Elimination Flashcards
Catharsis/Purgative
◦Prompt, fluid evacuation of the bowel
◦Fast and intense
◦May cause cramping, diarrhea
Bulk forming laxatives
psyllium
◦ similarly to fiber: Swell with water to form a gel that softens and increases fecal mass to press against wall and start peristalsis
◦Preferred temporary treatment of constipation, safe for everyday use
◦Used for diverticulosis and irritable bowel syndrome
◦Adverse effects: bloating, gas
- need to drink plenty of fluid !!
Don’t use for people with narrowing of intestinal lumen
Need to take right away after mixing bc it turns jelly
Can also treat diarrhea
Surfactant Laxatives
◦DOCUSATE SODIUM
◦Produce a soft stool several days after onset of treatment
◦Alter stool consistency by lowering surface tension, which allows penetration of water into feces
◦May also act on intestinal wall to
(1) inhibit fluid absorption
(2) stimulate secretion of water and electrolytes into intestinal lumen; in this respect, surfactants resemble stimulant laxatives
Avoid w/ intestinal disorders - irritate intestinal mucosa
Can become dependent on them
◦May use emollients (oils) to lubricate stools
Stimulant Laxatives
bisacodyl
directly stimulate the lining of the intestine by directly acting on the tissues lining the bowel wall or the nerves within the bowel wall. This increases intestinal motility to expel fecal matter.
◦Widely used and abused
◦Legitimately used for opioid-induced constipation and for constipation from slow intestinal transit
◦Often used in bowel preps
• work within a few hours and may cause intestinal cramping. Long-term, regular use should be avoided as these may cause laxative dependency
Osmotic Laxatives
magnesium citrate
◦Laxative salts or sugars (hypertonic)
◦Poorly absorbed salts that draw water into intestinal lumen; fecal mass softens and swells, wall stretches, and peristalsis is stimulated
◦ rarely used- cause dehydration and intestinal cramping
Most often for prep usual
Osmotic laxative adverse effect
◦Dehydration: Substantial water loss
◦Acute renal failure
◦Sodium retention: Exacerbated heart failure, hypertension, edema
Metoclopramide
Antiemetics / Prokinetic agent
⬇️ N/V and reflux
⬇️ transit time in intestine (empty fast) by increasing gastric motility
Need active bowel sounds or passing gas to make sure there not obstruction - NOT be given to a patient with a bowel obstruction as it can cause intestinal perforation.
used to increase gut motility after anesthesia to prevent paralytic ileus.
associated with EPS, tremors, tardive dyskinesia and neuroleptic malignant syndrome.
Adverse effects
- Sedation, diarrhea common
Loperamide
Anti diarrhea
⬇️ motility allowing water absorption
Opioid but little to no potential for abuse
⬇️ volume of discharge for ileostomy
Diphenoxylate
Anti diarrhea
Opioid — habit forming bc it gives a “high”
⬇️ motility allowing for water absorption
Rifaximin
antibiotic used to treat traveler’s diarrhea, irritable bowel syndrome, and hepatic encephalopathy. It reduces intestinal bacteria to stop traveler’s diarrhea and also kills bacteria in the gut that produce ammonia in hepatic encephalopathy.
Types of osmosis laxative
Saline – hypertonic sodium chloride is used to draw fluid into the bowel. (Sodium phosphate)
Electrolyte Salts – salts of magnesium or other electrolytes are used to shift fluid into the bowel. ( magnesium citrate and polyethylene glycol)
Sugars – hypertonic sugar solutions are used to cause fluid movement into the bowel through osmosis. ( milk and molasses enemas and lactulose)
Atropine
anticholinergic, is combined with diphenoxylate because it dries secretions as well as helps to prevent drug abuse and overdose of dyphenoxylate.
