Bowel Disorder DrugsDiarrhea- 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 weaknesso Chrone’s disease, dumping syndrome Acute Diarrhea Chronic DiarrheaBacteria TumorsViruses Diabetes mellitusDrug-induced Addison’s disease Nutritional factors Hyperthyroidism Protozoa Irritable bowel syndrome and AIDSGoals of Diarrhea Treatment- Stopping the stool frequency- Alleviating the abdominal cramps- Replenishing fluids and electrolytes- Preventing weight loss and nutritional deficits from malabsorptionAntidiarrheals- 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/Lomotilo Acute diarrhea for 2 or 3 days o Used in the hospital most of the time- Loperimide/Imodiumo Lost favor – opiate (pain relieve) with side effect of constipationo 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 Effectso 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: Interactionso Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugso Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin)o Toxic effects of methotrexate are more likely when given with adsorbentso Pepto bismol with potential bleeding because it contains aspirin- Nursing Implicationso Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergieso Do NOT give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye’s syndromeo Use adsorbents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusiono 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 changeso 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 persisto Monitor for therapeutic effectConstipation- 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 drugsLaxatives- Bulk-forming, Emollient (stool softeners, lubricant laxatives), Hyperosmotic, Saline, Stimulant, and Peripherally acting opioid- Mechanism of Actiono 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 oilo 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 GoLightlyo Saline Increase osmotic pressure within the intestinal tract, causing more water to enterthe 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 useo methylnaltrexone (Relistor) and alvimopan (Entereg)Laxative Group UseBulk-forming