Pharm T3 (Antidiarrheals & Laxatives 2)

Abnormal passage of stools with increased frequency, fludity, and weight, or with increase stool water excretion. 3 or more loose liquid stools per day.

What is diarrhea?

\-Sudden onset

\-Lasts 3 days to 2 weeks

\-Self-limiting

\-Resoleves without sequelae

acute diarrhea

\-Lasts for more than 3-4weeks

\-Recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomitting, weight loss & chronic weakness.

chronic diarrhea

\-Adsorbents

\-Antimotility drugs (Anticholinergics and opiates)

\-Probiotic (intestinal flora modifiers and bacterial replacement

The classifications of the 3 antidiarrheals?

\-Coat the walls of the GI tract

\-Bind to the causative bacteria or toxin, which is eliminated through the stool. ex: bismuth subsalicylate (Peptic-Bismol) activated charcoal

What do absorbents do?

used with caution in children and adolescents who have or are recovering from chicken pox or influenza because of the risk of Reye’s syndrome.

What must we be cautious with regarding bismuth subsalicylate? 

Warfarin sodium, aspirin, or other non steroidal anti-inflammatory drugs.

What medication does bismuth subsalicylate interact with?

\-Decreases bowel motility

\-Decrease transmit time through the bowel, allowing more time for water and electrolytes to be absorbed.

What do antimotility drugs do? 

\-**Opiates**: decrease bowel motility and reduces pain.

\-**Anticholinergic**: decrease muscle tone and peristalsis, have a drying effect, reduce gastric secretion

What are the two drug classifications in antimotility drugs?

headache, pruritus, heart failure, xerostomia, diabetes mellitus, and osteoporosis.

What are adverse effects of anticholinergic drugs?

Reduces pain associated with diarrhea by relief of rectal spasms.

Why are opiates used for antidiarrheal?

\-Loperamide (Imodium)

\-Lomotil (diphenoxylate/atropine)

What's an example of an antimotility drug (know the 2).

there isn't enough in it to get addicted. If abused they will experience urine retention, dry mouth, and dry eyes.

Why doesn't a patient get addicted to the opiates within these drugs? What happens if they try to abuse them?

suppress the growth of diarrhea & Re-establish the normal flora.

What are probiotics used for?

Lactobacillus

What is the most common probiotic organism?

Used to treat constipations, moving bowels regularly, and soften stool

What are laxatives used for?

* Bulk forming
* Emollient
* Hyperosmotic
* Saline
* Stimulant

the five types of laxatives?

acute and chronic constipation, irritable bowel syndrome and diverticulosis

What are bulk-forming laxatives used for?

240 mls of water or package directions to avoid a esophageal obstruction or blockage

What MUST bulk-forming laxatives be taken with and why?

Methylcellulose & Psyllium hydrophilic mucilloid (Metamucil)

What are two examples of bulk-forming laxatives?

240mls to avoid fecal impaction & to work properly 

How much water should the nurse mix bulk-forming laxatives with and why do we do this?

acute or chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions.

What are emollient laxatives used for and what do they do?

\-Stool softeners: Docusate salts (colace)

\-Lubricants: mineral oil

What are two examples of emollient laxatives?

Increase fecal water content, results in bowel distension, increased peristalsis and evacuation

what do hyperosmotic laxatives do

Chronic constipation, diagnostic and surgical procedures

What are hyperosmotic laxatives used for?

\-Polyethylene glycol 

\-Glycerin

\-Lactulose

What are the 3 hyperosmotic laxatives?

Constipation, diagnostic and surgical procedures.

What are saline laxatives used for?

Acute constipation, diagnostic and surgical procedures 

What are stimulant laxatives used for?

Stimulant class

What type of laxatives are most likely to cause dependence?

Patients experiencing nausea and vomiting and abdominal pain.

What type of patient should not take a laxative?

Polyethylene glycol (PEG 3350)

What drug do we use for total cleansing of the bowel?