Anti-Constipation and Antidiarrheal Drugs

Question 1

Acute Diarrhea

Answer 1

Sudden onset in a previously healthy person

Lasts from 2 days to 3 weeks

Self-limiting

Resolves without sequelae

Caused by bacteria, viruses, drugs, nutritional factors, and protozoa

Question 2

Chronic Diarrhea

Answer 2

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

Caused by tumors, diabetes mellitus, Addison’s disease, hyperthyroidism, irritable bowel syndrome, and AIDS

Question 3

Goals of Diarrhea Treatment

Answer 3

Stopping the stool frequency

Alleviating the abdominal cramps

Replenishing fluids and electrolytes

Preventing weight loss and nutritional deficits from malabsorption

Question 4

Adsorbents

Answer 4

Coat the walls of the GI tract

Bind to the causative bacteria or toxin, which is then eliminated through the stool

BISMUTH SUBSALICYLATE (PEPTOL-BISMOL)

Question 5

Antimotility Drugs: Anticholinergics

Answer 5

Decrease intestinal muscle tone and peristalsis of GI tract

Slows the movement of fecal matter through the GI tract

Question 6

Antimotility Drugs: Opiates

Answer 6

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

LOPERAMIDE (IMMODIUM) AND DIPHENOXYLATE (LOMOTIL)

Question 7

Probiotics

Answer 7

Known as intestinal flora modifiers and bacterial replacement drugs

Supply missing bacteria to the GI tract and suppress growth of diarrhea-causing bacteria

Question 8

Adverse Effects of Adsorbents

Answer 8

Increased bleeding time, constipation and dark stools, confusion, tinnitus, metallic taste, blue tongue

Question 9

Adverse Effects of Anticholinergics

Answer 9

Urinary retention, impotence, headache, confusion, dizziness, drowsiness, dry skin/flushing, blurred vision, hypotension, bradycardia

Question 10

Adverse Effects of Opiates

Answer 10

Drowsiness, nausea, vomiting, constipation, respiratory depression, hypotension, urinary retention, flushing

Question 11

Interactions of Antidiarrheals

Answer 11

Adsorbents decrease the absorption of many drugs including digoxin, quinidine, and hypoglycemic drugs

Adsorbents caused increased bleeding time when given with Warfarin

Question 12

Nursing Implications for Antidiarrheals

Answer 12

DO NOT GIVE BISMUTH SUBSALICYLATE TO CHILDREN OR TEENAGERS WITH CHICKENPOX OR INFLUENZA BECAUSE OF THE RISK OF REYE’S SYNDROME

Do not give anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon

Question 13

Bulk Laxative

Answer 13

PSYLLIUM (METAMUCIL)

Not digested but absorb liquid in the intestines and swell to form a soft, bulky stool

Used for acute and chronic constipation, IBS, diverticulosis

Question 14

Emollients

Answer 14

COLACE

“Wet” the stool

Used for acute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions (hemorrhoids, rectal surgery, birth)

Question 15

Hyperosmotic Laxatives

Answer 15

LACTULOSE (CHRONULAC)

ALSO USED TO LOWER SERUM AMMONIA LEVEL IN LIVER DISEASE

Draw water into the intestines to soften the stool

Used in chronic constipation, diagnostic and surgical preps

Question 16

Saline

Answer 16

MILK OF MAGNESIA, MAGNESIUM CITRATE (CITROMA)

Absorbs water from the blood into the intestines

Used for constipation, diagnostic and surgical preps

Question 17

Stimulant

Answer 17

BISACODYL (DULCOLAX)

Increases the movement of the intestines

Used for acute constipation, diagnostic and surgical preps

Question 18

Polyethylene Glycol (GoLytely)

Answer 18

Used before colonoscopies

Patient will have to defecate frequently

Question 19

Nursing Implications for Laxatives

Answer 19

INFORM PATIENTS NOT TO TAKE A LAXATIVE OR CATHARTIC IF THEY ARE EXPERIENCING NAUSEA, VOMITING, AND/OR ABDOMINAL PAIN

Long-term use of laxatives may result in decreased bowel tone and may lead to dependency

All laxatives should be swallowed whole