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Chapter 51 Bowel Disorder Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Presentation on theme: "Chapter 51 Bowel Disorder Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc."— Presentation transcript:

1 Chapter 51 Bowel Disorder Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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3 Diarrhea  Abnormal passage of stools with increased frequency, fluidity, and weight, or with increased stool water excretion 3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

4 Diarrhea (cont’d) Acute diarrhea  Sudden onset in a previously healthy person  Lasts from 3 days to 2 weeks  Self-limiting  Resolves without sequelae 4Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

5 Diarrhea (cont’d) Chronic diarrhea  Lasts for more than 3-4 weeks  Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness 5Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

6 Causes of Diarrhea Acute DiarrheaChronic Diarrhea BacteriaTumors VirusesDiabetes mellitus Drug-inducedAddison’s disease Nutritional factors Hyperthyroidism ProtozoaIrritable bowel syndrome AIDS 6Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

7 Goals of Diarrhea Treatment  Stopping the stool frequency  Alleviating the abdominal cramps  Replenishing fluids and electrolytes  Preventing weight loss and nutritional deficits from malabsorption 7Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

8 Antidiarrheals  Adsorbents  Antimotility drugs (anticholinergics and opiates)  Probiotics (bacterial replacement drugs) 8Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

9 Antidiarrheals: Mechanism of Action Adsorbents  Coat the walls of the gastrointestinal (GI) tract  Bind to the causative bacteria or toxin, which is then eliminated through the stool  Examples: bismuth subsalicylate (Pepto-Bismol), activated charcoal, aluminum hydroxide, others 9Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

10 Antidiarrheals: Mechanism of Action (cont’d) Antimotility drugs: anticholinergics  Decrease intestinal muscle tone and peristalsis of GI tract  Result: slows the movement of fecal matter through the GI tract  Examples: belladonna alkaloids 10Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

11 Antidiarrheals: Mechanism of Action (cont’d) Antimotility drugs: opiates  Decrease bowel motility and reduce pain by relief of rectal spasms  Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed  Examples: paregoric, opium tincture, codeine, loperamide (over the counter), diphenoxylate 11Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

12 Antidiarrheals: Mechanism of Action (cont’d) Probiotics  Also known as intestinal flora modifiers and bacterial replacement drugs  Bacterial cultures of Lactobacillus organisms work by:  Supplying missing bacteria to the GI tract  Suppressing the growth of diarrhea-causing bacteria  Example: L. acidophilus (Bacid) 12Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

13 Classroom Response Question The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose of the atropine in this combination is to A.enhance the effects of the diphenoxylate. B.discourage recreational use of the opiate diphenoxylate. C.counteract the adverse effects of the diphenoxylate. D.act as an adsorbent for bacteria in the bowel. 13Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

14 Antidiarrheals: Adverse Effects Adsorbents  Increased bleeding time  Constipation, dark stools  Confusion  Tinnitus  Metallic taste  Blue tongue 14Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

15 Antidiarrheals: Adverse Effects (cont’d) Anticholinergics  Urinary retention, impotence  Headache, dizziness, confusion, anxiety, drowsiness, confusion  Dry skin, flushing  Blurred vision  Hypotension, bradycardia 15Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

16 Antidiarrheals: Adverse Effects (cont’d) Opiates  Drowsiness, dizziness, lethargy  Nausea, vomiting, constipation  Respiratory depression  Hypotension  Urinary retention  Flushing 16Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

17 Antidiarrheals: Interactions  Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs  Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin)  Toxic effects of methotrexate are more likely when given with adsorbents 17Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

18 Antidiarrheals: Nursing Implications  Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies  Do NOT give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye’s syndrome 18Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

19 Classroom Response Question Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition? A.Anemia B.Diabetes mellitus C.Myasthenia gravis D.Hypertension 19Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

20 Antidiarrheals: Nursing Implications (cont’d)  Use adsorbents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion  Do not administer anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon 20Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

21 Antidiarrheals: Nursing Implications (cont’d)  Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes  Assess fluid volume status, I&O, and mucous membranes before, during, and after initiation of treatment 21Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

22 Antidiarrheals: Nursing Implications (cont’d)  Teach patients to notify their prescriber immediately if symptoms persist  Monitor for therapeutic effect 22Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

23 Classroom Response Question Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision? A.Anticholinergics B.Adsorbents C.Probiotics D.Opiates 23Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

24 Constipation  Abnormally infrequent and difficult passage of feces through the lower GI tract  Symptom, not a disease  Disorder of movement through the colon and/or rectum  Can be caused by a variety of diseases or drugs 24Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

25 Laxatives  Bulk-forming  Emollient (stool softeners, lubricant laxatives)  Hyperosmotic  Saline  Stimulant  Peripherally acting opioid 25Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

26 Laxatives: Mechanism of Action Bulk-forming  High fiber  Absorb water to increase bulk  Distend bowel to initiate reflex bowel activity  Examples  psyllium (Metamucil)  methylcellulose (Citrucel) 26Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

27 Laxatives: Mechanism of Action (cont’d) Emollient  Stool softeners and lubricants  Promote more water and fat in the stools  Lubricate the fecal material and intestinal walls  Examples  Stool softeners: docusate salts (Colace, Surfak)  Lubricants: mineral oil 27Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

28 Laxatives: Mechanism of Action (cont’d) Hyperosmotic  Increase fecal water content  Results in bowel distention, increased peristalsis, and evacuation  Examples:  Polyethylene glycol (PEG)  Sorbitol, glycerin  Lactulose (also used to reduce elevated serum ammonia levels) 28Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

29 Laxatives: Mechanism of Action (cont’d) Saline  Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines  Results in bowel distention, increased peristalsis, and evacuation  Examples  Magnesium hydroxide (Milk of Magnesia)  Magnesium citrate (Citroma) 29Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

30 Laxatives: Mechanism of Action (cont’d) Stimulant  Increases peristalsis via intestinal nerve stimulation  Examples  senna (Senekot)  bisacodyl (Dulcolax) 30Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

31 Peripherally Acting Opioid Antagonists  Treatment of constipation related to opioid use and bowel resection therapy  Block entrance of opioid into bowel  Strict regulations for use  Allow bowel to function normally with continued opioid use  methylnaltrexone (Relistor)  alvimopan (Entereg) 31Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

32 Laxatives: Indications Laxative GroupUse Bulk-formingAcute and chronic constipation, irritable bowel syndrome, diverticulosis EmollientAcute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions 32Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

33 Laxatives: Indications (cont’d) Laxative GroupUse HyperosmoticChronic constipation, diagnostic and surgical preps SalineConstipation, diagnostic and surgical preps StimulantAcute constipation, diagnosticand surgical preps 33Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

34 Classroom Response Question A patient is receiving lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose? A.Cleansing the bowel before a procedure B.Removal of helminths C.Reduction of high ammonia levels associated with liver failure D.Daily maintenance to prevent constipation 34Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

35 Laxatives: Adverse Effects  Bulk-forming  Impaction  Fluid overload  Electrolyte imbalances  Esophageal blockage  Emollient  Skin rashes  Decreased absorption of vitamins  Electrolyte imbalances  Lipid pneumonia 35Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

36 Laxatives: Adverse Effects (cont’d)  Hyperosmotic  Abdominal bloating  Electrolyte imbalances  Rectal irritation  Saline  Magnesium toxicity (with renal insufficiency)  Cramping  Electrolyte imbalances  Diarrhea  Increased thirst 36Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

37 Laxatives: Adverse Effects (cont’d)  Stimulant  Nutrient malabsorption  Skin rashes  Gastric irritation  Electrolyte imbalances  Discolored urine  Rectal irritation  All laxatives can cause electrolyte imbalances! 37Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

38 Laxatives: Nursing Implications  Obtain a thorough history of presenting symptoms, elimination patterns, and allergies  Assess fluid and electrolytes before initiating therapy  Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain 38Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

39 Laxatives: Nursing Implications (cont’d)  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 39Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

40 Laxatives: Nursing Implications (cont’d)  Patients should take all laxative tablets with 6 to 8 oz of water  Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water 40Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

41 Laxatives: Nursing Implications (cont’d)  Give bisacodyl with water because of interactions with milk, antacids, and juices  Inform patients to contact their prescriber if they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss  Monitor for therapeutic effect 41Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

42 Classroom Response Question A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient? A.Milk of magnesia B.A bulk-forming laxative C.Mineral oil D.No laxative should be given at this time 42Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

43 Irritable Bowel Syndrome  Chronic intestinal discomfort characterized by cramps, diarrhea, and/or constipation  Patients usually cope with the symptoms by avoiding irritating foods and/or taking over-the- counter (OTC) laxatives and antidiarrheal drugs 43Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

44 Drugs for Irritable Bowel Syndrome  tegaserod (Zelnorm)  lubiprostone (Amitiza)  alosetron (Lotronex) 44Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

45 Drugs for Irritable Bowel Syndrome: Nursing Implications  Perform a general assessment and additional assessment of liver functioning as well as assessment for any underlying cardiac disease  Follow administration guidelines  Assess for therapeutic response 45Copyright © 2014 by Mosby, an imprint of Elsevier Inc.


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