Transcript Laxatives and Antidiarrheals

Laxatives and
Antidiarrheals
CHAPTER 25
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
2
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
3
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
4
LAXATIVE CLASSIFICATIONS
Stimulant
Saline
Bulk-forming
Lubricant
 Stool
softeners
 Suppositories
Lactulose
Enemas
5
STIMULANT LAXATIVES
Action
 Chemical
irritation
Increase motility of the GI
tract
 Increase secretion of water into
large and small intestine
Example: bisacodyl
6
SALINE LAXATIVES
Increase
osmotic pressure within
the intestinal tract
 Cause more water to enter the
intestines
 Result in:
Bowel distention, increased
peristalsis, and evacuation
7
SALINE LAXATIVES
Contain
salt
Unpleasant taste
Systemically absorbed
Result in:
 Poor client compliance
 Risk for dehydration
 Risk for congestive heart failure
8
BULK-FORMING LAXATIVES
Safest
form
 Absorbs water to increase bulk
 Distends bowel to initiate
reflex bowel activity
Not systemically absorbed
 High fiber
9
BULK-FORMING LAXATIVES
Natural
or semisynthetic
Examples: psyllium
hydrophilic muciloid
(Metamucil),
methylcellulose (Citrucel),
and polycarbophil
(Fibercon)

10
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.
11
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
12
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)
13
SUPPOSITORIES
Usually
in a wax base
Administered
Absorbed
rectally
systemically
14
SUPPOSITORIES
Available
containing stimulant
drugs
 Glycerin
Absorbs water from tissues,
creating more mass
 Bisacodyl
Induces peristaltic
contraction by direct
stimulation of sensory nerves
15
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
16
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
17
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
18
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
19
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
20
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
21
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
22
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
23
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)
24
DRUGS THAT REDUCE GI MOTILITY
Opiate
derivatives
- reduce propulsive movement of the
small
intestine and colon
- dependence with prolonged use
- depression of the CNS
25
DRUGS THAT REDUCE GI MOTILITY
Anticholinergic
drugs
- reduce intestinal motility
- potential dangerous side
effects – limits
usefulness
26
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
27
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)
28
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
29
NURSING
CONSIDERATIONS
Adults
with fever,
dehydration, or persistent
diarrhea should contact
provider
Infants and young children
need sooner evaluation
30
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
31