ADSORBENTS & LAXATIVEADSORBENTS & LAXATIVE

By By

Wiwik KusumawatiWiwik Kusumawati

OBJECTIVEOBJECTIVE

• At the end of this topic the students will At the end of this topic the students will be able to :be able to :

1.1. Explain Explain mechanism of actionmechanism of action of both of both adsorbents and laxative agentsadsorbents and laxative agents

2.2. Explain Explain side effectsside effects of both adsorbents of both adsorbents and laxative agentsand laxative agents

3.3. Explain Explain indicationindication of both adsorbents and of both adsorbents and laxative agentslaxative agents

4.4. Explain Explain interactionsinteractions between adsorbents between adsorbents and other drugsand other drugs

5.5. Mention Mention classificationclassification of laxative agents of laxative agents

AntidiarrhealsAntidiarrheals

1.1. AdsorbentsAdsorbents

2.2. AnticholinergicsAnticholinergics

3.3. OpiatesOpiates

AdsorbentsAdsorbents

• Mechanism of actionMechanism of action

• Coat the walls of the GI tractCoat the walls of the GI tract

• Bind to the causative bacteria or toxin, Bind to the causative bacteria or toxin, which is then eliminated through the which is then eliminated through the stoolstool

• Examples: bismuth subsalicylate Examples: bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, activated (Pepto-Bismol), kaolin-pectin, activated charcoal, attapulgite (Kaopectate)charcoal, attapulgite (Kaopectate)

AdsorbentsAdsorbents

• Side EffectsSide Effects

• Increased bleeding timeIncreased bleeding time

• Constipation, dark stoolsConstipation, dark stools

• Confusion, twitchingConfusion, twitching

• Hearing loss, tinnitus, metallic taste, Hearing loss, tinnitus, metallic taste, blue gumsblue gums

AdsorbentsAdsorbents

• InteractionInteraction

• Adsorbents decrease the absorption Adsorbents decrease the absorption of many agents, including digoxin, of many agents, including digoxin, clindamycin, quinidine, and clindamycin, quinidine, and hypoglycemic agentshypoglycemic agents

• Adsorbents cause increased bleeding Adsorbents cause increased bleeding time when given with anticoagulantstime when given with anticoagulants

CONSTIPATIONCONSTIPATION

• Abnormally infrequent and difficult Abnormally infrequent and difficult passage of feces through the lower GI passage of feces through the lower GI tracttract

• Symptom, not a diseaseSymptom, not a disease• Disorder of movement through the Disorder of movement through the

colon and/or rectumcolon and/or rectum• Can be caused by a variety of Can be caused by a variety of

diseases diseases or drugsor drugs

LAXATIVE AGENTLAXATIVE AGENT

•Drugs used for treatment of Drugs used for treatment of acute acute constipationconstipation (drugs accelerating (drugs accelerating the passage of food through the the passage of food through the intestine)intestine)..

•AA symptomatic therapysymptomatic therapy which which should not be used chronicallyshould not be used chronically

LAXATIVE AGENTLAXATIVE AGENT

1.1. Bulk formingBulk forming

2.2. EmollientEmollient

3.3. HyperosmoticHyperosmotic

4.4. SalineSaline

5.5. StimulantStimulant

Bulk formingBulk forming

• High fiberHigh fiber

• Absorbs water to increase bulkAbsorbs water to increase bulk

• Distends bowel to initiate reflex bowel Distends bowel to initiate reflex bowel activityactivity

• Examples:Examples: – psyllium (psyllium (MetamucilMetamucil))– methylcellulose (methylcellulose (CitrucelCitrucel))– polycarbophilpolycarbophil

EmollientEmollient

• Stool softeners and lubricantsStool softeners and lubricants• Promote more water and fat in the Promote more water and fat in the

stoolsstools• Lubricate the fecal material and Lubricate the fecal material and

intestinal wallsintestinal walls• Examples:Examples:

– Stool softeners: docusate salts (Stool softeners: docusate salts (Colace, Colace, SurfakSurfak))

– Lubricants: mineral oilLubricants: mineral oil

HyperosmoticHyperosmotic

• Increase fecal water contentIncrease fecal water content• Result: bowel distention, increased Result: bowel distention, increased

peristalsis, and evacuationperistalsis, and evacuation• Examples:Examples:

– polyethylene glycol (polyethylene glycol (GoLYTELYGoLYTELY))– sorbitolsorbitol– glyceringlycerin– lactulose (lactulose (ChronulacChronulac))

SalineSaline

• Increase osmotic pressure within the Increase osmotic pressure within the intestinal tract, causing more water intestinal tract, causing more water to enter the intestinesto enter the intestines

• Result: bowel distention, increased Result: bowel distention, increased peristalsis, and evacuationperistalsis, and evacuation

StimulantStimulant

• Increases peristalsis via intestinal Increases peristalsis via intestinal nerve stimulationnerve stimulation

• Examples:Examples:– castor oilcastor oil– sennasenna– cascaracascara

– bisacodylbisacodyl

INDICATIONSINDICATIONS

Laxative GroupLaxative GroupBulk formingBulk forming

EmollientEmollient

UseUseAcute and chronic Acute and chronic

constipationconstipation

Irritable bowel syndromeIrritable bowel syndrome

DiverticulosisDiverticulosis

Acute and chronic Acute and chronic constipationconstipation

Softening of fecal Softening of fecal impaction; facilitation impaction; facilitation of BMs in anorectal of BMs in anorectal conditionsconditions

INDICATIONSINDICATIONS

Laxative GroupLaxative GroupHyperosmoticHyperosmotic

SalineSaline

UseUseChronic constipationChronic constipation

Diagnostic and surgical Diagnostic and surgical prepspreps

ConstipationConstipation

Diagnostic and surgical Diagnostic and surgical prepspreps

Removal of helminths Removal of helminths and parasitesand parasites

INDICATIONSINDICATIONS

Laxative GroupLaxative GroupStimulantStimulant

UseUseAcute constipationAcute constipation

Diagnostic and surgical Diagnostic and surgical bowel prepsbowel preps

SIDE EFFECTSSIDE EFFECTS

• Bulk formingBulk forming– ImpactionImpaction– Fluid overloadFluid overload

• EmollientEmollient– Skin rashesSkin rashes– Decreased absorption of vitaminsDecreased absorption of vitamins

• HyperosmoticHyperosmotic– Abdominal bloatingAbdominal bloating– Rectal irritationRectal irritation

SIDE EFFECTSSIDE EFFECTS

• SalineSaline– Magnesium toxicity (with renal Magnesium toxicity (with renal

insufficiency)insufficiency)– CrampingCramping– DiarrheaDiarrhea– Increased thirstIncreased thirst

• StimulantStimulant– Nutrient malabsorptionNutrient malabsorption– Skin rashesSkin rashes– Gastric irritationGastric irritation– Rectal irritationRectal irritation