Phenolphthalein

Phenolphthalein

It tends to act longer than other laxatives because it enters the

enterohepatic circulation and is re-excreted in bile into the intestine

SJS and lupus erythematosus.

phenolphthalein may cause allergic reactions, including

Bartter’s-like syndrome (kidney disorder; appears in childhood; dec K level (hypokalemia)

Phenolphthalein may cause

Melanosis coli

condition usually associated with chronic laxative use in which dark pigment is deposited in the lamina propria (one of the lining layers) of the large intestine (colon). The pigment deposition results in a characteristic dark brown to black discoloration of the lining of the large intestine.

May also result in cathartic colon (Melanosis coli)

Bartter’s-like syndrome

(kidney disorder; appears in childhood; dec K level (hypokalemia)

Phenolphthalein

The drug has been discontinued.

Phenolphthalein

Colors the alkaline urine red

Phenolphthalein

Disrupts the water and electrolyte balance of the body and can thus cause symptoms of illness (e. g., cardiac arrhythmias secondary to hypokalemia).

Cascara sagrada

Calcium sennosides (Senokot)

Anthraquinones

Senokot

Calcium sennosides BN

Rhamnus purshiana

Cascara sagrada From dried bark of

Cascara sagrada

It has very little action on the small intestine but promotes peristalsis in the large intestine

Widely used cathartic.

- It is used for relief of transient constipation.

Cascara sagrada use

Calcium sennosides (Senokot)

A natural complex of anthraquinone glycosides found in senna,

isolated from Cassia angustifolia as calcium salts, contains 55% to 65% of the calcium salts.

Cassia angustifolia

Calcium sennosides (Senokot) from

Ricinus communis

Castor Oil obtained from the seed of

Emulsoil; Neoloid; Purge

Castor Oil BN

Castor Oil

Small bowel irritant laxative

Castor Oil

MOA:

● Hydrolyzed to ricinoleic acid (upper GIT) which stimulates water secretion in the intestine while decreasing glucose absorption

Ricin

toxic component of castor bean

Emollient Laxatives

Stool Softener aka

Stool Softener (Emollient Laxatives)

Substances included in this category are surface-acting or wetting agents, which are nonabsorbable and relatively nontoxic

Stool Softener (Emollient Laxatives)

Have a detergent action that facilitates the mixing of watery and fatty substances to increase luminal mass

Stool Softener (Emollient Laxatives)

Mechanism of action: Their action is attributed to their surface-active property:

○ lowering surface tension > permit the intestinal fluids to penetrate the fecal mass more readily > produce soft, easily passed stools

Docusate (Colace, Surfak) Glycerin

Mineral Oil

Stool Softener (Emollient Laxatives)

Docusate (Colace, Surfak) Glycerin

used to produce short-term laxation and to reduce straining at defecation they are used to prevent constipation

Mineral Oil

almost non-absorbable and makes feces softer and passed easier and coats fecal contents and thereby inhibits absorption of water

prevent and treat fecal impaction in children and debilitated adults

Mineral Oil use

Mineral Oil

Decreases the absorption of fat soluble vitamins (long-term use) and causes lipid pneumonitis can develop if aspirated

TEGASEROD

Serotonin Agonist

Stimulation of 5HT4 also activates cAMP dependent chloride secretion from the colon, leading to increased stool liquidity

○ Promotes gastric emptying and enhances small and large bowel transit

TEGASEROD MOA

Diarrhea

Excessive fluid weight, with 200 g/day representing the upper limit of normal stool water weight for healthy adults

TEGASEROD

Taken before meals nerve afferent

TEGASEROD

Irritable bowel syndrome with constipation

TEGASEROD

For chronic constipation

aching sensation with tenesmus (straining, ineffective and painful stooling).

Clinical Presentation of Diarrhea

Signs and symptoms

Typically demonstrates hyperperistalsis with borborygmi and generalized or local tenderness.

Diarrhea

Physical examination

1. Clear liquids & oral soln’s (gatorade, pedialyte)

2. IV electrolyte soln’s.

Nonpharm treatment:

Clear liquids & oral soln’s (gatorade, pedialyte)

intended as soon as intake of usual foods and fluids is discontinued and before serious fluid looses or deficit occurs.

Lactated Ringers Injection USP

Ringers Injection USP

IV electrolyte soln’s.

NaCl, KCI, CaCl, and Na lactate

Lactated Ringers Injection USP:

NaCl, KCI and CaCl

Ringers Injection USP

Oral Rehydration Salts

Balanced salt solutions containing glucose, sucrose or rice powder

Oral Rehydration Salts

Increase water absorption from the bowel lumen by increasing

sodium substrate transport across intestinal epithelial cells.

Oral Rehydration Salts

Can remedy 99% of acute cases of childhood diarrhea