Drug Name Mechanism of Action
Contraindication
Lactulose
Classification
Therapeutic: Laxatives
Pharmacologic: Osmotic
Dosage and Route:
(Adults): 15–30 mL/day up to
60 mL/day as liquid
Doctor’s Order
LD of Lactulose 300ml in
700mL PNSS q 4hrs then
maintenance dose of 30mL
daily.
Pregnancy category: B
Effect
Increases water content and
softens the stool. Lowers
the pH of the colon, which
inhibits the diffusion of
ammonia from the colon into
the blood, thereby reducing
Blood ammonia levels.
Therapeutic Effects:
Decreased blood ammonia
levels with
improved mental status in
PSE.
Indication and Side effect and Adverse
Action
Adjunct in the management of
portal-systemic (hepatic)
encephalopathy (PSE).
Contraindicated in:
Use Cautiously in: OB,
Lactation: Safety not
established.
Nursing Considerations and
GI: belching, cramps, Assessment
distention, flatulence, ● Assess patient for
diarrhea. abdominal distention,
Endo: hyperglycemia presence of bowel sounds, and
(diabetic patients) normal pattern of bowel
function.
● Assess color, consistency,
and amount of stool produced.
● PSE: Assess mental status
(orientation, level of
consciousness) before and
periodically throughout
Course of therapy.
● Lab Test Considerations:
blood ammonia
Concentrations by 25–50%.
● May cause blood glucose
levels in diabetic patients.
● Monitor serum electrolytes
periodically when used
Chronically. May cause
diarrhea with resulting
hypokalemia and
hypernatremia.
Implementation
● When used in hepatic
encephalopathy, adjust dose
until patient averages 2–3 soft
bowel movements
per day. During initial
therapy, 30–45 mL may be
given hourly to induce rapid
laxation.
● Darkening of solution does
not alter potency.
● PO: Mix with fruit juice,
water, milk, or carbonated
citrus beverage to improve
flavor. Administer with a
full glass (240 mL) of water
or juice. May be administered
on an empty stomach for more
rapid results.
● Dissolve single dose
packets (Kristalose) in 4 oz of
water. Solution should be
colorless to slightly pale
yellow.
Caution patients that this
medication may cause
belching, flatulence, or
abdominal cramping.
Health care professional
should be notified if this
becomes bothersome or if
diarrhea occurs.
 Drug Name Mechanism of Action Indication and Side effect and Adverse Nursing Considerations and
Contraindication Effect Action
Rifaximin Inhibits bacterial RNA Reduction SIDE EFFECTS BASELINE ASSESSMENT
synthesis by binding of risk for recurrence of Occasional (11%–5%):  Check baseline hydration
to a subunit of bacterial overt hepatic Flatulence, headache, status: skin turgor, mucous
Classification DNA-dependent encephalopathy. OFF- abdominal discomfort, membranes for dryness,
PHARMACOTHERAPEUTIC: RNA polymerase. LABEL: Treatment of rectal tenesmus, defecation urinary status.
Antiinfective. Therapeutic Effect: hepatic encephalopathy. urgency, nausea. Rare (4%–  Assess stool frequency,
CLINICAL: Site-specific Bactericidal. 2%): Constipation, fever, consistency.
antibiotic. Contraindications: vomiting. INTERVENTION/EVALUATION
Hypersensitivity to ADVERSE EFFECTS/  Encourage adequate fluid
Dosage and Route: other rifamycin antibiotics. TOXIC REACTIONS intake.
PO: ADULTS, ELDERLY: Cautions: Hypersensitivity reaction,  Assess bowel sounds for
550 mg 2 times/ Severe hepatic impairment. superinfection peristalsis.
day occur rarely  Monitor daily pattern of bowel
activity, stool consistency.
Doctor’s Order  Assess for GI disturbances,
Rifaximin 550mg PO q 12hrs blood in stool.
PATIENT/FAMILY TEACHING
Pregnancy category: C • Report if diarrhea worsens or if
blood
occurs in stool, fever develops
within
48 hrs