ADSORBENTS & LAXATIVEADSORBENTS & LAXATIVEBy By

Wiwik KusumawatiWiwik Kusumawati

OBJECTIVEOBJECTIVE• At the end of this topic the students will At the end of this topic the students will

be able to :be able to :1.1. Explain Explain mechanism of actionmechanism of action of both of both

adsorbents and laxative agentsadsorbents and laxative agents2.2. Explain Explain side effectsside effects of both adsorbents of both adsorbents

and laxative agentsand laxative agents3.3. Explain Explain indicationindication of both adsorbents and of both adsorbents and

laxative agentslaxative agents4.4. Explain Explain interactionsinteractions between adsorbents between adsorbents

and other drugsand other drugs5.5. Mention Mention classificationclassification of laxative agents of laxative agents

AntidiarrhealsAntidiarrheals1.1. AdsorbentsAdsorbents2.2. AnticholinergicsAnticholinergics3.3. OpiatesOpiates

AdsorbentsAdsorbents• Mechanism of actionMechanism of action• Coat the walls of the GI tractCoat the walls of the GI tract• Bind to the causative bacteria or toxin, Bind to the causative bacteria or toxin,

which is then eliminated through the which is then eliminated through the stoolstool

• Examples: bismuth subsalicylate Examples: bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, activated (Pepto-Bismol), kaolin-pectin, activated charcoal, attapulgite (Kaopectate)charcoal, attapulgite (Kaopectate)

AdsorbentsAdsorbents• Side EffectsSide Effects• Increased bleeding timeIncreased bleeding time• Constipation, dark stoolsConstipation, dark stools• Confusion, twitchingConfusion, twitching• Hearing loss, tinnitus, metallic taste, Hearing loss, tinnitus, metallic taste,

blue gumsblue gums

AdsorbentsAdsorbents• InteractionInteraction• Adsorbents decrease the absorption Adsorbents decrease the absorption

of many agents, including digoxin, of many agents, including digoxin, clindamycin, quinidine, and clindamycin, quinidine, and hypoglycemic agentshypoglycemic agents

• Adsorbents cause increased bleeding Adsorbents cause increased bleeding time when given with anticoagulantstime when given with anticoagulants

CONSTIPATIONCONSTIPATION• Abnormally infrequent and difficult Abnormally infrequent and difficult

passage of feces through the lower GI passage of feces through the lower GI tracttract

• Symptom, not a diseaseSymptom, not a disease• Disorder of movement through the Disorder of movement through the

colon and/or rectumcolon and/or rectum• Can be caused by a variety of diseases Can be caused by a variety of diseases

or drugsor drugs

LAXATIVE AGENTLAXATIVE AGENT•Drugs used for treatment of Drugs used for treatment of acute acute

constipationconstipation (drugs accelerating (drugs accelerating the passage of food through the the passage of food through the intestine)intestine)..

•AA symptomatic therapysymptomatic therapy which which should not be used chronicallyshould not be used chronically

LAXATIVE AGENTLAXATIVE AGENT1.1. Bulk formingBulk forming2.2. EmollientEmollient3.3. HyperosmoticHyperosmotic4.4. SalineSaline5.5. StimulantStimulant

Bulk formingBulk forming• High fiberHigh fiber• Absorbs water to increase bulkAbsorbs water to increase bulk• Distends bowel to initiate reflex bowel Distends bowel to initiate reflex bowel

activityactivity• Examples:Examples:

– psyllium (psyllium (MetamucilMetamucil))– methylcellulose (methylcellulose (CitrucelCitrucel))– polycarbophilpolycarbophil

EmollientEmollient• Stool softeners and lubricantsStool softeners and lubricants• Promote more water and fat in the Promote more water and fat in the

stoolsstools• Lubricate the fecal material and Lubricate the fecal material and

intestinal wallsintestinal walls• Examples:Examples:

– Stool softeners: docusate salts (Stool softeners: docusate salts (Colace, Colace, SurfakSurfak))

– Lubricants: mineral oilLubricants: mineral oil

HyperosmoticHyperosmotic• Increase fecal water contentIncrease fecal water content• Result: bowel distention, increased Result: bowel distention, increased

peristalsis, and evacuationperistalsis, and evacuation• Examples:Examples:

– polyethylene glycol (polyethylene glycol (GoLYTELYGoLYTELY))– sorbitolsorbitol– glyceringlycerin– lactulose (lactulose (ChronulacChronulac))

SalineSaline• Increase osmotic pressure within the Increase osmotic pressure within the

intestinal tract, causing more water intestinal tract, causing more water to enter the intestinesto enter the intestines

• Result: bowel distention, increased Result: bowel distention, increased peristalsis, and evacuationperistalsis, and evacuation

StimulantStimulant

• Increases peristalsis via intestinal Increases peristalsis via intestinal nerve stimulationnerve stimulation

• Examples:Examples:– castor oilcastor oil– sennasenna– cascaracascara– bisacodylbisacodyl

INDICATIONSINDICATIONSLaxative GroupLaxative GroupBulk formingBulk forming

EmollientEmollient

UseUseAcute and chronic Acute and chronic

constipationconstipationIrritable bowel syndromeIrritable bowel syndromeDiverticulosisDiverticulosisAcute and chronic Acute and chronic

constipationconstipationSoftening of fecal Softening of fecal

impaction; facilitation of impaction; facilitation of BMs in anorectal BMs in anorectal conditionsconditions

INDICATIONSINDICATIONSLaxative GroupLaxative GroupHyperosmoticHyperosmotic

SalineSaline

UseUseChronic constipationChronic constipationDiagnostic and surgical Diagnostic and surgical

prepsprepsConstipationConstipationDiagnostic and surgical Diagnostic and surgical

prepsprepsRemoval of helminths Removal of helminths

and parasitesand parasites

INDICATIONSINDICATIONSLaxative GroupLaxative GroupStimulantStimulant

UseUseAcute constipationAcute constipationDiagnostic and surgical Diagnostic and surgical

bowel prepsbowel preps

SIDE EFFECTSSIDE EFFECTS• Bulk formingBulk forming

– ImpactionImpaction– Fluid overloadFluid overload

• EmollientEmollient– Skin rashesSkin rashes– Decreased absorption of vitaminsDecreased absorption of vitamins

• HyperosmoticHyperosmotic– Abdominal bloatingAbdominal bloating– Rectal irritationRectal irritation

SIDE EFFECTSSIDE EFFECTS• SalineSaline

– Magnesium toxicity (with renal insufficiency)Magnesium toxicity (with renal insufficiency)– CrampingCramping– DiarrheaDiarrhea– Increased thirstIncreased thirst

• StimulantStimulant– Nutrient malabsorptionNutrient malabsorption– Skin rashesSkin rashes– Gastric irritationGastric irritation– Rectal irritationRectal irritation