reduces absorption of certain drugs- cimetidine. raises blood concentration of meds metabolized through the liver. may reduce effects of skin tests for allergies. timing of antacids-should be given 1 hour before antacid.
usual time span between ingestion and defecation is 24-36 hours. stimulates peristalsis by absorbing water, increasing bulk of feces to form emollient gel. causes dilation of intestine initiating reflex bowel activity promoting bowel movement. used for chronic diarrhea.
Bulk Forming side effects
Metamucil: may increase blood glucose (watch diabetic pts). Citrucel- contraindicated in GI obstruction and hepatitis. Time for results- 12-24 hours.
draws water into the G/I tract increasing fecal water content, resulting in distension, increased peristalsis, and evacuation
Hyperosmotic side effects
Golytely- contraindicated in GI obstruction, bowel perforation. Lactulose- low galactose diet. Glycerin- no contraindications- very mild laxative, used on children and adults Time for results (ONSET)- Golytely- 1 hour. Lactulose- 24 hours. Glycerin- 16-36 minutes
Saline Cathartic agents
magnesium citrate (Citrate of Magnesia) magnesium hydroxide (MOM)
Saline Cathartic actions
draws water into the small intestine. salt commonly used for rapid evacuation of the bowel in preparation for some GI diagnostic tests (colonoscopy)
Saline Cathartic side effects
contraindicated in renal insufficiency, abdominal pain/ nausea/ vomiting, intestinal obstruction, rectal bleeding G/I: diarrhea F /E: imbalances Time for results- ½- 3 hours (onset)
soften fecal impaction through the passage of water and lipids into fecal matter, facilitate easy bowel movements for patients with anorectal conditions (hemorrhoids), may be used prophalactially to prevent constipation in high risk patients
Stool Softeners side effects
diarrhea, contraindicated in bowel obstruction, nausea/vomiting Time for results- 6-8 hours
Individual agents- may be given orally or by enema mineral oil
Lubricants Mechanism of action
eases passage of stool by preventing water from leaving the stool, lubricates the intestines
Lubricants Adverse effect
contraindicated in bowel obstruction, abdominal pain, nausea/vomiting Time for results- 12-24 hours
Laxatives Assess for contraindications/use cautiously
abdominal pain. patients with limited fluid intake (bulk-forming). monitor blood sugar in diabetics. renal disease.
LAXATIVES Education of the patient/family
take with lots of water(movement and hydration). encourage other ways to prevent constipation: exercise. increase fluids, increase bran products. know when to expect results. dependency. best on an empty stomach. suppository works. refrigerate citrate. mix castor oil with juice. senna products may discolor urine (red tint).
coats the walls of the G/I tract, absorbing the bacteria or toxins causing diarrhea. promotes intestinal adsorption of fluids and electrolytes.
Anticholinergics Individual agents
Atropine Belladonna alkaloids .Donnatal.
anticholinergics Mechanism of action
Antimotility- decrease peristalsis, decrease muscle tone , used in combination with adsorbents and opiates.
Synthetic opiates agents
Codeine. loperamide. diphenoxylate/atropine.
Synthetic opiates actions
decrease bowel motility, secondary- reducing pain related to diarrhea and abdominal cramping, allow for water absorption due to decreased peristalsis
Intestinal Flora Modifiers agents
Lactobacillus acidophilus (Bacid, Lactinex)
Intestinal Flora Modifiers action
suppresses growth of bacteria by restoring the natural flora of the bowel, they are natural organisms obtained from bacterial cultures, may need to be given post antibiotic therapy
ANTIDIARRHEALS Use cautiously in contraindication
geriatric patients with fecal impaction children <2 yr abdominal pain
Pepto-Bismol interferes with absorption of digoxin, tetracycline. increases the effects of oral anticoagulants (cumdine) Pepto Bismol-children or teenagers during or after chickenpox or flu-like illnesses; medication may temporarily cause stools and tongue to appear gray-black: salicylate toxicity assess for constipation. addictive effect with CNS depressants.
ANTIDIARRHEALS Education of the patient family
shake liquid instruct patient that this med contains aspirin notify professional if diarrhea persists for more than 2 days or if accompanied by high fever dizziness added CNS depression with alcohol, antihistamines, sedatives, etc. dry mouth notify immediately; if blood is passed fluid replacement