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. Objectives:By the end of this lecture the student should be able to know:- Definition and causes of constipation-Management of constipation- Different classes of purgatives, at least one or tow examples on each and their MOA- Major side effects to purgatives. . Constipation Constipation is o
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1. Purgatives=Laxatives
2. Objectives:
By the end of this lecture the student should be able to know:
- Definition and causes of constipation
-Management of constipation
- Different classes of purgatives, at least one or tow examples on each and their MOA
- Major side effects to purgatives
3. Constipation
Constipation is one of the most common digestive complaints
It varies greatly between different people, as each persons bowel movements differ
Most cases of constipation are caused by a low fiber diet and/or dehydration
4. The stool can be hard and dry.
Constipation is most common in children and older people, and affects women more than men.
One in 200 women have severe, continuous constipation and it is most common before a period and during pregnancy.
5. Causes of constipation:
** In adults
Often there is no identified cause of constipation, but it may be due to one or a number of the following factors:
- Not enough fluid (water) in the diet
- Not enough fiber (fruit, vegetables, cereals) in the diet.
6. - Drugs such as analgesics ( Morphine, Codeine ), antidepressants, and antacids
( aluminum and Calcium salts )
- Too much calcium in the diet
- Too much iron in the diet
- Pregnancy
7.
- Drinking an excessive amount of strong tea or coffee (this increases urine production and so decreases the amount of fluid in the bowel)
- Recent abdominal surgery, hemorrhoids, or anal fissure can make it painful to defecate and lead to constipation
- Anxiety in some people can lead to constipation
8. ** In babies and children
- Not enough fiber in a child's diet
- Not getting enough fluids
- Any illness with high fever and vomiting, can cause dehydration and lead to constipation.
- An allergy to cows milk or medicines may also cause constipation
9. - Very rarely, in babies, constipation may be a sign of a disorder, such as hypothyroidism, or anal stenosis
- Constipation is also more common in children with Down's syndrome, cerebral palsy and spina bifida.
10. ** Travelling, constipation is often experienced by people when they are travelling or on holiday
( diarrhea is more common )
This is because of the change in their normal routine diet
11. ** The following conditions may lead to constipation:
- Irritable bowel syndrome (IBS)
- Kidney failure
- Colon/rectal cancer
- Multiple Sclerosis (MS)
- Spinal injury
- Hypothyroidism
12. Management of constipation:
- Treatment of the cause
- Preventive measures:
- Eating more fruits, vegetables and grains, which are high in fiber
- Drinking plenty of water and other liquids
13. - Getting enough exercise
- Asking your doctor if medicines you take may cause constipation
- Using laxatives only if your doctor says you should
14. Purgatives=Laxatives
Definition
An over-the-counter (OTC) drugs that promote passage of feces mainly by reducing the viscosity of the contents of lower colon or simply drugs that relieve constipation, including bulk-forming laxatives, lubricants, stool softeners, saline laxatives, stimulant laxatives and combinations
15. Classes and MOA of purgatives
1.- Bulk-forming laxatives
High fiber diet ( green vegetables, fruits)
Methylcellulose Polycarbophil
Ispaghula husk psllium
They are not absorbed and add bulk and water to stools. The larger stools help trigger the bowel to contract and move the stools out
16. 2.- Lubricant laxatives
Glycerin
Mineral oil
They loose stools and lubricate the intestine
They work by coating the surface of the stools
This helps the stools hold in water so they
move out of the body more easily
17. 3.- Stool softeners
Docusate sodium
Help mix fluid and water into stools to soften them
This makes stools easier to pass out of the body
18. 4.- Saline laxatives
Magnesium hydroxide (milk of Magnesia)
Magnesium sulfate (Epsom salt)
Draw fluids and water into the bowel from nearby tissue by osmosis
This softens stools and helps the bowel move them out
19. 5.- Stimulant laxatives
Bisacodyl
Castor oil
Senna, Rhubarb… and many others
Stimulant or irretant purgatives are the
harshest laxatives. They cause the bowel to
squeeze or contract to move the stools out.
20. Stimulant laxatives should generally be used only when they are recommended by the physician, such as in cases of preparing for a bowel exam or after surgery when patients shouldn’t strain to have a bowel movement ( e.g. patients with HF or hemorrhoids)
21. Purgatives are available in tablets, syrup, powder and suppositories dosage forms
Common side effects of laxatives:
Most laxatives don’t have side effects
Sometimes they can cause diarrhea ( major side effect) cramping, gas, bloating, nausea and allergy
22.
Stimulant laxatives are most likely to cause side effects
Mineral oil if accidentally aspirated it can cause a type of pneumonia
Chronic use of purgatives is not advised