1 / 31

Laxatives and Antidiarrheals

Laxatives and Antidiarrheals. Constipation. Passage of feces through the lower GI tract is slow or nonexistent May be caused by - ignoring the defecation urge - environmental changes - low residue diet - decreased physical activity - emotional stress

luigi
Download Presentation

Laxatives and Antidiarrheals

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Laxatives and Antidiarrheals

  2. Constipation • Passage of feces through the lower GI tract is slow or nonexistent • May be caused by - ignoring the defecation urge - environmental changes - low residue diet - decreased physical activity - emotional stress - eating constipating foods - constipating drugs - misuse of laxatives - low fluid intake

  3. Laxatives • Facilitate the passing of fecal material from the colon and rectum • Reasons for use - test preparation - reduce strain of defecation - parasitic infections - poison removal - constipation

  4. Laxatives • Use is widespread • Overuse can be an issue especially in the elderly • Occasional constipation may be normal • Laxative dependence can occur • Prolonged use can lead to - fluid and electrolyte loss - malnutrition - liver disease

  5. Laxative Classifications • Stimulant • Saline • Bulk-forming • Lubricant • Stool softeners • Suppositories • Lactulose • Enemas

  6. Stimulant Laxatives • Action • Chemical irritation • Increase motility of the GI tract • Increase secretion of water into large and small intestine • Example: bisacodyl

  7. Saline Laxatives • Increase osmotic pressure within the intestinal tract • Cause more water to enter the intestines • Result in: • Bowel distention, increased peristalsis, and evacuation

  8. Saline Laxatives • Contain salt • Unpleasant taste • Systemically absorbed • Result in: • Poor client compliance • Risk for dehydration • Risk for congestive heart failure

  9. Bulk-Forming Laxatives • Safest form • Absorbs water to increase bulk • Distends bowel to initiate reflex bowel activity • Not systemically absorbed • High fiber

  10. Bulk-Forming Laxatives • Natural or semisynthetic • Examples: psyllium hydrophilic muciloid (Metamucil), methylcellulose (Citrucel), and polycarbophil (Fibercon)

  11. Bulk-Forming Laxatives • Must be followed with a large amount of fluid • If chewed or taken in dry powder form, these agents can cause esophageal obstruction and/or fecal impaction.

  12. Lubricant Laxatives • Oils lubricate the fecal material and intestinal walls, thereby promoting fecal passage: • Prevent fat-soluble vitamins from being absorbed • Popular lubricant • Mineral oil • Often made from petroleum products • Not digested or absorbed

  13. Stool Softeners • Detergent-like drugs: • Permit mixing of fats and fluids with the fecal mass • Stool becomes softer and is passed much easier • Takes several days to work • Example: docusate salts (Colace and Surfak)

  14. Suppositories • Usually in a wax base • Administered rectally • Absorbed systemically

  15. Suppositories • Available containing stimulant drugs • Glycerin • Absorbs water from tissues, creating more mass • Bisacodyl • Induces peristaltic contraction by direct stimulation of sensory nerves

  16. Lactulose Laxatives • Two monosaccharides that are not digested or absorbed • Digested in the colon by bacteria to form acids substances • Acid substances cause water to be drawn into the colon

  17. GoLYTELY • Polyethylene glycol (electrolyte solution and salt) • Must consume 4 liters within 3 hours • Causes a large volume of water to be retained in the colon • Acts within one hour • Produces a diarrheal state

  18. Enemas • Hyperosmotics • Solution contain salts (e.g., Fleet enema) • Administered rectally and cause a laxative effect by osmotically drawing fluid into the colon to initiate defecation

  19. Long-Term Use • Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. • Encourage • A healthy, high-fiber diet • Increased fluid intake

  20. Nursing Considerations • Assess bowel patterns • Encourage fluids for patients taking laxatives • The elderly, children, and patients with electrolyte imbalances should not take saline laxatives • Bulk laxatives can take days to be effective

  21. Nursing Considerations • Educate patients that laxatives can be habit-forming • Teach patients proper technique for self-administration of suppositories and enemas • Some laxatives should not be used for longer than 1 week • Use in infants and debilitated patients should be directed by their provider

  22. Diarrhea • Abnormally frequent passage of watery stools • Failure of the small and large colon to adequately absorb fluid from the intestinal contents • A symptom of an underlying disorder

  23. Diarrhea • Patients with chronic or severe acute diarrhea must be diagnosed before treatment • Untreated diarrhea can lead to dehydration and malnutrition • Therapy is aimed at reducing GI motility, remove irritants, or replace normal bacterial flora

  24. Adsorbents • Most commonly used • Claylike materials administered in a tablet or liquid suspension form after each loose bowel movement • Bind to the causative bacteria or toxin, and are eliminated through the stool • Little scientific proof that they work • Examples: kaolin-pectin, attapulgite (Kaopectate)

  25. Drugs that Reduce GI Motility • Opiate derivatives - reduce propulsive movement of the small intestine and colon - dependence with prolonged use - depression of the CNS

  26. Drugs that Reduce GI Motility • Anticholinergic drugs - reduce intestinal motility - potential dangerous side effects – limits usefulness

  27. Antidiarrheals • Loperamide HCl (Imodium) • Made from chemicals related to meperidine, a narcotic • Diphenoxylate HCl and atropine sulfate (Lomotil) • Narcotic and anticholinergic drug • Reduces GI motility

  28. Anticholinergics • Decrease intestinal muscle tone and peristalsis of GI tract • Result: slows the movement of fecal matter through the GI tract • Example: belladonna alkaloids (Donnatal)

  29. Nursing Considerations • Monitor fluid intake and output • Monitor body weight in infants • Monitor for CNS depression • Adsorbents should not be administered with other drugs • Lactobacillus must be refrigerated

  30. Nursing considerations • Adults with fever, dehydration, or persistent diarrhea should contact provider • Infants and young children need sooner evaluation

  31. Nursing considerations • Patients with glaucoma or enlarged prostates should not take anticholinergic antidiarrheals • Do not use antidiarrheals with patients with acute abdominal pain • Antidiarrheals can cause constipation

More Related