Laxatives Aka cathartics Used for relief of constipation When straining is undesirable (MI, post-op) Bowel prep for

rep for testing Poisoning Anthelmintic treatment Most are OTC and often abused by older people

Chemical Stimulants

Caster oil

o Directly stimulate the nerve plexus causing increased movement and stimulation of the local reflexes o They can block the absorption of fats including fat soluble vit. o They are minimally absorbed and excert effects directly on GI o Can cause lyte imbal Bulk Stimulants magnesium citrate (Citrate Magnesia)

o Stimulate GI activity by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors and activates local activity o All are taken orally and not absorbed systemically o Be sure to drink plenty of water b/c it can cause swelling of esophagus and obstructing o Do not give to pts with hx of sz b/c the lyte absorption and induce a Sz Lubricants Mineral oil o Forms slippery coat making feces softer and easier to pass o Not absorbed systemically o Can be taken orally or by suppository Pt teaching All laxatives interfere with absorption of other medications and should be taken at least 30 min. apart Be sure to drink plenty of water All cause GI and CNS side effects abd cramping - diarrhea dizzy HA- weakness all related to loss of lytes

 Do not chew tablets Be sure to stress the importance of eating high fiber foods Caution of cathartic dependence- with over use body begins to depend on the extra stimulation.

Gastrointestinal stimulants

metoclopramide (Reglan)

o Stimulate parasympathetic activity within the GI by increasing GI secretions and motility on a general level throughout the tract o Are indicated when more rapid movement of GI contents are desirable o Can be given po, IM, IV Do not give to pts with GI obstruction Reg or lact Can cause decrease in BP and HR due to parasympathetic effects GI effects include n/v/d and spasm They decrease absorption of other drugs Decrease in immunosuppressive effects Increase sedation Antidiarrheals loperamide (Imodium)

o Block stimulation of GI for symptomatic relief from diarrhea o Slows motility and movement of water and lytes through direction action on lining of GI Do not give in instances of poisoning b/c it can be worsened by the slowing of the GI tract GI effects include constipation- distention- n/v dry mouth Opium derivatives are associated with light headedness sedation and resp. depression Antiemetic agents prochlorperazine (Compazine) Metoclopramide (Reglan) Meclizine (Antivert) Ondansetron (Zofran) Hydroxyzine (Vistaril) Trimethobenazmide (Tigan)

o Used to manage n/v by depressing the hyperactive vomiting reflex o Choice of drug depends on cause of vomiting Most cause CNS depression and photosensitivity