Laxatives & Antidiarrheals Use

Chapter 26

Laxatives and Antidiarrheals

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

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Laxative Classifications

Stimulant Saline Bulk-forming Lubricant

Stool softeners Suppositories

Lactulose Enemas


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Stimulant Laxatives

Action Chemical irritation

Increase motility of the GI tract Increase secretion of water into large and

small intestine Example: bisacodyl


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Saline Laxatives

Increase osmotic pressure within the intestinal tract

Cause more water to enter the intestines Result in:

Bowel distention, increased peristalsis, and evacuation

(continues)


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Saline Laxatives

Contain salt Unpleasant taste Systemically absorbed Result in:

Poor client compliance Risk for dehydration Risk for congestive heart failure

(continued)


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Bulk-Forming Laxatives

Safest form Absorbs water to increase bulk Distends bowel to initiate reflex bowel activity

Not systemically absorbed High fiber Natural or semisynthetic

Examples: psyllium hydrophilic muciloid (Metamucil), methylcellulose (Citrucel), and polycarbophil (Fibercon)

(continues)


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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.

(continued)


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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 (liquid petroleum)

Not digested or absorbed


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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)


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Suppositories

Usually in a wax base Administered rectally Absorbed systemically Available containing stimulant drugs

Glycerin Absorbs water from tissues, creating more mass

Bisacodyl Induces peristaltic contraction by direct stimulation

of sensory nerves


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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


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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


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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


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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


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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)


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Antidiarrheals

Reduce GI motility Opium is a narcotic.

Decreases bowel motility and rectal spasms Depresses the CNS; monitor closely Decreases transit time through the bowel;

more time for water and electrolytes to be absorbed

Paregoric is an opium tincture. May cause physical dependence

(continues)


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Antidiarrheals

Loperarmide HCl (Imodium) Made from chemicals related to meperidine,

a narcotic Diphenoxylate HCl and atropine sulfate

(Lomotil) Narcotic and anticholinergic drug

Reduces GI motility

(continued)


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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)


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Nursing Implications

Monitor for therapeutic effect

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Laxatives & Antidiarrheals Use