Laxative Group Use
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Transcript Laxative Group Use
Chapter 51
BOWEL DISORDER DRUGS
DSN
Copyright © 2014 by Mosby, an imprint of Elsevier
Inc.
KEVIN DOBI, MS, APRN
2
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Inc.
Diarrhea
3
Abnormal passage of stools with increased
frequency, fluidity, and weight, or with increased
stool water excretion
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Inc.
Diarrhea4 (cont’d)
Acute diarrhea
Sudden onset in a previously healthy person
Lasts from 3 days to 2 weeks
Self-limiting
Resolves without sequelae
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Diarrhea5 (cont’d)
Chronic diarrhea
Lasts for more than 3-4 weeks
Associated with recurring passage of diarrheal
stools, fever, loss of appetite, nausea, vomiting,
weight loss, and chronic weakness
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Causes of6 Diarrhea
Acute Diarrhea
Diarrhea
Bacteria
Viruses
Drug-induced
Nutritional factors
Protozoa
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Chronic
Tumors
Diabetes mellitus
Addison’s disease
Hyperthyroidism
Irritable bowel
syndrome
AIDS
Goals of Diarrhea
Treatment
7
Stopping the stool frequency
Alleviating the abdominal cramps
Replenishing fluids and electrolytes
Preventing weight loss and nutritional deficits
from malabsorption
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Inc.
Antidiarrheals
8
Adsorbents
Antimotility drugs (anticholinergics and opiates)
Probiotics (bacterial replacement drugs)
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Antidiarrheals:
Mechanism
9 of Action
Adsorbents
Coat the walls of the gastrointestinal (GI) tract
Bind to the causative bacteria or toxin, which is
then eliminated through the stool
Examples: bismuth subsalicylate (Pepto-Bismol),
activated charcoal, aluminum hydroxide, others
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Inc.
Antidiarrheals:
Mechanism of 10Action (cont’d)
Antimotility drugs: anticholinergics
Decrease intestinal muscle tone and peristalsis of
GI tract
Result: slows the movement of fecal matter
through the GI tract
Examples: belladonna alkaloids
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Antidiarrheals:
Mechanism of 11Action (cont’d)
Antimotility drugs: opiates
Decrease bowel motility and reduce pain by relief
of rectal spasms
Decrease transit time through the bowel, allowing
more time for water and electrolytes to be
absorbed
Examples: paregoric, opium tincture, codeine,
loperamide (over the counter), diphenoxylate
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Antidiarrheals:
Mechanism of 12Action (cont’d)
Probiotics
Also known as intestinal flora modifiers and
bacterial replacement drugs
Bacterial cultures of Lactobacillus organisms
work by:
Supplying missing bacteria to the GI tract
Suppressing the growth of diarrhea-causing bacteria
Example: L. acidophilus (Bacid)
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Classroom Response Question
13
The antidiarrheal drug Lomotil contains both
diphenoxylate, a synthetic opiate agonist, and
atropine, an anticholinergic. The purpose of the
atropine in this combination is to
A.
B.
C.
D.
enhance the effects of the diphenoxylate.
discourage recreational use of the opiate diphenoxylate.
counteract the adverse effects of the diphenoxylate.
act as an adsorbent for bacteria in the bowel.
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Antidiarrheals:
Adverse14 Effects
Adsorbents
Increased bleeding time
Constipation, dark stools
Confusion
Tinnitus
Metallic taste
Blue tongue
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Antidiarrheals:
Adverse Effects
(cont’d)
15
Anticholinergics
Urinary retention, impotence
Headache, dizziness, confusion, anxiety,
drowsiness, confusion
Dry skin, flushing
Blurred vision
Hypotension, bradycardia
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Antidiarrheals:
Adverse Effects
(cont’d)
16
Opiates
Drowsiness, dizziness, lethargy
Nausea, vomiting, constipation
Respiratory depression
Hypotension
Urinary retention
Flushing
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Antidiarrheals:
17 Interactions
Adsorbents decrease the absorption of many
drugs, including digoxin, quinidine, and
hypoglycemic drugs
Adsorbents cause increased bleeding time and
bruising when given with anticoagulants
(warfarin)
Toxic effects of methotrexate are more likely when
given with adsorbents
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Antidiarrheals:
Nursing Implications
18
Obtain thorough history of bowel patterns,
general state of health, and recent history of
illness or dietary changes; assess for allergies
Do NOT give bismuth subsalicylate to children or
teenagers with chickenpox or influenza because of
the risk of Reye’s syndrome
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Classroom Response Question
19
Before administering belladonna alkaloids, it is most
important for the nurse to assess the patient for a
history of which condition?
A.
B.
C.
D.
Anemia
Diabetes mellitus
Myasthenia gravis
Hypertension
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Antidiarrheals:
Nursing Implications
(cont’d)
20
Use adsorbents carefully in elderly patients or
those with decreased bleeding time, clotting
disorders, recent bowel surgery, confusion
Do not administer anticholinergics to patients
with a history of narrow-angle glaucoma, GI
obstruction, myasthenia gravis, paralytic ileus,
and toxic megacolon
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Antidiarrheals:
Nursing Implications
(cont’d)
21
Teach patients to take medications exactly as
prescribed and to be aware of their fluid intake
and dietary changes
Assess fluid volume status, I&O, and mucous
membranes before, during, and after initiation of
treatment
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Antidiarrheals:
Nursing Implications
(cont’d)
22
Teach patients to notify their prescriber
immediately if symptoms persist
Monitor for therapeutic effect
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Classroom Response Question
23
Which antidiarrheal does the nurse associate with the
development of adverse effects of urinary retention,
headache, confusion, dry skin, rash, and blurred
vision?
A.
B.
C.
D.
Anticholinergics
Adsorbents
Probiotics
Opiates
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Constipation
24
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
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Laxatives
25
Bulk-forming
Emollient (stool softeners, lubricant laxatives)
Hyperosmotic
Saline
Stimulant
Peripherally acting opioid
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Laxatives: Mechanism
of Action
26
Bulk-forming
High fiber
Absorb water to increase bulk
Distend bowel to initiate reflex bowel activity
Examples
psyllium (Metamucil)
methylcellulose (Citrucel)
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Laxatives: Mechanism
of Action (cont’d)
27
Emollient
Stool softeners and lubricants
Promote more water and fat in the stools
Lubricate the fecal material and intestinal walls
Examples
Stool softeners: docusate salts (Colace, Surfak)
Lubricants: mineral oil
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Laxatives: Mechanism
of Action (cont’d)
28
Hyperosmotic
Increase fecal water content
Results in bowel distention, increased peristalsis,
and evacuation
Examples:
Polyethylene glycol (PEG)
Sorbitol, glycerin
Lactulose (also used to reduce elevated serum ammonia
levels)
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Laxatives: Mechanism
of Action (cont’d)
29
Saline
Increase osmotic pressure within the intestinal
tract, causing more water to enter the intestines
Results in bowel distention, increased peristalsis,
and evacuation
Examples
Magnesium hydroxide (Milk of Magnesia)
Magnesium citrate (Citroma)
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Laxatives: Mechanism
of Action (cont’d)
30
Stimulant
Increases peristalsis via intestinal nerve
stimulation
Examples
senna (Senekot)
bisacodyl (Dulcolax)
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Peripherally Acting31Opioid Antagonists
Treatment of constipation related to opioid use
and bowel resection therapy
Block entrance of opioid into bowel
Strict regulations for use
Allow bowel to function normally with continued
opioid use
methylnaltrexone (Relistor)
alvimopan (Entereg)
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Laxatives: 32Indications
Laxative Group
Bulk-forming
Emollient
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Inc.
Use
Acute and chronic
constipation, irritable
bowel syndrome,
diverticulosis
Acute and chronic
constipation, fecal
impaction, facilitation
of bowel movements
in anorectal conditions
Laxatives: Indications
(cont’d)
33
Laxative Group
Hyperosmotic
Saline
Stimulant
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Use
Chronic constipation,
diagnostic and surgical
preps
Constipation,
diagnostic and surgical
preps
Acute constipation,
diagnostic and
surgical preps
Classroom Response Question
34
A patient is receiving lactulose four times a day but
does not have a history of constipation. In fact, he has
had bowel movements every day. What is the probable
reason for the lactulose?
A. Cleansing the bowel before a procedure
B. Removal of helminths
C. Reduction of high ammonia levels associated with
liver failure
D. Daily maintenance to prevent constipation
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Laxatives: Adverse
Effects
35
Bulk-forming
Impaction
Fluid overload
Electrolyte imbalances
Esophageal blockage
Emollient
Skin rashes
Decreased absorption of vitamins
Electrolyte imbalances
Lipid pneumonia
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Laxatives: Adverse
36 Effects (cont’d)
Hyperosmotic
Abdominal bloating
Electrolyte imbalances
Rectal irritation
Saline
Magnesium toxicity (with renal insufficiency)
Cramping
Electrolyte imbalances
Diarrhea
Increased thirst
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Laxatives: Adverse
37 Effects (cont’d)
Stimulant
Nutrient malabsorption
Skin rashes
Gastric irritation
Electrolyte imbalances
Discolored urine
Rectal irritation
All laxatives can cause electrolyte imbalances!
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Laxatives: Nursing
Implications
38
Obtain a thorough history of presenting
symptoms, elimination patterns, and allergies
Assess fluid and electrolytes before initiating
therapy
Inform patients not to take a laxative or cathartic
if they are experiencing nausea, vomiting, and/or
abdominal pain
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Laxatives: Nursing Implications
(cont’d)
39
A healthy, high-fiber diet and increased
fluid intake should be encouraged as an
alternative to laxative use
Long-term use of laxatives often results in
decreased bowel tone and may lead to dependency
All laxative tablets should be swallowed whole, not
crushed or chewed, especially if enteric coated
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Laxatives: Nursing Implications
(cont’d)
40
Patients should take all laxative tablets with
6 to 8 oz of water
Patients should take bulk-forming laxatives as
directed by the manufacturer with at least
240 mL (8 oz) of water
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Laxatives: Nursing Implications
(cont’d)
41
Give bisacodyl with water because of interactions
with milk, antacids, and juices
Inform patients to contact their prescriber if they
experience severe abdominal pain, muscle
weakness, cramps, and/or dizziness, which may
indicate possible fluid or electrolyte loss
Monitor for therapeutic effect
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Classroom Response Question
42
A 48-year-old patient has been admitted with
abdominal pain, and states that she has not had a
bowel movement for 4 days. Her abdomen is distended
and slightly tender. Which laxative would be
appropriate for this patient?
A. Milk of magnesia
B. A bulk-forming laxative
C. Mineral oil
D. No laxative should be given at this time
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Irritable Bowel
Syndrome
43
Chronic intestinal discomfort characterized by
cramps, diarrhea, and/or constipation
Patients usually cope with the symptoms by
avoiding irritating foods and/or taking over-thecounter (OTC) laxatives and antidiarrheal drugs
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Drugs for Irritable44 Bowel Syndrome
tegaserod (Zelnorm)
lubiprostone (Amitiza)
alosetron (Lotronex)
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Drugs for Irritable Bowel Syndrome:
Nursing Implications
45
Perform a general assessment and additional
assessment of liver functioning as well as
assessment for any underlying cardiac disease
Follow administration guidelines
Assess for therapeutic response
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