Name of Institution

Amity Institute of Pharmacy

B. Pharm., Semester one
Pharmacy
Dr. Pawan Kumar Porwal

1
 Name of Institution
Gastrointestinal agents

• Acidifiers: Ammonium chloride and Dil. HCl

• Antacid: Ideal properties of antacids, combinations of antacids, Sodium

Bicarbonate*, Aluminum hydroxide gel, Magnesium hydroxide mixture

• Cathartics: Magnesium sulphate, Sodium orthophosphate, Kaolin and Bentonite

• Antimicrobials: Mechanism, classification, Potassium permanganate, Boric acid,

Hydrogen peroxide*, Chlorinated lime*, Iodine and its preparations

 Constipation Name of Institution

 Abnormally infrequent and difficult passage of feces

through the lower GI tract

 Symptom, not a disease

 Disorder of movement through the colon and/or rectum

 Can be caused by a variety of diseases or drugs

LAXATIVES –
CATHARTICS – Name of Institution
PURGATIVES
• Increase fluid content in feces
• Uses
• Chronic constipation
• Older
• Trichobezars

• Evacuate colon
• Radiographs
• Pelvic fractures
• Perianal

• Most gentle to harsh

• Laxatives (soften) < Cathartics (evacuate) < Purgatives
(evacuate)
 LAXATIVES – Name of Institution
CATHARTICS - PURGATIVES

• Types of Laxatives • Types of Cathartics

include: include:
– Emollients – Osmotic
• Mineral oil • Hypertonic salts
– Milk of magnesia
• Cod liver oil
– Epsom salts
• White petrolatum
• Lactulose
• Glycerin
• Docusate sodium succinate
– Stimulant/ Irritant
(Colace) • Castor oil
– Bulk-forming
Name of Institution
 Laxatives: Name of Institution

Mechanism of Action
Bulk forming

 High fiber

 Absorbs water to increase bulk

 Distends bowel to initiate reflex bowel activity

 Examples:

 psyllium (Metamucil)

 methylcellulose (Citrucel)

 Polycarbophil (FiberCon)
 Laxatives: Name of Institution

Mechanism of Action
Emollient
 Stool softeners and lubricants
 Promote more water and fat in the stools
 Lubricate the fecal material and intestinal walls
 Examples:
 Stool softeners: docusate salts (Colace, Surfak)
 Lubricants: mineral oil

Saline
 Increase osmotic pressure within the intestinal tract, causing more water to enter
the intestines
 Result: bowel distention, increased peristalsis, and evacuation
 Laxatives: Name of Institution

Mechanism of Action
Hyperosmotic
 Increase fecal water content
 Result: bowel distention, increased peristalsis, and
evacuation
 Examples:
 polyethylene glycol (GoLYTELY)
 sorbitol (increases fluid movement into intestine)
 glycerin
 lactulose (Chronulac)
 Laxatives: Name of Institution

Mechanism of Action
 Saline laxative examples:
 magnesium sulfate (Epsom salts)
 magnesium hydroxide (MOM)
 magnesium citrate
 sodium phosphate (Fleet Phospho-Soda, Fleet
enema)
 Laxatives: Name of Institution

Mechanism of Action
Stimulant
 Increases peristalsis via intestinal nerve stimulation
 Examples:
 castor oil (Granulex)
 senna (Senokot)
 cascara
 Laxatives:
Indications Name of Institution

Laxative Group Use

Bulk forming Acute and chronic constipation
Irritable bowel syndrome
Diverticulosis
Acute and chronic constipation

Softening of fecal impaction;

Emollient facilitation of BMs in
anorectal conditions
 Laxatives: Indications Name of Institution

Laxative Group Use

Hyperosmotic Chronic constipation
Diagnostic and surgical preps
Constipation

Saline Diagnostic and surgical preps

Removal of helminths and parasites

Stimulant Acute constipation

Diagnostic and surgical bowel preps
 Laxatives: Side Effects Name of Institution

 Bulk forming
All laxatives can
 Impaction
cause electrolyte
 Fluid overload imbalances!
 Emollient
 Skin rashes
 Decreased absorption of vitamins
 Hyperosmotic
 Abdominal bloating
 Rectal irritation
 Laxatives: Side Effects Name of Institution

 Saline
 Magnesium toxicity (with renal insufficiency)
 Cramping
 Diarrhea
 Increased thirst
 Stimulant
 Nutrient malabsorption
 Skin rashes
 Gastric irritation
 Rectal irritation
 Laxatives: Implications Name of Institution

 Obtain a thorough history of presenting symptoms, elimination

patterns, and allergies
 Assess fluid and electrolytes before initiating therapy
 Patients should not take a laxative or cathartic if they are
experiencing nausea, vomiting, and/or abdominal pain
 A healthy, high-fiber diet and increased fluid intake should be
encouraged as an alternative to laxative use
 Long-term use of laxatives often results in decreased bowel
tone and may lead to dependency
 All laxative tablets should be swallowed whole, not crushed or
chewed, especially (if enteric coated)
 Laxatives: Implications Name of Institution

 Patients should take all laxative tablets with 6 to 8 ounces of water

 Patients should take bulk-forming laxatives as directed by the manufacturer
with at least 240 mL (8 ounces) of water
 Bisacodyl and cascara sagrada should be given with water due to
interactions with milk, antacids, and H2 blockers
 Patients should contact their provider if they experience severe abdominal
pain, muscle weakness, cramps, and/ or dizziness, which may indicate fluid
or electrolyte loss
 Monitor for therapeutic effect
 Magnesium Sulphate Name of Institution

• Synonyms: Epsom salt

• Formula: MgSO4.7H2O or MgO4S
• Molecular Weight:120.361 g/mol (Anhydrous), 246.67 g/mol
• Magnesium is a naturally occurring mineral that is important for many
systems in the body especially the muscles and nerves.
• An injectable solution of magnesium sulfate is used to treat magnesium
deficiency and refractory arrhythmias in patients who are critically ill.
• Magnesium sulfate is used as a laxative to relieve occasional
constipation.
• A dose of 1-2 mEq/kg of magnesium sulfate produced plasma
concentrations of 8.5-12.2 mEq/L, and can increase heart rate,
inotropy, and cardiac output.
Method of Preparation Name of Institution

Incompatibility: Addition of alcohol may cause precipitation of Magnesim Sulphate

Alkali hydroxide or alkali carbonate forms basic hydroxide and carbonates
Sodium Orthophosphate Name of Institution

• Synonyms: Sodium Acid Phosphate (sodium biphosphate),

• Molecular formula: NaH2 PO4.2H2O
• Molecular weight: 156.01
• I.P limit: It contains not less than 98.0% and not more than 100.5% of
NaH2PO4 calculated with reference to the dried substance.
• Properties: Colorless, odorless, crystalline powder with saline acidic taste.
Freely soluble in water and practically in soluble in alcohol. Slightly
deliquescent.
• Preparation:
• It is prepared by adding phosphoric acid to hot concentrated solution of
disodium phosphate until liquid ceases to give precipitate with barium
chloride. The solution is then concentrated to the crystallization point.
• By reaction with phosphoric acid with calculated quantity of sodium
hydroxide.
Disodium Hydrogen Phosphate Name of Institution

(Phosphor soda)
• Molecular formula: Na2HPO4.12H2O

• Molecular weight: 358.14

• I.P limit: It contains not less than 98.0% and not more than 101% of

NaH2PO4 calculated with reference to the dried substance.

• Properties: Colorless, odorless, crystalline powder. Soluble in water and

practically in soluble in alcohol. Very efflorescent.
• Preparation:
– It is prepared by reaction of orthophosphoric acid calculated quantity of
sodium hydroxide.
– From bone ashes or mineral phosphorite, which is treated with sulphuric acid
Kaolin Name of Institution

• Kaolin is characterized as
• Light kaolin
• Light kaolin natural
• Heavy kaolin (China clay)
• Light Kaolin
• IP Preparation: It differs from the heavy variety mainly in the degree of purity and in
particle size.
– It is prepared from heavy kaolin by elutriation, Reducing gritty and coarse particles.
– It should not contain any dispersing agent.
• Properties: It is a light white powder, unctuous (Ointment like, soft) to touch.
Standards: Besides identification test limits prescribed are: arsenic, heavy metals,
chloride, soluble matter, loss on drying and on ignition. Furher it has to be tested for
coarse particles and fine particles.
• Uses: Used IN cathartics. Light kaolin is mainly used as adsorbent for toxic substances
from the gastro-intestinal tract and to provide bulk by swelling with water in conditions
of diarrhoea. It may also be used in poultices. dusting powders, toilet powders and as
filtering aid . Storage: It should be stored in a well-closed container.
Heavy Kaolin Name of Institution

• IP Occurrence: This is a purified form of a natural clay having an approximate

composition Al2O3.2SiO2.2H2O.
• Natural kaolin is contaminated with carbonates of calcium and magnesium and ferric
oxide. These can be easily removed by treatment with hydrochloric acid, followed by
filtration, washing and drying
• Properties: It is a soft whitish powder, odorless and almost tasteless. It is insoluble in
water, organic solvents, mineral acids and alkali solutions.
• Standards: The pharmacopoeia prescribes identification and limits for: acidity or
alkalinity, arsenic, heavy metals, chloride, sulphate, substances soluble in mineral
acids, organic impurities and loss on ignition tests are also included for determining
adsorption power and swelling power.
• Uses: Heavy kaolin is used in the preparation of poultices. As it is liable to be
contaminated with spore bearing bacille and other bacteria.
• Storage: It should be stored in a well-closed container.
 Bentonite Name of Institution

• The term bentonite is applied commercially to any plastic, colloidal, and

swelling clay regardless of its geological origin.
• Such clays are ordinarily composed largely of minerals of the montmorillonite
group.
• Bentonite derived from ash falls tends to be in beds of uniform thickness
(from a few millimetres to 15 m) and extensive over large areas.
• Bentonite from ash falls and other sources occurs worldwide in strata
spanning a broad range of ages, but is most abundant in Cretaceous or
younger rocks.
• Bentonite is a rock or a clay base industrial material. It is therefore a mixture
of minerals.
Bentonite Name of Institution

• Bentonite feels greasy and soap-like to the touch.

• Freshly exposed bentonite is white to pale green or blue and, with
exposure, darkens in time to yellow, red, or brown.
• The special properties of bentonite are an ability to form thixotrophic gels
with water, an ability to absorb large quantities of water with an
accompanying increase in volume of as much as 12–15 times its dry bulk,
and a high cation exchange capacity.
• Physical and chemical properties Bentonite is used as filler in
pharmaceuticals, and due to its absorption/adsorption functions, it allows
paste formation. Such applications include industrial protective creams,
calamine lotion, wet compresses, and antiirritants for eczema.
• In medicine, bentonite is used as an antidote in heavy metal poisoning.
Personal care products such as mud packs, sunburn paint, baby and
facepowders, and face creams may all contain bentonite.
Name of Institution