LAXATIVES

=​ «LAXATIVES» = = DEFINITION = = = = Laxative drug or other substance used to stimulate the action of the intestines in eliminating waste from the body. The term // laxative // usually refers to a mild-acting substance; substances of increasingly drastic action are known as cathartics, purgatives, hydrogogues, and drastics, respectively. Laxatives or cathartics fall into three general categories: irritants that stimulate the muscular action of the intestines (cascara, phenolphthalein, senna); compounds that increase the amount of bulk in the intestines either by withdrawing water from the body (salines such as Epsom salts, citrate of magnesia) or by increasing the bulk when combined with fluids (agar-agar, bran, the various cellulose substances); and lubricants such as mineral oil, which ease the passage of waste and counteract excessive drying of the intestinal contents. Frequent or regular use of cathartics may seriously disrupt the natural digestive processes. When food and even waste products are forced out of the intestinal tract too rapidly, the body is deprived of vital substances, including the nutrients absorbed in the small intestine and the water, vitamins, and minerals extracted from the waste matter in the large intestine. Vitamins A and D, which are soluble in oil, are removed from the body even when the least irritating laxative, mineral oil, is taken. In addition to disrupting digestive and nutritional processes, laxatives reinforce the condition they are intended to overcome. When the intestines are purged, it may be several days before they can fill again with sufficient waste to induce natural elimination. The harm can be perpetuated by frequent use aimed at forcing daily elimination. The response to laxatives is soon lessened, so that larger and more frequent doses may become necessary. Laxatives should be avoided especially when there is abd ominal pain. An inflamed appendix may rupture after the use of a laxative  = = =

The basic types of laxatives are bulk-forming laxatives, lubricant laxatives, stool softeners (also called emollient laxatives), and stimulant laxatives.

**Bulk-forming Laxatives** Bulk-forming laxatives contain materials, such as cellulose and psyllium, that pass through the digestive tract without being digested. In the intestines, these materials absorb liquid and swell, making the stool soft, bulky, and easier to pass. The bulky stool then stimulates the bowel to move. Laxatives in this group include such brands as FiberCon, Fiberall, and Metamucil.

**Lubricant Laxatives** Mineral oil is the mostly widely used Lubricant Laxative. Taken by mouth, the oil coats the stool. This keeps the stool moist and soft and makes it easier to pass. Lubricant laxatives are often used for patients who need to avoid straining - after abdominal surgery, for example.

**Stool Softeners (emollient laxatives)** As their name suggests, Stool Softeners make stools softer and easier to pass by increasing their moisture content. This type of laxative does not really stimulate bowel movements, but it makes it possible to have bowel movements without straining. Stool Softeners are best used to prevent constipation in people who need to avoid straining - because of recent surgery, for example. However, they are not very effective at treating existing constipation. Docusate (Colace, Sof-Lax) is an example of a stool softener.

**Stimulant Laxatives** Ingredients in these laxatives stimulate muscles and nerves in the intestines. This helps move the stool along. Although these laxatives are popular and effective, they should be used with care, as they are more likely than other types to cause side effects. They may also work more quickly and powerfully than other laxatives. Examples of stimulant laxatives are Bisacodyl (Correctol) and Senna (Senokot).

**Saline laxative** such as magnesium citrate and sodium phosphate, exert an osmotic effect that increases the water content and volume of stool.

**Hyperosmotic laxative** such as lactulose, exert an osmotic effect and may have some effect on intestinal moyility.


 * INDICATIONS**

1. CONSTIPATION- is a common symptom, but it often remains unrecognized until the patient develops sequelae, such as anorectal disorders or diverticular disease. Several definitions of constipation have been proposed based on stool frequency in different populations. However, for surgical purposes, the most useful definition of constipation is a change in the bowel habit or defecatory behavior that results in acute or chronic symptoms or diseases that would be resolved with relief of the constipation.

2. NEUROGENIC BOWEL DYSFUNCTION- is common in patients with spinal cord injury (SCI), amyotrophic lateral sclerosis, spina bifida, multiple sclerosis, and diabetes mellitus. Other neurologic conditions such as stroke, traumatic brain injury, and brain tumors may secondarily cause abnormal bowel function, mostly in the form of constipation and incontinence.

3. IRRITABLE BOWEL SYSNDROME - is characterized by a combination of abdominal pain and altered bowel function. There are many possible causes. For instance, there may be a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine. There is no abnormality in the structure of the intestine.


 * Generic Name:** Bisacodyl


 * Brand Name(s):** Correctol, Dulcolax, Fleet Bisacodyl


 * Specific class:** diphenylmethane derivative


 * Common side effects:** CNS: Dizziness, faintness, muscle weakness with excessie use. GI: abdominal cramps, burning sensation in rectum with suppositories, nausea and vomiting.


 * Available Dosage forms:** Tablets (enteric coated): 5 mg


 * Contraindications:** Contraindicated in patients hypersensitivity to drug or its components and in those with rectal bleeding, gastroenteritis, intestinal obstruction, abdominal pain, nausea, vomiting, or other symptoms of appendicitis or acute surgical abdomen.


 * Pregnancy Category:** B


 * Generic Name:** calcium polycarbophil


 * Brand Name(s):** Equalactin Fiberall, FiberCon


 * Specific class:** hydrophilic drug


 * Common side effects:** GI: intestinal obstructin, abdominal fullness and increased flatus


 * Available Dosage forms:**Tablets: 500 mg, 625 mg; Tablets //(chewable)//: 500 mg


 * Contraindications:** Contraindicated in patients with signs or symptoms of GI obstruction or those with swallowing difficulty.


 * Pregnancy Category:** A


 * Generic Name:** magnesium hydroxide (milk of magnesia)


 * Brand Name(s):** Milk of Magnesia, Milk of Magnesia-Concentrated, Phillips' Milk of Magnesia


 * Specific class:** Magnesium salt
 * Common Side Effects:** GI: Abdominal cramping, diarrhea, nausea


 * Available Dosage forms:** //Chewable Tablets//: 300 mg, 600 mg, Oral Suspension: 400 mg/5ml. 800 mg/5ml


 * Contraindications:** Contraindicated in pregnant patients about to deliver and in patients with myocardial damage, heart block, fecal impaction, rectal fissures, intestinal obstruction or perforation, renal disease, or signs and symptoms of appendicitis or acute surgical abdomen, such as abdominal pain, nausea, or vomiting.


 * Pregnancy Category:** B


 * Generic Name:** docusate sodium (dioctyl sodium sulfosuccinate)


 * Brand Name(s):** Colace, Coloxyl, Colyxyl Enema


 * Specific class:** surfactant


 * Common Side Effects:** GI: bitter taste, mild abdominal cramping, diarrhea


 * Available Dosage Forms:** Capsules: 240 mg, 100 mg, 50 mg, 250 mg Enema concenrate: 18 g/100 ml (must be diluted) Oral liquid: 150 mg/15 ml


 * Contraindications:** Contraindicated in patients hypersentivity to drug and in those with intestinal obstruction or tion, or acute surgical abdomen, such as undiagnosed abdominal pain or vomiting.


 * Pregancy Category:** C


 * Generic Name:** docusate calcium ( dioctyl calcium sulfosuccinate)


 * Brand Name(s):** DC softgels, Surfak


 * Specific class:** surfactant


 * Common Side Effects:** GI: bitter taste, mild abdominal cramping, diarrhea


 * Available Dosage Forms:** Capsules: 240 mg


 * Contraindications:** Contraindicated in patients hypersentivity to drug and in those with intestinal obstruction or tion, or acute surgical abdomen, such as undiagnosed abdominal pain or vomiting.


 * Pregancy Category:** C


 * Generic Name:** polyethylene glycol


 * Brand Name(s):** Glycolax, Miralax


 * Specific class:** osmotic drug


 * Common Side Effects:** GI: abdominal bloating, cramping, diarrhea, excess stool frequency, flatulence, nausea.


 * Available Dosage Forms:** Powder: single-dose 17 g packets; 16 ounce (255-g), 24 ounce (527-g) containers


 * Contraindications:** Contraindicated in patients alergic to drug and those with known or suspected bowel obstruction


 * Pregancy Category:** C


 * Generic Name:** polyethylene glycol and electrolyte solution


 * Brand Name(s):** Colyte, Glycoprep, Go-Evac,


 * Specific class:** polyethylene glycol nonabsorbable solution


 * Common Side Effects:** EENT: rhinorrhea GI: abdominal fullness, bloating, cramps, nausea, vomiting SKIN: allergic reaction, anal irritation, dermatitis, urticaria


 * Available Dosage Forms:** Powder for oral solution: PEG 3350 (227.1 g), sodium sulfate (21.5 g), sodium chloride (5.53 g), potassium chloride (2.82 g), sodium bicarbonate (6.36 g) per 4 L (colyte); PEG 3350 (60g ), sodium chloride (1.46), potassium chloride ( 0.745 g), sodium bicarbonate (1.68 g), sodium sulfate (5.68g)/L (Colav)


 * Contraindications:** Contraindicated in patients with GI obstruction or perforation, gastric retention, toxic clitis, or megacolon.


 * Pregancy Category:** C


 * Generic Name:** sodium phosphates


 * Brand Name(s):** Fleet Enema, Fleet Phosphosoda


 * Specific class:** acid salt


 * Common Side Effects:** GI: abdominal cramping


 * Available Dosage Forms:** Enema: 160mg/ml sodium phosphate and 60 mg/ml sodium biphosphate Liquid: 2.4 g/5 ml sodium phosphate and 900 mg sodium biphosphate/ 5 ml


 * Contraindications:** Contraindicated in patients on sodium restricted diets and in patients with intestinal obstruction, intestinal perforation, edema, heart failure, megacolon, impaired renal function, or signs and symptoms of appendicitis or acute surgical abdomen, such as abdominal pain, nausea, or vomiting.


 * Pregancy Category:** NR

 AQUINO, Angelica CHUA, Christal Jane CORPUZ, Monique Mae GARCIA, Rose Ann 3:00-4:00/ MWF/ A-206

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