CONSTIPATION

&
DIARRHOEA
 MANAGEMENT

Drugs used for treatment of Constipation:

1. LAXATIVES & APERIENTS - Milder in action

2. CATHARTICS & PURGATIVES - Stronger in action

These agents loosens the stools and increase bowel movements.

MOA: Acts by inhibiting Na-K-ATPase in villous cells of intestine which is needed for
reabsoprtion of fluids.
This leads to prevention of fluid reabsorption and free passage of stools.
Interactions: Bisacodyl should not be given with antacids. (causes irritation in stomach)
Always bisacodyl should be formulated as enteric coated drug, due to its irritability property.
Other MOA: They also stimulate adenyl cyclase enzyme in crypt cells which
increases fluid secretion in intestine and softens stools.
• In Dysentery by Shigella - Nalidixic acid is used.
• In Cholera by Vibrio cholera - Tetracyclins are used.
• In Amoebiasis by Entamoeba histolytica - Metronidazole and Tinidazole are used.
• In Salmonella infections - Co-trimoxazole is used.
• In Traveller's diarrhoea - Contamination of water with E.coli, - fluoroquinolones are used.
*ETEC - Enterotoxigenic E.coli *EPEC - Enteropathogenic E.coli Infection
 MECHANISM OF ACTION
COTRIMOXAZOLE:
 Combination of Trimethoprim and sulfamethoxazole in 1:5 ratios.
 Sulfonamides are structurally similar to PABA. As they replace
PABA, it forms altered folic acid which damages microbes.
Sulfonamides are used to treat all types of infections except
pus forming ones as pus is a rich source of PABA.
Interaction: Should not be given with procaine. It releases PABA
on metabolism & antagonizes action of sulfonamides.
SULFASALAZINE:
MECHANISM OF ACTION
 Sulfapyridine acts as carrier to deliver sulfasalazine towards
large intestine.
 5-Amino salicylic acid due to its structural similarity with aspirin,
inhibits COX and reduces PG levels. It gives anti-diarrhoeal activity.