism of action:
Osmotic effect in the rectum.
Adverse effects:
Occasional rectal irritation.
Uses:
Intermittent constipation in children.
4/20/2015 1:33 PM28
29. 4- Fecal softeners/emollient
laxatives
Mechanism of action:
1. Reduces surface tension of stools → increases
penetration of fluids into feces → soft bulky stools
2. Docusate salts (sodium or calcium) (weak laxatives)
3. Stimulate intestinal fluid and electrolyte secretion (by
altering mucosal permeability)
Dosage forms:
1. Oral form (active within 1-3 d)
2. Rectal form has a rapid onset of action but is
contraindicated in hemorrhoids and anal fissure.
Uses:
Used in hospitalized patients following myocardial
infarction or surgery, when straining at defecation
should be avoided but activity and fluid intake
may be restricted.
4/20/2015 1:33 PM29
30. Fecal softeners/emollient
laxatives (cont.)
2. Mineral oil:
Mechanism of action:
1. Indigestible and with minimal absorption. Coat stool
and allow easier passage.
2. Inhibit colonic absorption of water → increasing stool
weight and decrease stool transit time.
Dosage forms:
Oral or rectal. Laxative effect is noted after 2 or 3 days of
oral use.
Indications:
Similar to docusates
4/20/2015 1:33 PM30
31. Fecal softeners/emollient
laxatives (cont.)
Mineral oil:
Adverse effects:
1. May be absorbed systemically →
foreign-body reaction in lymphoid
tissue.
2. May be aspirated (in debilitated or
recumbent patients) → lipoid
pneumonia
3. Decreases absorption of fat-soluble
vitamins (A, D, E, and K)
4. When given orally, mineral oil may
leak from the anal sphincter.
4/20/2015 1:33 PM31
32. New agents
Lubiprostone
Mechanism of action:
Opening of chloride channels locally in the GI
luminal epithelium, which stimulates chloride-rich
intestinal fluid secretion and shortens GI transit
time
Uses:
Chronic idiopathic constipation in adults
Adverse effects:
1. Headache
2. Diarrhea, and nausea, as a result of
delayed gastric emptying.
4/20/2015 1:33 PM32
33. Laxative abuse syndrome
Mechanism:
1. With the use of strong purgatives, the colon may be so thoroughly
evacuated that a bowel movement may not occur normally until a
few days later. This delay reinforces the need for more laxative.
Eventually the patient may require daily laxatives to maintain bowel
function.
4/20/2015 1:33 PM33
34. Let the coming year be a glorious one that rewards all your
future endeavours with success
DEPT.OF PHARMACOLOGY