BOWEL DISORDER DRUGS DSN KEVIN DOBI, MS, APRN Copyright © 2014 by Mosby, an imprint of Elsevier...

BOWEL DISORDER DRUGS

DSN KEVIN DOBI , MS, APRN

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Chapter 51


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Diarrhea

Abnormal passage of stools with increased frequency, fluidity, and weight, or with increased stool water excretion


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Diarrhea (cont’d)

Acute diarrheaSudden onset in a previously healthy

personLasts from 3 days to 2 weeksSelf-limitingResolves without sequelae


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Diarrhea (cont’d)

Chronic diarrheaLasts for more than 3-4 weeksAssociated with recurring passage of

diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness


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Causes of Diarrhea

Acute Diarrhea Chronic Diarrhea

Bacteria TumorsViruses Diabetes mellitusDrug-induced Addison’s disease Nutritional factors Hyperthyroidism Protozoa Irritable bowel

syndromeAIDS


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Goals of Diarrhea Treatment

Stopping the stool frequencyAlleviating the abdominal crampsReplenishing fluids and electrolytesPreventing weight loss and nutritional

deficits from malabsorption


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Antidiarrheals

AdsorbentsAntimotility drugs (anticholinergics and

opiates)Probiotics (bacterial replacement drugs)


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Antidiarrheals: Mechanism of Action

AdsorbentsCoat the walls of the gastrointestinal (GI)

tractBind to the causative bacteria or toxin,

which is then eliminated through the stoolExamples: bismuth subsalicylate (Pepto-

Bismol), activated charcoal, aluminum hydroxide, others


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Antidiarrheals: Mechanism of Action (cont’d)

Antimotility drugs: anticholinergicsDecrease intestinal muscle tone and

peristalsis of GI tractResult: slows the movement of fecal matter

through the GI tractExamples: belladonna alkaloids


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Antimotility drugs: opiatesDecrease bowel motility and reduce pain

by relief of rectal spasmsDecrease transit time through the bowel,

allowing more time for water and electrolytes to be absorbed

Examples: paregoric, opium tincture, codeine, loperamide (over the counter), diphenoxylate


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ProbioticsAlso known as intestinal flora modifiers

and bacterial replacement drugsBacterial cultures of Lactobacillus

organisms work by: Supplying missing bacteria to the GI tract Suppressing the growth of diarrhea-causing

bacteriaExample: L. acidophilus (Bacid)


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Classroom Response Question


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The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose of the atropine in this combination is to

A. enhance the effects of the diphenoxylate.B. discourage recreational use of the opiate

diphenoxylate.C. counteract the adverse effects of the

diphenoxylate.D. act as an adsorbent for bacteria in the bowel.

Antidiarrheals: Adverse Effects

AdsorbentsIncreased bleeding timeConstipation, dark stoolsConfusionTinnitusMetallic tasteBlue tongue


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Antidiarrheals: Adverse Effects (cont’d)

AnticholinergicsUrinary retention, impotenceHeadache, dizziness, confusion, anxiety,

drowsiness, confusionDry skin, flushingBlurred visionHypotension, bradycardia


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Antidiarrheals: Adverse Effects (cont’d)

OpiatesDrowsiness, dizziness, lethargyNausea, vomiting, constipationRespiratory depressionHypotensionUrinary retentionFlushing


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Antidiarrheals: Interactions

Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs

Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin)

Toxic effects of methotrexate are more likely when given with adsorbents


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Antidiarrheals: Nursing Implications

Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies

Do NOT give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye’s syndrome


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Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition?

A. AnemiaB. Diabetes mellitus C. Myasthenia gravisD. Hypertension

Antidiarrheals: Nursing Implications (cont’d)

Use adsorbents carefully in elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion

Do not administer anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon


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Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes

Assess fluid volume status, I&O, and mucous membranes before, during, and after initiation of treatment


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Teach patients to notify their prescriber immediately if symptoms persist

Monitor for therapeutic effect


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Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision?

A. AnticholinergicsB. Adsorbents C. ProbioticsD. Opiates

Constipation

Abnormally infrequent and difficult passage of feces through the lower GI tract

Symptom, not a diseaseDisorder of movement through the colon

and/or rectumCan be caused by a variety of diseases

or drugs


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Laxatives

Bulk-formingEmollient (stool softeners, lubricant

laxatives)HyperosmoticSalineStimulantPeripherally acting opioid


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Laxatives: Mechanism of Action

Bulk-formingHigh fiberAbsorb water to increase bulkDistend bowel to initiate reflex bowel

activityExamples

psyllium (Metamucil) methylcellulose (Citrucel)


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Laxatives: Mechanism of Action (cont’d)

EmollientStool softeners and lubricantsPromote more water and fat in the stoolsLubricate the fecal material and intestinal

wallsExamples

Stool softeners: docusate salts (Colace, Surfak) Lubricants: mineral oil


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HyperosmoticIncrease fecal water contentResults in bowel distention, increased

peristalsis, and evacuationExamples:

Polyethylene glycol (PEG) Sorbitol, glycerin Lactulose (also used to reduce elevated serum

ammonia levels)


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SalineIncrease osmotic pressure within the

intestinal tract, causing more water to enter the intestines

Results in bowel distention, increased peristalsis, and evacuation

Examples Magnesium hydroxide (Milk of Magnesia) Magnesium citrate (Citroma)


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StimulantIncreases peristalsis via intestinal nerve

stimulationExamples

senna (Senekot) bisacodyl (Dulcolax)


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Peripherally Acting Opioid Antagonists

Treatment of constipation related to opioid use and bowel resection therapy

Block entrance of opioid into bowelStrict regulations for useAllow bowel to function normally with

continued opioid use methylnaltrexone (Relistor) alvimopan (Entereg)


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Laxatives: Indications

Laxative Group UseBulk-forming Acute and chronic

constipation, irritable bowel syndrome, diverticulosis

Emollient Acute and chronicconstipation, fecal impaction,

facilitation of bowel movements in anorectal conditions


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Laxatives: Indications (cont’d)

Laxative Group UseHyperosmotic Chronic

constipation,diagnostic and

surgical prepsSaline Constipation,

diagnostic and surgical preps

Stimulant Acute constipation, diagnostic and

surgical prepsCopyright © 2014 by Mosby, an imprint of Elsevier Inc.

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A patient is receiving lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose?

A. Cleansing the bowel before a procedureB. Removal of helminthsC. Reduction of high ammonia levels associated

with liver failureD. Daily maintenance to prevent constipation

Laxatives: Adverse Effects

Bulk-forming Impaction Fluid overload Electrolyte imbalances Esophageal blockage

Emollient Skin rashes Decreased absorption of vitamins Electrolyte imbalances Lipid pneumonia


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Laxatives: Adverse Effects (cont’d)

Hyperosmotic Abdominal bloating Electrolyte imbalances Rectal irritation

Saline Magnesium toxicity (with renal insufficiency) Cramping Electrolyte imbalances Diarrhea Increased thirst


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Laxatives: Adverse Effects (cont’d)

Stimulant Nutrient malabsorption Skin rashes Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation

All laxatives can cause electrolyte imbalances!


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Laxatives: Nursing Implications

Obtain a thorough history of presenting symptoms, elimination patterns, and allergies

Assess fluid and electrolytes before initiating therapy

Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, and/or abdominal pain


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Laxatives: Nursing Implications (cont’d)

A healthy, high-fiber diet and increased fluid intake should be encouraged as an alternative to laxative use

Long-term use of laxatives often results in decreased bowel tone and may lead to dependency

All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated


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Patients should take all laxative tablets with 6 to 8 oz of water

Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water


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Give bisacodyl with water because of interactions with milk, antacids, and juices

Inform patients to contact their prescriber if they experience severe abdominal pain, muscle weakness, cramps, and/or dizziness, which may indicate possible fluid or electrolyte loss

Monitor for therapeutic effect


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A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient?A. Milk of magnesiaB. A bulk-forming laxativeC. Mineral oilD. No laxative should be given at this time

Irritable Bowel Syndrome

Chronic intestinal discomfort characterized by cramps, diarrhea, and/or constipation

Patients usually cope with the symptoms by avoiding irritating foods and/or taking over-the-counter (OTC) laxatives and antidiarrheal drugs


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Drugs for Irritable Bowel Syndrome

tegaserod (Zelnorm)lubiprostone (Amitiza) alosetron (Lotronex)


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Drugs for Irritable Bowel Syndrome: Nursing Implications

Perform a general assessment and additional assessment of liver functioning as well as assessment for any underlying cardiac disease

Follow administration guidelinesAssess for therapeutic response


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BOWEL DISORDER DRUGS DSN KEVIN DOBI, MS, APRN Copyright © 2014 by Mosby, an imprint of Elsevier...

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Transcript of BOWEL DISORDER DRUGS DSN KEVIN DOBI, MS, APRN Copyright © 2014 by Mosby, an imprint of Elsevier...