Chapter 58

Laxative and Antidiarrheal Agents

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 Actions of Drugs Used to Affect
Motor Activity of the GI Tract
• Speed up or improve movement of intestinal
contents when it becomes slow or sluggish
(constipation)
• Increase the tone of the GI tract and stimulate
motility throughout the system
• Decrease movement along the GI tract when
rapid movement decreases the time for
absorption of nutrients (diarrhea)

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Site of Action of Drugs Affecting
GI Motility

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 Types of Laxatives

• Chemical stimulants

– Chemically irritate the lining of the GI tract

• Bulk stimulants

– Cause the fecal matter to increase in bulk

• Lubricants

– Help the intestinal contents move more smoothly

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 Types of Chemical Stimulants

• Cascara (generic): reliable agent that leads to

intestinal evacuation

• Senna (Senokot): reliable drug, similar to cascara

in action (OTC)

• Castor oil (Neoloid): old standby for thorough

evacuation of the intestine

• Bisacodyl (Dulcolax): very popular OTC laxative

that has been withdrawn from the market

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 Types of Bulk Stimulants

• Magnesium sulfate (Epsom Salts)

• Magnesium citrate (Citrate of Magnesia)

• Magnesium hydroxide (Milk of Magnesia)

• Lactulose (Chronulac)

• Polycarbophil (FiberCon)

• Psyllium (Metamucil)

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 Types of Lubricating Laxatives
• Docusate (Colace)
– Exerts a detergent action on the surface of the
intestinal bolus, making a softer stool
• Glycerin (Sani-Supp)
– Hyperosmolar laxative used to gently evacuate
the rectum without the systemic effects higher
in the GI tract
• Mineral oil (Agoral Plain)
– Forms a slippery coat on the contents of the
intestinal tract
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 Laxatives
• Actions
– Work in 3 ways:
 Direct chemical stimulation of the GI tract
 Production of bulk or increased fluid in the
lumen
 Lubrication of the intestinal bolus to
promote passage through the GI tract
• Indications
– Short-term relief of constipation
– Prevent straining when it is clinically
undesirable

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 Laxatives (cont.)
• Indications (cont.)
– Evacuate the bowel for diagnostic procedures
– Removal of ingested poisons
– Adjunct in anthelmintic therapy
• Pharmacokinetics
– Only minimally absorbed, laxatives exert their
therapeutic effect directly in the GI tract
• Contraindications
– Acute abdominal disorders
• Cautions
– Pregnancy and lactation
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 Laxatives (cont.)
• Adverse effects
– GI: diarrhea, abdominal cramping, and
nausea
– CNS: dizziness, headache, and weakness
– CV: sweating, palpitations, flushing, and
fainting
– Cathartic dependency
• Drug-to-drug interaction
– Some interfere with the timing or process of
absorption
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 Types of Gastrointestinal Stimulants

• Dexpanthenol (Ilopan)
– Increases acetylcholine levels and stimulates
the parasympathetic system
• Metoclopramide (Reglan)
– Blocks dopamine receptors and makes the GI
cells more sensitive to acetylcholine
– Leads to increased GI activity and rapid
movement of food through the upper GI tract

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 Gastrointestinal Stimulants
• Actions
– Stimulate parasympathetic activity within the GI
tract
– Increase GI secretions and motility
• Indication
– When rapid movement of GI contents is desirable
• Pharmacokinetics
– Rapidly absorbed
– Metabolized in the liver and excreted in urine
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Gastrointestinal Stimulants (cont.)

• Contraindications
– Allergy
– GI obstruction
• Cautions
– Pregnancy
– Lactation

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 Gastrointestinal Stimulants (cont.)

• Adverse effects
– Nausea, vomiting, diarrhea, intestinal spasms,
cramping, decreased blood pressure and heart
rate, weakness, and fatigue
• Drug-to-drug interactions
– Digoxin
– Cyclosporine
– Alcohol
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 Types of Antidiarrheal Drugs

• Bismuth subsalicylate (Pepto-Bismol): coats the lining

of the GI tract and soothes irritation-stimulating local
reflexes that cause excessive GI activity and diarrhea

• Loperamide (Imodium): directly affects the muscle

layers of the GI tract; slows peristalsis and allows
increased time for absorption of fluid and electrolytes

• Opium derivatives (paregoric): suppresses spasm

within the GI tract; stops peristalsis and diarrhea

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 Antidiarrheal Drugs
• Action
– Slow the motility of the GI tract through direct
action on the lining of the GI tract
• Indications
– Relief of symptoms of acute or chronic diarrhea
– Reduction of volume of discharge from ileostomies
– Prevention and treatment of traveler’s diarrhea
• Pharmacokinetics
– Vary depending on agent
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 Antidiarrheal Drugs (cont.)
• Contraindication
– Allergy
• Cautions
– Pregnancy
– Lactation
– History of GI obstruction
– History of acute abdominal conditions
– Diarrhea due to poisonings

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 Antidiarrheal Drugs (cont.)
• Adverse effects
– Constipation – Toxic megacolon

– Abdominal distension – Fatigue

– Abdominal discomfort – Weakness

– Nausea – Dizziness

– Dry mouth
• Drug-to-drug interactions
– Vary depending on the drug

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Use of Laxative and Antidiarrheal Agents
Across the Lifespan

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Prototype Chemical Stimulant Laxatives

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Prototype Bulk Laxatives

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Prototype Lubricant Laxatives

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Prototype Gastrointestinal Stimulants

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Prototype Antidiarrheal Drugs

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Nursing Considerations for Laxatives

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Gastrointestinal Stimulants

• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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 Nursing Considerations for
Antidiarrheal Drugs
• Assessment (history and physical exam)

• Nursing diagnosis

• Implementation

• Evaluation

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