Bowel Disorder Drugs Diarrhea Abnormal passage of stools with increased frequency fluidity and weight or with increased stool water excretion Color watery chunks soft form frequency Anything the patient is taking by mouth is not absorbing Acute diarrhea Sudden onset in a previously healthy person Lasts from 3 days to 2 weeks Self limiting and Resolves without sequelae Chronic diarrhea 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 o Chrone s disease dumping syndrome Acute Diarrhea Chronic Diarrhea Bacteria Tumors Viruses Diabetes mellitus Drug induced Addison s disease Nutritional factors Hyperthyroidism Protozoa Irritable bowel syndrome and AIDS Goals of Diarrhea Treatment Stopping the stool frequency Alleviating the abdominal cramps Replenishing fluids and electrolytes Preventing weight loss and nutritional deficits from malabsorption Antidiarrheals Adsorbents Antimotility drugs anticholinergics and opiates and Probiotics bacterial replacement drugs Mechanism of Action o Adsorbents Coat the walls of the gastrointestinal GI tract Bind to the causative bacteria or toxin which is then eliminated through the stool Examples bismuth subsalicylate Pepto Bismol activated charcoal aluminum hydroxide others Bacteria bind to it and are eliminated Increase clotting time bleed too much with a cut Not to be used for children o Antimotility drugs anticholinergics Decrease intestinal muscle tone and peristalsis of GI tract Result slows the movement of fecal matter through the GI tract Examples belladonna alkaloids Anti cholenergic medication o Early demensia o Antimotility drugs opiates 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 Examples paregoric opium tincture codeine loperamide Imodium over the counter diphenoxylate Lomotil Diphenoxylate Lomotil o Acute diarrhea for 2 or 3 days o Used in the hospital most of the time Loperimide Imodium o Lost favor opiate pain relieve with side effect of constipation o Slows motility o High abuse potential o Controlled substance o Can overdose o Probiotics Also known as intestinal flora modifiers and bacterial replacement drugs Bacterial cultures of Lactobacillus organisms work by Supplying missing bacteria to the GI tract Suppressing the growth of diarrhea causing bacteria Example L acidophilus Bacid Antidiarrheals Adverse Effects o Adsorbents Increased bleeding time Constipation dark stools Confusion Tinnitus pepto bismol with overuse Metallic taste pepto bismol Blue tongue pepto bismol o Anticholinergics Urinary retention impotence Headache dizziness confusion anxiety drowsiness confusion Dry skin flushing Blurred vision Hypotension bradycardia ALL ANTICHOLINERGICS CAUSE PATIENTS TO HAVE A DRY MOUTH Can increase the likelihood of early dementia o Opiates Drowsiness dizziness lethargy Nausea vomiting constipation Respiratory depression Hypotension Urinary retention Flushing Antidiarrheals Interactions o Adsorbents decrease the absorption of many drugs including digoxin quinidine and hypoglycemic drugs o Adsorbents cause increased bleeding time and bruising when given with anticoagulants warfarin o Toxic effects of methotrexate are more likely when given with adsorbents o Pepto bismol with potential bleeding because it contains aspirin Nursing Implications o Obtain thorough history of bowel patterns general state of health and recent history of illness or dietary changes assess for allergies o Do NOT give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye s syndrome o Use adsorbents carefully in elderly patients or those with decreased bleeding time clotting disorders recent bowel surgery confusion o Do not administer anticholinergics to patients with a history of narrow angle glaucoma give but VERY low dose GI obstruction myasthenia gravis paralytic ileus and toxic megacolon o Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes o Assess fluid volume status I O and mucous membranes before during and after initiation of treatment and weight o Teach patients to notify their prescriber immediately if symptoms persist o Monitor for therapeutic effect Constipation Abnormally infrequent and difficult passage of feces through the lower GI tract Symptom not a disease Disorder of movement through the colon and or rectum Can be caused by a variety of diseases or drugs Laxatives Bulk forming Emollient stool softeners lubricant laxatives Hyperosmotic Saline Stimulant and Peripherally acting opioid Mechanism of Action o Bulk forming Very safe in older adult High fiber Absorb water to increase bulk Distend bowel to initiate reflex bowel activity psyllium Metamucil methylcellulose Citrucel o Emollient Stool softeners and lubricants Promote more water and fat in the stools Lubricate the fecal material and intestinal walls Stool softeners docusate salts Colace Surfak o Prevent constipation when taking Opiates Lubricants mineral oil o Hyperosmotic Increase fecal water content Results in bowel distention increased peristalsis and evacuation Polyethylene glycol PEG Sorbitol glycerin Lactulose also used to reduce elevated serum ammonia levels o GoLightly o Saline Increase osmotic pressure within the intestinal tract causing more water to enter the intestines Results in bowel distention increased peristalsis and evacuation Magnesium hydroxide Milk of Magnesia Magnesium citrate Citroma o Over the counter o Stimulant Increases peristalsis via intestinal nerve stimulation Works very fast Don t give in the hospital senna Senekot o Natural plant source bisacodyl Dulcolax o May cause abdominal cramping Peripherally Acting Opioid Antagonists Treatment of constipation related to opioid use and bowel resection therapy Block entrance of opioid into bowel Strict regulations for use Allow bowel to function normally with continued opioid use o methylnaltrexone Relistor and alvimopan Entereg Laxative Group Bulk forming Emollient Hyperosmotic Saline Stimulant Use Acute and chronic constipation irritable bowel syndrome diverticulosis Acute and chronic constipation fecal impaction facilitation of bowel movements in anorectal conditions Chronic constipation diagnostic and surgical preps Constipation diagnostic and surgical preps Acute constipation