Laxatives and Antidiarrheals

1. Chapter 26 Laxatives and Antidiarrheals

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 2

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 3 Stimulant Laxatives Action Chemical irritation Increase motility of the GI tract Increase secretion of water into large and small intestine Example: bisacodyl

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 4 Saline Laxatives Increase osmotic pressure within the intestinal tract Cause more water to enter the intestines Result in: Bowel distention, increased peristalsis, and evacuation

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 5 Saline Laxatives Contain salt Unpleasant taste Systemically absorbed Result in: Poor client compliance Risk for dehydration Risk for congestive heart failure

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 6 Bulk-Forming Laxatives Safest form Absorbs water to increase bulk Distends bowel to initiate reflex bowel activity Not systemically absorbed High fiber Natural or semisynthetic Examples: psyllium hydrophilic muciloid (Metamucil), methylcellulose (Citrucel), and polycarbophil (Fibercon)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 7 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.

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 8 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 (liquid petroleum) Not digested or absorbed

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 9 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)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 10 Suppositories Usually in a wax base Administered rectally Absorbed systemically Available containing stimulant drugs Glycerin Absorbs water from tissues, creating more mass Bisacodyl Induces peristaltic contraction by direct stimulation of sensory nerves

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 11 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

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 12 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

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 13 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

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 14 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

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 15 Adsorbents

16. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 16 Antidiarrheals Reduce GI motility Opium is a narcotic. Decreases bowel motility and rectal spasms Depresses the CNS; monitor closely Decreases transit time through the bowel; more time for water and electrolytes to be absorbed Paregoric is an opium tincture. May cause physical dependence

17. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 17 Antidiarrheals Loperarmide HCl (Imodium) Made from chemicals related to meperidine, a narcotic Diphenoxylate HCl and atropine sulfate (Lomotil) Narcotic and anticholinergic drug Reduces GI motility

18. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 18 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)

19. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 26 - 19 Nursing Implications Monitor for therapeutic effect