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Nur210 Laxatives

Pharmacology laxatives

What are properties of lubricants? Mineral oil (Haley's MO) Coats fecal contents for easier passage Reduces water reabsorption in colon - makes stool a little bit softer Used to prevent straining Decrease absorption of fat soluble vitamins (A, D, E and K) because of the coating
What are properties of osmotic laxatives? Milk of magnesia Osmotic effect increases pressure in the bowels - draws water into intestinal lumen Stimulates peristalsis used for acute emptying of bowel Avoid in patients with kidney dysfunction
What are properties of stimulant laxatives? bisacodyl (Dulcolax) Irritate intestinal mucosa to increase motility - can cause semisolid stool in 6-12 hours Used to prepare bowel for diagnostic procedures Can cause severe cramping People will abuse to lose weight Chronic use fluid imbalance
What are properties of surfactant laxatives? Docusole sodium (Colace) - take 1-3 days to work Detergents that lower surface tension Increase secretion of water by intestine - causes bulk formation Short-term therapy to prevent straining Little to no value for chronic constipation
What are properties of bulk-forming laxatives? Psyllium (metamucil) - takes several days to work Least irritating, most natural, identical to dietary fiber Best for chronic constipation Used to relieve mild, watery diarrhea Can cause esophageal obstruction; turns to concrete upon standing
What are the classifications of laxatives? Lubricants Osmotic Stimulant Surfactant Bulk-forming
What are indicators for laxative use? Constipation - stool consistency; frequency Treatment/procedure preparation (i.e. colonoscopy) Eases defecation Stimulates defecation
What are some steps to take in bowel training? Provide privacy and normal position Recognize the "urge" Gastro-colonic reflex - food in/ food out Increase fluid intake - stimulates food in/food out reflex Increase fiber Increase activity Avoid valsalva maneuver - very hard on heart
How would one do an assessment for constipation? Assess rectal and colon problems Assess medications - narcotics cause constipation as does anasthesia Assess lifestyle - eat enough fiber? active? stress? change in routine? Assess age - older lose sensation, peristalsis and perineal/anal muscle tone
What are the Rome II criteria for functional constipation? Adults - Two or more of the following at 12 weeks: straining, lumpy hard stool, sensation of incomplete evacuation, less than 3 stools/week Infants/children - pebble-like hard stool, firm stools 2X/week or less for 2 weeks
What are properties of normal feces? 75% H2O, 25% solid material Soft, brown, formed stool 100-400 grams/day Frequency varies with individuals
What is the function of the large intestine? 90% of H2O reabsorption occurs in the large intestine Reabsorb H2O and electrolytes Flatus and fecal elimination
What are proton pump inhibitors? Prilosec, Nexium (omeprazole) Blocks the proton pump (H+) Inhibits gastric acid secretion Short half-life; supposed to be used for short-term Side effects - headache, GI nausea, vomiting and diarrhea
How do Histamine-2-antagonists work? Same effects as antacids, but don't have to take as frequently Inhibit histamine receptors of parietal cells (that produce acid) Decrease acid production
What are some Histamine-2-agonists? End in -tidine May have to double dosage to reach prescription strength Cimetidine (Tagament) - interacts with multiple meds; increased confusion in older adults Ranitidine (Zantac) - not as much confusion; doesn't enter CNS readily Axid,Pepcid
What are effects of antacids? Increase pH; want above 5 to inhibit pepsin activity Decreases destruction of gut wall Neutralizes stomach acid
What are properties of antacids? Neutralize stomach acid ADRs - constipation (aluminum hydroxide), diarrhea (magnesium hydroxide), drug interactions, too much sodium Used for GERD and as calcium supplement
What is some information on Helicobacter pylori? Test for presence by biopsy, breath, serum and stool Treatment - at least 2 antibiotics to minimize resistance Also need to be on Histamine-2-antagonists or PPIs
What are the classes of antiulcer drugs? Antiobiotics - against H. pylori Antacids Antisecretory agents - Histamine-2-antagonist and proton pump inhibitors
What are some lifestyle modifications to prevent peptic ulcers? Stop smoking Avoid ASA and NSAIDs Little evidence to support changing diet, avoiding alcohol, or decreasing stress
What are aggressive factors associated with peptic ulcer formation? Helicobacter pylori - 75% of people with peptic ulcers have this bacterial infection Gastric acid Smoking - nicotine - decreases bicarbonate NSAIDs Corticosteroids
What are defensive factors against the formation of peptic ulcers? Protect the stomach Mucus Bicarbonate (neutralize acid) Blood flow Prostaglandins
Created by: ssbourbon



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