Chapter 51 STUDENT Bowel Disorders & Drugs PDF

Chapter 51: Bowel Disorder Drugs This chapter explores commonly used medications for treating bowel disorders, including diarrhea and constipation. These medications target various aspects of bowel function and motility, offering relief from uncomfortable symptoms. The Digestive System Organs Inv...

Chapter 51: Bowel Disorder Drugs This chapter explores commonly used medications for treating bowel disorders, including diarrhea and constipation. These medications target various aspects of bowel function and motility, offering relief from uncomfortable symptoms. The Digestive System Organs Involved The digestive system consists of the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus. Diarrhea Overview Definition Types Diarrhea is a common condition that involves Diarrhea is classified as acute or chronic, frequent, loose stools. depending on duration. Acute Chronic Acute diarrhea is characterized by sudden onset Chronic diarrhea is characterized by persistent and typically resolves within a few weeks. symptoms lasting longer than a few weeks. Chronic Diarrhea Duration Symptoms Chronic diarrhea lasts longer than 3 to 4 Symptoms may include recurring weeks. diarrhea, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness. Causes of Diarrhea Acute Diarrhea Chronic Diarrhea Caused by viral, bacterial, or parasitic infections. It is Lasts for more than 4 weeks and may be caused by a usually self-limiting and lasts for a few days. variety of factors. These factors can include conditions that affect the digestive system, such as inflammatory Bacteria bowel disease or irritable bowel syndrome, or Viruses conditions that affect other systems of the body, such Protozoa as diabetes mellitus or hyperthyroidism. Tumors Diabetes mellitus Addison's disease Hyperthyroidism Irritable bowel syndrome AIDS Goals of Diarrhea Treatment Stopping Stool Alleviating Abdominal Frequency Cramps Diarrhea is characterized by an Abdominal cramps and increase in stool frequency and discomfort are common with liquidity. Antidiarrheal diarrhea. Medications often medications aim to reduce these target these symptoms to symptoms, promoting normal improve patient comfort and bowel function. well-being. Replenishing Fluids Preventing Weight Loss and Electrolytes Diarrhea can cause weight loss Diarrhea can lead to dehydration and nutritional deficiencies. and electrolyte imbalances. Oral Addressing these issues is vital to rehydration therapy is crucial to ensure adequate nutrition and restore fluid and electrolyte overall health. balance. Antidiarrheals: Mechanism of Action Adsorbents Adsorbents bind to causative bacteria or toxins, eliminating them through the stool. Examples include bismuth subsalicylate (Pepto-Bismol) and activated charcoal. Antimotility Drugs Antimotility drugs slow down the movement of the GI tract, reducing diarrhea. This category includes anticholinergics and opiates. Probiotics Probiotics, also known as intestinal flora modifiers or bacterial replacement drugs, introduce beneficial bacteria to the GI tract, restoring balance and improving digestive health. Antidiarrheals: Mechanism of Action (Cont.) Antimotility Drugs: Anticholinergics Example: Belladonna Alkaloids Anticholinergics reduce intestinal muscle tone and Belladonna alkaloids are a class of anticholinergic peristalsis in the GI tract. This action slows the drugs used to treat diarrhea by decreasing GI motility. movement of fecal matter through the GI tract. These alkaloids can be found in plants such as deadly nightshade and belladonna, and they have been used for centuries in traditional medicine. Antidiarrheals: Opiates Mechanism of Effects Action Opiates decrease the transit Opiate antidiarrheals work time through the bowel, by decreasing bowel allowing more time for motility. These drugs also water and electrolytes to be reduce pain by relieving absorbed. rectal spasms. Examples Common examples include paregoric, opium tincture, codeine, loperamide (Imodium), atropine (Lomotil), and diphenoxylate. Antidiarrheals: Mechanism of Action (Cont.) Probiotics Mechanism of Action Probiotics are live bacteria that are similar to those found in Probiotics work by supplying missing "good" bacteria to the a healthy gut. These bacteria are commonly called "good" GI tract, which can help to restore the balance of bacteria in bacteria because they help to keep the digestive system the gut. functioning properly. Antidiarrheals: Adverse Effects (Cont.) 1 1. Opiates 2 2. Anticholinergics Common side effects of Anticholinergics may opiates include cause urinary retention, drowsiness, dizziness, impotence, headache, and lethargy. These dizziness, confusion, effects may be more anxiety, drowsiness, dry pronounced in older skin, flushing, blurred adults. vision, hypotension, and bradycardia. Antidiarrheals: Interactions Adsorbents Adsorbents can decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs. Anticoagulants Adsorbents can increase bleeding time and bruising when given with anticoagulants, such as warfarin Methotrexate Toxic effects of methotrexate are more likely when given with adsorbents. Antidiarrheals: Nursing Implications (Cont.) Adsorbents Anticholinergics Use adsorbents carefully in older adults. Do not administer to patients with a history of narrow- angle glaucoma. Avoid use in patients with decreased bleeding time, clotting disorders, or confusion. Contraindicated for patients with GI obstruction, myasthenia gravis, paralytic ileus, or toxic megacolon. Constipation Overview Lower GI Tract Dysfunction Symptom, Not a Disease Constipation is a condition characterized by the Constipation is a symptom, not a disease. It can be infrequent and difficult passage of stool through the caused by various factors, including dietary changes, lower gastrointestinal tract. The rectum and colon are medical conditions, and certain medications. the two primary areas affected. Laxatives: Bulk Forming High Fiber Water Absorption Bulk forming laxatives are composed of high fiber. These medications absorb water in the They are a natural and safe treatment for gastrointestinal tract to increase stool mass and constipation. They are best for patients with chronic bulk. This distends the bowel and promotes the constipation who are not sensitive to fiber. natural reflex that stimulates bowel movements. Examples Adverse Effects Psyllium (Metamucil) and methylcellulose (Citrucel) Esophageal obstructions and fecal impactions can be are commonly used bulk forming laxatives. These serious adverse effects of bulk forming laxatives. medications work by absorbing water in the gut to These drugs can also cause gas, bloating, and increase stool bulk and frequency. abdominal discomfort. Make sure to drink plenty of fluids with these laxatives. Laxatives: Emollients Mechanism of Lubrication Action Emollients lubricate the Emollients are stool fecal material and softeners and lubricants. intestinal walls, easing the They increase the amount passage of stool. of water and fat in the stool. Types Adverse Effects Examples include Mineral oil can cause docusate salts, such as problems with lipid Colace and Surfak, and pneumonia if aspirated. mineral oil. Laxatives: Hyperosmotic 1 Mechanism 2 Effect Hyperosmotic laxatives This increases stool water attract water into the content, which softens intestinal lumen. the stool and increases its bulk. 3 Result Bowel distention and increased peristalsis occur, stimulating evacuation. Laxatives: Saline Mechanism of Action Effect Examples Saline laxatives draw water into This distends the bowel, Common saline laxatives include the intestines, increasing stimulating peristalsis and magnesium hydroxide (Milk of osmotic pressure and volume. promoting bowel evacuation. Magnesia) and magnesium citrate (Citroma). Laxatives: Stimulant Mechanism of Action Examples Stimulant laxatives increase intestinal peristalsis. They Senna (Senokot) and bisacodyl (Dulcolax) are commonly stimulate the nerves in the intestinal wall. prescribed stimulant laxatives. Laxatives: Indications (Part 1) Bulk Forming Emollient Bulk-forming laxatives are a common Emollient laxatives work by softening first-line treatment for constipation. the stool and making it easier to pass. These medications work by absorbing These medications are useful for water in the intestines and increasing treating acute and chronic constipation, stool bulk. They can also be helpful for fecal impaction, and facilitating bowel managing irritable bowel syndrome and movements for patients with anorectal diverticulosis. conditions. Laxatives: Indications (Part 2) Hyperosmotic Saline Stimulant Hyperosmotic laxatives draw water Saline laxatives increase the Stimulant laxatives stimulate into the colon, increasing stool amount of fluid in the intestinal intestinal muscle contractions. mass. tract. 1. Chronic constipation 1. Constipation 1. Acute constipation 2. Diagnostic procedures 2. Diagnostic procedures 2. Diagnostic procedures 3. Surgical preparations 3. Surgical preparations 3. Surgical preparations Laxatives: Adverse Effects Stimulant Laxatives General Laxative Considerations 1. Nutrient malabsorption All laxatives can cause electrolyte imbalances, 2. Skin rashes particularly when used for prolonged periods. 3. Gastric irritation Some laxatives, like stimulant laxatives, can cause 4. Electrolyte imbalances dependency with prolonged use. 5. Discolored urine 6. Rectal irritation Laxatives: Nursing Implications Patient History Fluid and Electrolyte Contraindications Assessment Collect a thorough history of the Inform patients not to take a laxative patient’s symptoms, elimination Assess the patient’s fluid and or cathartic if they are experiencing patterns, and allergies. This electrolyte status before initiating nausea, vomiting, or abdominal pain. information is essential for laxative therapy. Some laxatives can These symptoms could indicate a determining the cause of cause fluid and electrolyte more serious medical condition. constipation and developing an imbalances, which can be dangerous, appropriate treatment plan. especially in patients with underlying health conditions. Laxatives: Nursing Implications (Cont.) 1 1. Dietary Changes 2 2. Long-Term Use Encourage clients to Prolonged laxative use increase fiber intake and can diminish bowel tone, fluid consumption as possibly leading to alternatives to laxative dependency. use. 3 3. Tablet Administration Laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated. Laxatives: Nursing Implications (Cont.) Dosage and Administration Bulk-Forming Laxatives Patients should take all laxative tablets with 6 to 8 oz of water. Patients should take bulk-forming laxatives with at least 8 oz of water as directed by the manufacturer.