C HAPTER 25 Laxatives and Antidiarrheals

C ONSTIPATION 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

L AXATIVES 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

L AXATIVES 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

L AXATIVE C LASSIFICATIONS Stimulant Saline Bulk-forming Lubricant Stool softeners Suppositories Lactulose Enemas 5

S TIMULANT L AXATIVES Action Chemical irritation Increase motility of the GI tract Increase secretion of water into large and small intestine Example: bisacodyl 6

S ALINE L AXATIVES Increase osmotic pressure within the intestinal tract Cause more water to enter the intestines Result in: Bowel distention, increased peristalsis, and evacuation 7

S ALINE L AXATIVES Contain salt Unpleasant taste Systemically absorbed Result in: Poor client compliance Risk for dehydration Risk for congestive heart failure 8

B ULK -F ORMING L AXATIVES Safest form Absorbs water to increase bulk Distends bowel to initiate reflex bowel activity Not systemically absorbed High fiber 9

B ULK -F ORMING L AXATIVES Natural or semisynthetic Examples: psyllium hydrophilic muciloid (Metamucil), methylcellulose (Citrucel), and polycarbophil (Fibercon) 10

B ULK -F ORMING L AXATIVES 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

L UBRICANT L AXATIVES 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

S TOOL S OFTENERS 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

S UPPOSITORIES Usually in a wax base Administered rectally Absorbed systemically 14

S UPPOSITORIES Available containing stimulant drugs Glycerin Absorbs water from tissues, creating more mass Bisacodyl Induces peristaltic contraction by direct stimulation of sensory nerves 15

L ACTULOSE L AXATIVES 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

G O LYTELY 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

E NEMAS 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

L ONG -T ERM U SE 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

N URSING C ONSIDERATIONS 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

N URSING C ONSIDERATIONS 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

D IARRHEA 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

D IARRHEA 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

A DSORBENTS 24 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)

D RUGS THAT R EDUCE GI M OTILITY Opiate derivatives - reduce propulsive movement of the small intestine and colon - dependence with prolonged use - depression of the CNS 25

D RUGS THAT R EDUCE GI M OTILITY Anticholinergic drugs - reduce intestinal motility - potential dangerous side effects – limits usefulness 26

A NTIDIARRHEALS 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

A NTICHOLINERGICS 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

N URSING C ONSIDERATIONS 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

N URSING CONSIDERATIONS Adults with fever, dehydration, or persistent diarrhea should contact provider Infants and young children need sooner evaluation 30

N URSING 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