Laxatives1 and Purgatives
Laxatives1 and Purgatives
Laxatives1 and Purgatives
*
.
*Constipation is generally defined as
infrequent and/or unsatisfactory
defecation fewer than 3 times per week.
*Patients may define constipation as
passing hard stools or straining,
incomplete or painful defecation.
*
Epidemiology
Lack of exercise
Age
Drug induced
Disease States/Conditions
Non-drug Approach
Drug Approach
No evidence that increased exercise is beneficial in
severe constipation
Aim for 25-30g fibre/day
Unless dehydrated, increasing fluid does not relieve
chronic constipation and may increase the risk of fluid
overload eg heart or renal failure
*
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1. Bulk forming
*High fiber
*Absorbs water to increase bulk
*Distends bowel to initiate reflex bowel activity
Examples:
*psyllium (Metamucil)
*methylcellulose (Citrucel)
*polycarbophil
*
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2005, 2002 by Mosby, Inc.
* psyllium (Metamucil)
Improve stool consistency and frequency with regular
use
*
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2005, 2002 by Mosby, Inc.
Saline laxative; saline cathartic; examples:
*magnesium sulfate (Epsom salts)
*magnesium hydroxide (MOM)
*magnesium citrate
*sodium phosphate (Fleet Phospho-Soda, Fleet
enema)
*
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2005, 2002 by Mosby, Inc.
* sodium phosphate (Fleet Phospho-
Soda, Fleet enema)
*Saline cathartics are nonabsorbable salts
(anions and cations) that hold water in the
intestine by osmosis and distend the bowel.
*increasing intestinal activity and producing
defecation in a few hours.
*Electrolyte solutions containing polyethylene
glycol (PEG) are used as colonic lavage solutions
to prepare the gut for radiologic or endoscopic
procedures.
4. Stimulant
*Increases peristalsis via intestinal nerve
stimulation
Examples:
*castor oil
*senna
*cascara
*bisacodyl *
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2005, 2002 by Mosby, Inc.
* castor oil
*Senna is a widely used stimulant laxative.
* Its active ingredient is a group of sennosides,
a natural complex of glycosides.
*Taken orally, it causes evacuation of the
bowels within 8 to 10 hours.
*It also causes water and electrolyte secretion
into the bowel.
*In combination products with a docusate-
containing stool softener, it is useful in treating
opioid-induced constipation.
*Bisacodyl, available as suppositories and enteric-
coated tablets, is a potent stimulant of the colon.
*It acts directly on nerve fibers in the mucosa of the
colon.
*Adverse effects include abdominal cramps and the
potential for atonic colon with prolonged use.
*.
*Antacids should not be taken at the same
time as the enteric-coated tablets. The
antacid would cause the enteric coating
to dissolve prematurely in the stomach,
resulting in stomach irritation and pain.
*The same adverse effects could be
expected with milk, H2-receptor
antagonists, and PPIs
*Castor oil is broken down in the small
intestine to ricinoleic acid, which is very
irritating to the gut, and promptly increases
peristalsis.
*Itshould be avoided by pregnant patients,
because it may stimulate uterine
contractions.
*Bulk forming
*Impaction
*Fluid overload
*Emollient
*Skin rashes
*Decreased absorption of vitamins
*Hyperosmotic
*Abdominal bloating
*Rectal irritation
*
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* Saline
*Magnesium toxicity (with renal insufficiency)
*Cramping
*Diarrhea
*Increased thirst
* Stimulant
*Nutrient malabsorption
*Skin rashes
*Gastric irritation
*Rectal
*irritation
*
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2005, 2002 by Mosby, Inc.
*All laxatives can cause electrolyte
imbalances!
*
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2005, 2002 by Mosby, Inc.
*Obtain a thorough history of presenting
symptoms, elimination patterns, and
allergies
*Assess fluid and electrolytes before
initiating therapy
*Patients should not take a laxative or
cathartic if they are experiencing nausea,
vomiting, and/or abdominal pain
*
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2005, 2002 by Mosby, Inc.
*A healthy, high-fiber diet and increased
fluid intake should be encouraged as an
alternative to laxative use
*Long-term use of laxatives often results in
decreased bowel tone and may lead to
dependency
*All laxative tablets should be swallowed
whole, not crushed or chewed, especially
if enteric coated
*
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2005, 2002 by Mosby, Inc.
*Bisacodyl and cascara sagrada should be
given with water due to interactions with
milk, antacids, and H2 blockers
*
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2005, 2002 by Mosby, Inc.
*Patients should contact their
physician if they experience severe
abdominal pain, muscle weakness,
cramps, and/or dizziness, which may
indicate possible fluid or electrolyte
loss
*Monitor for therapeutic effect
*
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2005, 2002 by Mosby, Inc.