Pharmacology: Laxatives

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Questions and Answers

What type of patients may benefit from laxatives, in addition to those who are constipated?

Patients who are on low residue diets, postpartum, elderly, or have diverticular disease, spastic colon, or hemorrhoids.

What is the mechanism of action of Magnesium Hydroxide and Magnesium Citrate?

Nonabsorbable ions → ↑ osmotic pressure in bowel → watery stools in 1-3 hr.

Why must Magnesium Hydroxide be introduced gradually?

To avoid GI impaction.

What is the class of drug that Magnesium Hydroxide and Magnesium Citrate belong to?

Laxative (Saline Cathartic) Signup and view all the answers

What is the mechanism of action of Loperamide (Imodium) in the large intestine?

Increased tone and decreased propulsive peristaltic waves in large intest.→ decreased gut motility due to inhibition of ACh release by neurons Signup and view all the answers

What is the name of the agent that is described as 'Gentle'?

Magnesium Hydroxide Signup and view all the answers

What is the recommended caution when using Loperamide (Imodium) in kids?

Use with great caution, as kids are especially sensitive to atropine toxicity Signup and view all the answers

What is the potential problem associated with large amounts of Na+ in Magnesium Citrate?

Dehydration in patients on low Na+ diets. Signup and view all the answers

What is the effect of excessive doses of Loperamide (Imodium) on the respiratory system?

Potentially serious respiratory depression (may not be evident until 12-30 hr later) Signup and view all the answers

What is the utility of Magnesium Hydroxide and Magnesium Citrate in terms of endoscopic exam preparation?

Acute evacuation of bowel in preparation for endoscopic exam. Signup and view all the answers

How does Loperamide (Imodium) interact with other substances?

Potentiates effects of barbiturate, tranquilizers, alcohol, and other narcotics Signup and view all the answers

What is another utility of Magnesium Hydroxide and Magnesium Citrate?

Elimination of drugs/toxins for suspected drug/food poisoning. Signup and view all the answers

What is the special feature of Loperamide (Imodium)?

Atropine is included primarily to prevent drug abuse Signup and view all the answers

What is the mechanism of action of Paregoric?

Increased gastric tone → delayed gastric emptying Signup and view all the answers

What is the composition of Paregoric?

Preparation of oral morphine, anise oil, benzoic acid, camphor, diluted alcohol, and glycerin Signup and view all the answers

What is the utility of Loperamide (Imodium)?

Antidiarrheal Signup and view all the answers

What is the mechanism of action of the laxative discussed in the passage?

It absorbs and retains water, increasing fecal volume, which increases the rate of transit. Signup and view all the answers

What is the absorption of the laxative like?

It is not absorbed. Signup and view all the answers

What is the potential toxicity of the laxative?

It can bind to other drugs, reducing their absorption. Signup and view all the answers

When should the laxative be administered in relation to other medications?

More than 1 hour before or after other medications. Signup and view all the answers

What is the utility of the laxative?

It is useful in patients with alternating constipation and diarrhea, especially in irritable bowel syndrome. Signup and view all the answers

What is the Noble Truth of the Arising of Sorrow according to the passage?

It arises from craving, which leads to rebirth, bringing delight and passion. Signup and view all the answers

What is the Noble Truth of the Stopping of Sorrow according to the passage?

It is the complete stopping of craving, leaving no passion. Signup and view all the answers

What is the Noble Eightfold Path mentioned in the passage?

Right Views, Right Resolve, Right Speech, Right Action, Right Livelihood, Right Effort, Right Mindfulness, and Right Concentration. Signup and view all the answers

What is the class of antibiotic that Ciprofloxacin (Cipro) belongs to?

Fluorinated quinolone Signup and view all the answers

What is the mechanism of action of Ciprofloxacin (Cipro)?

Inhibits bacterial DNA synthesis Signup and view all the answers

What is the recommended treatment duration for diarrhea with Trimethoprim-Sulfamethoxazole (Bactrim, Septra)?

Until symptoms resolve, or no longer than 3 days Signup and view all the answers

What is the special feature of Difenoxin, an antidiarrheal medication?

Has 5x potency of diphenoxylate Signup and view all the answers

Why is atropine included in some antidiarrheal medications?

To prevent drug abuse Signup and view all the answers

What is a contraindication for the use of Ciprofloxacin (Cipro)?

Pregnant or nursing women, prepubertal children Signup and view all the answers

What is the utility of Trimethoprim-Sulfamethoxazole (Bactrim, Septra) in treating infections?

UTIs due to Enterobacteriaceae, Enterococcus, Staphylococcus, Pseudomonas, and infectious diarrhea Signup and view all the answers

What is a potential side effect of excessive doses of Difenoxin?

Pronounced euphoria, potentially serious respiratory depression Signup and view all the answers

What is the effect of prolonged use of large dose salicylates on vitamin K actions?

Blockage of vitamin K actions in prothrombin synthesis leading to hypoprothrombinemia Signup and view all the answers

What is the mechanism of vitamin B1 (Thiamine) in the body?

Coenzyme in decarboxylation reactions, facilitating conduction of impulses in peripheral nerves Signup and view all the answers

What is the effect of a megadose of vitamin B6 (Pyridoxine) on the body?

Severe (often irreversible) sensory neuropathy Signup and view all the answers

What is the relationship between vitamin B1 (Thiamine) deficiency and caloric intake?

RDA of vitamin B1 is directly proportional to caloric intake Signup and view all the answers

What is the effect of certain medications on vitamin B6 (Pyridoxine) levels?

Penicillamine, hydralazine, and isoniazid complex with B6, leading to decreased B6 levels Signup and view all the answers

What is the relationship between vitamin B6 (Pyridoxine) and nicotinic acid conversion?

Vitamin B6 is a cofactor of tryptophan → nicotinic acid conversion Signup and view all the answers

What is the effect of pregnancy on vitamin B6 (Pyridoxine) demand?

Pregnancy increases vitamin B6 demand Signup and view all the answers

What is the common effect of vitamin B1 (Thiamine) deficiency in alcoholics?

Deficiency is common in alcoholics Signup and view all the answers

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Study Notes

Laxatives

Birth, age, disease, death, and unpleasant contact are all forms of sorrow.
Craving leads to rebirth, which brings delight and passion, and seeks pleasure.
The Noble Eightfold Path is the way to stop sorrow, consisting of Right Views, Right Resolve, Right Speech, Right Conduct, Right Livelihood, Right Effort, Right Mindfulness, and Right Concentration.

Magnesium Hydroxide

Class: Laxative (Bulk-Forming Agent)
Mechanism: Absorbs and retains water, increasing fecal volume and rate of transit.
Not absorbed, useful for patients with alternating constipation and diarrhea, and those on low residue diets, postpartum, elderly, or with diverticular disease, spastic colon, or hemorrhoids.

Magnesium Citrate

Class: Laxative (Saline Cathartic)
Mechanism: Nonabsorbable ions increase osmotic pressure in the bowel, leading to watery stools in 1-3 hours.
Not much absorbed, toxicity may accumulate in infants, old folk, and patients with impaired renal function.

Opioids

Loperamide (Imodium)
- Class: Opioid (Antidiarrheal) (OTC)
- Mechanism: Increases gastric tone, delaying gastric emptying, and decreasing gut motility.
- Effects due to inhibition of ACh release by neurons in the intestines.
- Toxicity: dizziness, drowsiness, mild euphoria, and potential respiratory depression.
Paregoric
- Class: Opioid (Antidiarrheal)
- Mechanism: Increases gastric tone, delaying gastric emptying.
- Preparation of oral morphine, anise oil, benzoic acid, camphor, diluted alcohol, and glycerin.
- Toxicity: usually not severe, GI, CNS, and potential respiratory depression.

Antibiotics

Ciprofloxacin (Cipro)
- Class: Fluorinated quinolone
- Mechanism: Inhibits bacterial growth.
- Prolonged use of large dose salicylates blocks vitamin K actions in prothrombin synthesis, leading to hypoprothrombinemia.
- Used for UTIs due to Enterobacteriaceae, Enterococcus, Staph, and Pseudomonas, and infectious diarrhea.
Trimethoprim-Sulfamethoxazole (Bactrim, Septra)
- Class: Antimicrobial
- Mechanism: Inhibits bacterial growth.

Vitamins

Vitamin B1 (Thiamine)
- Class:
- Mechanism: Coenzyme in decarboxylation reactions, facilitates conduction of impulses in peripheral nerves.
- Deficiency leads to dry and wet beriberi, Wernicke-Korsakoff's syndrome, and is common in alcoholics.
Vitamin B6 (Pyridoxine)
- Class:
- Mechanism: Derivatives serve as coenzymes in many intermediate reactions.
- Deficiency leads to cheilosis, glossitis, dermatitis, and peripheral neuropathy.
- Liver damage increases the need for vitamin B6, and penicillamine, hydralazine, and isoniazid complex with B6, decreasing its availability.

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