Pharmacotherapy of BOWEL DISORDERS AND OTHER GASTROINTESTINAL

CONDITIONS

Pathophysiology of Constipation
• Water is reabsorbed as water travels through the large intestine. Reabsorption of
the proper amount of water results in stools of a normal, soft-formed consistency.
If the waste material remains in colon for an extended period, however, too much
water will reabsorbed, leading to small, hard stool that are difficult to evacuate
from rectum with straining.
• Constipation is a decrease in the frequency of bowel movement.

Pharmacotherapy with Laxatives

• Laxatives are drugs that promotes evacuation of the bowel or defecation that are
commonly used to prevent and treat constipation.
• Cathartics is a related term that implies accelerated, stronger, and more complete
bowel emptying
• Indications of Laxative use:
o Prophylaxis
 Prevent straining in patients following myocardial infarction
 Patients who are bedridden or otherwise unable to exercise
o Treatment
 Relief of simple, chronic constipation
 Cleanse the bowel prior to diagnostic or surgical procedures of the
colon, including colonoscopy and barium enema.
• Laxatives
o Bulk forming Laxatives.
 Bulk-forming agents absorbed water, thus adding size to the fecal
mass. Because fibers absorbs water and expands to provide” Bulk,
these agent must be taken with plenty of water.
 Bulk forming laxatives are agent of choice for the treatment and
prevention of chronic constipation.
 Ex. PSYLLIUM MUCILLOID(Metamucil).
 Nursing Responsibility when using Psyllium mucilloid.
• Mix powder with at least 8 ounces of pleasant tasting
liquid, such as fruit juices, immediately before use.
Insufficient fluid may cause fibers to swell and cause
choking. Do not give if patient has difficulty swallowing.
o Stimulant Laxatives.
 Stimulant laxatives promotes Peristalsis.
 They should not be used routinely, because they may cause
laxative dependence.
 These products are often used as a “bowel prep” prior to bowel
exams or surgery.
 Ex. BISACODYL(Dulcolax)

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 • Bisacodyl is the most frequently used stimulant-type
laxative.
• Bisacodyl should not be taken with milk or other dairy
products because this can dissolve the enteric coating and
cause dyspepsia.( Enteric coating is a barrier applied to oral
medication so it does not dissolve until it reaches the
intestine)
• Onset of Action is 8-12 hours (PO) if taken at bedtime or
15 to 60 minutes (rectal).
• Enteric coating should not be crushed or chewed.
 Ex. Castor oil (Emulsoil)
• Castor oil is one of the oldest and worst-tasting laxatives
that was approved by FDA in 1939.
• A stimulant type of laxative
• This drugs is pregnancy category X
o Surfactant Laxatives
 Surfactants, commonly called stool softeners, causes more water
and fat to be absorbed into the stool.
 Stool softeners are generally prescribed for patient who have
condition that puts them at risk for constipation, or an Myocardial
infarction (MI)where straining during defecation should be
avoided.
 Ex. DOCUSATE(Colace).
• Docusate is the most frequently prescribed surfactant-type
laxative or stool softener.
• This drug permits additional water and lipid to penetrate
the stool, resulting in softer stools.
• Docusate takes several days to act and therefore not
effective when a rapid and complete bowel evacuation is
necessary.

Pathophysiology of Diarrhea
• The small intestine receives about 9 liters of fluid, or chyme, daily. Most are
reabsorbed, such that only about 1 liter reaches the colon. Travel through the
colon results in even more reabsorption, and only about 100 mL remains to
form stools.
• When the small or large intestine fails to reabsorbed sufficient fluid, diarrhea
may occur.
• Diarrhea is an increase in the frequency and fluidity of bowel movements.
• Common etiology:
o Infection, the most frequently encountered diarrhea-producing
organism are Salmonella,Giardia, Shigella and Escherichia coli
(traveler’s diarrhea).
o Foods. Dairy products in lactose intolerant patients, foods with
capsaicin( hot pepper).

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 o Drugs. Magnesium Antacids like Magnesium Hydroxide

Pharmacotherapy of Diarrhea
• Opioids are the most effective drugs for controlling severe diarrhea.Opioids
can dramatically slow peristalsis in the colon.
o The most common opioid antidiarrheals are codeine and
diphenoxylate with atropine( Lomotil).
o Diphenoxylate acts directly on the intestine to slow peristalsis,thereby
allowing for more fluid and electrolyte absorption in the intestine
o Opioids caused Central Nervous System(CNS) depression at high
dosage and are generally reserved for short term therapy of acute
diarrhea due to potential for dependence.
• Antidiarrheal medication is contraindicated in cases of diarrhea caused by
pseudomembranous colitis(infection of the colon) that is caused by
Clostridium difficile. This infection can cause fatal toxic megacolon.
• Antidiarrheals
o Diphenoxylate with Atropine (Lomotil)
 Mechanism of action: Diphenoxylate acts on the smooth
muscle cells of the intestine to slow peristalsis
 It acts within 45 – 65 minutes
 The atropine in not added for its anticholinergic effect but to
discourage patients from taking too much of the drug.
 Lomotil as approved for use in children 2 years and older, but
Not recommended for Infants.
 Adverse effect: Anticholinergic effect of atropine, which
includes tachycardia, dry mouth, flushing and drowsiness.
 Treatment of over dose. Overdose with Lomotil may be
serious. Narcotic antagonist such as NALOXONE (Narcan) is
administered parenterally to reverse respiratory depression
within minutes.
 Patient Education
• Avoid caffeine because it can aggravate diarrhea.
• Take this only as prescribed because long term use
may cause dependency.
• Other Antidiarrheals
o Loperamide(Imodium)
 Drug of choice sympthomatic treatment of acute diarrhea and
maintenance therapy of chronic diarrhea.
 Shares the antidiarrheal properties of opiods but has no
analgesic action and does not produce dependence.

Pharmacotherapy of Inflammatory Bowel disease

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 • Inflammatory bowel disease(IBD) is characterized by the presence of ulcer in the
distal portion of the small intestine( Crohn’s disease) or mucosal erosion in the
large intestine( Ulcerative Colitis)
• Most common clinical presentation of ulcerative colitis is abdominal cramping
with frequent bowel movement.. severe diseases may lead to weight loss, bloody
diarrhea , high fever and dehydration
• Symptoms of Crohn’s disease is similar those of ulcerative colitis.
• Drugs for Inflammatory Bowel Disease (IBD)
o Sulfasalazine(Azulfidine)
 Mechanism of action: Sulfasalazine inhibits the mediators of
inflammation in the colon such as prostaglandin and leukotrines

Pharmacotherapy of NAUSEA AND VOMITING

• Antiemetics are prescribed to treat nausea, vomiting, and motion sickness.
• Drugs from at least eight classes are used to prevent or treat nausea and vomiting.
• Antiemetic drugs
o Anticholinergic agents
 Scopalamine- the most common drug used for motion sickness that
is usually administered as a transdermal patch
o Antipsychotic agentS.
 The primary indication of phenothiazine as the treatment of
psychoses, but they are also effective antiemetics.
Ex. Is Procholorperazine(Compazine)
• Prochlorperazine is the most frequently prescribed
antiemetic among the phenothiazine.

 Non phenothiazine that have high antiemetic effect include

Haloperidol (Haldol)

Pharmacotherapy of Pancreatitis
• Pancreatitis results when digestive enzyme remains in the pancreas rather than
Being release in the duodenum. Upon becoming activated and escaping the
surrounding tissue, the enzyme causes inflammation in the pancreas., which can
lead to hemorrhage and necrosis.
• Pancreatic enzyme are administered as replacement therapy for patient with
chronic pancreatitis.
• Drugs
o PANCRELIPASE(Pancrease)
 Mechanism of action: This agent facilitate the breakdown and
conversion of lipids into glycerol and fatty acids
 Drug interaction: Pancrelipase interact with Iron, which may result
to decrease in absorption of iron.
 Overdose: Highl level of uric acid may occur with overdose.
 Can be taken before, during or immediately after meals

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