{"id":365,"date":"2019-11-04T23:42:21","date_gmt":"2019-11-05T04:42:21","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-6-antidiarrheal-laxatives\/"},"modified":"2023-07-04T13:50:52","modified_gmt":"2023-07-04T17:50:52","slug":"7-6-antidiarrheal-laxatives","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-6-antidiarrheal-laxatives\/","title":{"raw":"7.6 Antidiarrheal Medications and Laxatives","rendered":"7.6 Antidiarrheal Medications and Laxatives"},"content":{"raw":"There are three common mechanisms of action of [pb_glossary id=\"654\"]antidiarrheal[\/pb_glossary]\u00a0<\/strong>medications: adsorbents, which help eliminate the toxin or bacteria from the GI tract; [pb_glossary id=\"729\"]antimotility[\/pb_glossary]<\/strong> agents, which slow peristalsis; and probiotics, which help to restore the normal bacteria found in the lower intestine. Nurses should closely monitor for dehydration; oral rehydration agents may be needed to replace fluid and electrolyte loss, but they do not treat diarrhea. Antibacterial agents may also be used to treat diarrhea caused by specific infections, such as campylobacter or giardia, but they are not routinely needed.[footnote]World Health Organization. (2017, May 2). Diarrhoeal disease.<\/em>https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/diarrhoeal-disease<\/a>[\/footnote]\r\n\r\nWhen administering antidiarrheals, the nurse should document an abdominal assessment, frequency of bowel movements and stool characteristics, and if there is skin breakdown in the anal area. The nurse should also keep in mind that antidiarrheals should be used very cautiously with children because some categories are contraindicated.\r\n

Adsorbents<\/h1>\r\n[pb_glossary id=\"655\"]Adsorption[\/pb_glossary]<\/strong> is the adhesion of molecules to a surface. This process differs from absorption, where a substance is dissolved or penetrates into a surface. Bismuth subsalicylate (brand name Pepto Bismol) is an example of an adsorbent (see Figure 7.6a[footnote]\"PeptoBismol Bottle.JPG<\/a>\" by ParentingPatch<\/a> is licensed under CC BY-SA 3.0<\/a>[\/footnote]).\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"283\"]\"Photo Figure 7.6a Bismuth Subsalicylate[\/caption]\r\n\r\nMechanism of Action<\/strong> Adsorbent medications work by coating the walls of the GI tract and binding the causative bacteria or toxin for elimination from the GI tract through the stool.[footnote]Lilley, L., Collins, S., & Snyder, J. (2014). Pharmacology and the Nursing Process.<\/em> pp. 782-862. Elsevier.[\/footnote] Bismuth subsalicylate also decreases the flow of fluids and electrolytes into the bowel, reducing inflammation within the intestine.[footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n\r\nSpecific Administration Considerations <\/strong>Bismuth subsalicylate contains salicylate. It should be avoided if the client has an allergy to salicylates (including aspirin) or if the client is taking other salicylate products such as aspirin. It should not be used if the client has an ulcer, a bleeding problem, or bloody or black stool. For more information on salicylates, read Chapter 10.6.<\/a> Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use this product. When using this product, if changes in behavior with nausea and vomiting occur, consult a doctor because these symptoms could be an early sign of Reye's syndrome, a rare but serious illness. Liquid products should be shaken well before use. Tablets should be swallowed whole and not chewed unless they are a chewable tablet. Medication can cause a black or darkened tongue. If symptoms worsen, a fever, or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours, contact the provider. [footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain. [\/footnote],[footnote]A.D.A.M. Medical Encyclopedia [Internet]. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Client Teaching & Education<\/h2>\r\nClients should be advised to take medication as directed.\u00a0 They should be aware of potential color changes to stool that may occur and that the medication contains aspirin.\u00a0 They should discontinue the medication if tinnitus occurs.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Antimotility<\/h1>\r\nAntimotility medications help to treat diarrhea by slowing peristalsis. There are two categories of antimotility medication: anticholinergics and opiate-like medication.\r\n

Anticholinergics<\/em><\/h2>\r\nMechanism of Action<\/strong> Hyoscyamine is an anticholinergic that works on the smooth muscle of the GI tract to inhibit propulsive motility, and decreases gastric acid secretion.\r\n\r\nSpecific Administration Considerations<\/strong> Read drug label information for all contraindications, including but not limited to glaucoma, myasthenia gravis, and paralytic ileus. Diarrhea may be an early symptom of incomplete intestinal obstruction, and the use of this drug would be inappropriate and possibly harmful. CNS symptoms and other adverse effects that are common with anticholinergic medications may occur.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote],[footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Patient Teaching & Education<\/h2>\r\nClients should receive instruction that these medications may cause dizziness and drowsiness.\u00a0 If clients experience dry mouth, frequent oral hygiene may alleviate discomfort.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Opioid-like medication<\/em><\/h1>\r\nMechanism of Action<\/strong> Loperamide has an opioid-like chemical structure but causes fewer CNS effects. It works by decreasing the flow of fluids and electrolytes into the bowel and by slowing down the movement of the bowel to decrease the number of bowel movements (see Figure 7.6b[footnote]\"Loperamide2mg.JPG<\/a>\" by Kristoferb<\/a> is licensed under CC BY-SA 3.0<\/a>[\/footnote]).\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"560\"]\"Photo Figure 7.6b Loperamide[\/caption]\r\n\r\nSpecific Administration Considerations<\/strong> Loperamide should not be given to a child younger than two years of age because of the risk of serious breathing and heart problems. Taking more than the prescribed dose can cause a serious abnormal heart rhythm that can lead to death. Read the drug label carefully for information about interaction with other medications, especially antidysrhythmics and antipsychotics.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote],[footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n

Patient Teaching & Education<\/h2>\r\nClients should take medications as directed.\u00a0 They should also avoid alcohol and other CNS depressants.\u00a0 The medications may cause drowsiness.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Probiotics<\/h1>\r\nProbiotics are used for the prevention and treatment of diarrhea. They are often used concomitantly with antibiotics to prevent the common associated side effects of diarrhea (see Figure 7.6c[footnote]\"WildWood Probiotic Soyogurt<\/a>\" by Veganbaking.net<\/a> is licensed under CC BY-SA 2.0<\/a>[\/footnote]). An example of a probiotic is lactobacillus.\r\n\r\n[caption id=\"attachment_359\" align=\"aligncenter\" width=\"480\"]\"Photo Figure 7.6c Probiotics come in several forms[\/caption]\r\n\r\nMechanism of Action<\/strong> Probiotics help replenish normal bacterial flora in the gastrointestinal tract.\r\n\r\nSpecific Administration Considerations\/ Patient Teaching<\/strong> & Education<\/strong> Side effects of probiotics, such as gas and bloating, are mild. Probiotics are safe for use in children.[footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote],[footnote]A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; \u00a92019. Heartburn; [reviewed 2019 May 10; cited 2019 October 27]. https:\/\/medlineplus.gov\/ency\/anatomyvideos\/000068.htm<\/a>[\/footnote]\r\n\r\nNow let\u2019s take a closer look at the medication grids comparing medications used to treat diarrhea, in Table 7.6a[footnote]Lilley, L., Collins, S., & Snyder, J. (2014).\u00a0Pharmacology and the Nursing Process.\u00a0pp. 782-862. Elsevier.[\/footnote][footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018). Pharmacology: A patient-centered nursing process approach.<\/em>\u00a0pp. 443-454. Elsevier.[\/footnote][footnote]This work is a derivative of Daily Med<\/a> by U.S. National Library of Medicine<\/a> in the public domain<\/a>. [\/footnote].\r\n\r\nMedication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Table 7.6a Comparing Medications Used to Treat Diarrhea [footnote] This work is a derivative of\u00a0 Daily Med <\/a>by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [\/footnote][footnote]RNPedia. (2021). https:\/\/www.rnpedia.com[\/footnote[footnote]OpenMD.Com at openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral[\/footnote]<\/caption>\r\n
Class<\/th>\r\nPrototype\/Generic<\/th>\r\nAdministration Considerations<\/th>\r\nTherapeutic Effects<\/th>\r\nAdverse\/Side Effects<\/th>\r\n<\/tr>\r\n
Adsorbents<\/th>\r\nbismuth subsalicylate<\/a> (Pepto Bismol)<\/td>\r\nAvoid if taking other salicylates. Do not use in children or teenagers recovering from chickenpox or flu-like symptoms as may cause Reye's syndrome. Do not use if the client has an ulcer, bleeding problem, or bloody or black stool.<\/td>\r\nDecreased diarrhea symptoms<\/td>\r\nMay cause black or darkened tongue. Contact provider if symptoms worsen, a fever or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours.<\/td>\r\n<\/tr>\r\n
Anticholinergic<\/th>\r\nhyoscyamine<\/a><\/td>\r\nContraindicated in glaucoma, myasthenia gravis, or paralytic ileus.<\/td>\r\nDecreased diarrhea symptoms<\/td>\r\nMay cause CNS and other adverse effects associated with anticholinergic medication.<\/td>\r\n<\/tr>\r\n
Opiate-like medication<\/th>\r\nloperamide<\/a> (Imodium)<\/td>\r\nContraindicated in children younger than 2 and with several other medications; read drug label information before administering.<\/td>\r\nDecreased diarrhea symptoms<\/td>\r\nBlack Box Warning: May cause abnormal heart rhythm.<\/td>\r\n<\/tr>\r\n
Probiotics<\/th>\r\nlactobacillus<\/a><\/td>\r\nPediatric dosing is age-based and varies by product.<\/td>\r\nPrevention of diarrhea or decreased symptoms of diarrhea<\/td>\r\nMild, such as gas and bloating.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
Clinical Reasoning and Decision-Making Activity 7.6a\"Image\r\n\r\n<\/header>\r\n
\r\n
    \r\n \t
  1. A client has been prescribed loperamide for diarrhea associated with gastroenteritis. The client begins to complain of \"heart palpitations.\" What is the nurse's next best response?<\/li>\r\n \t
  2. A child, aged 6, has diarrhea. The mother asks the nurse what OTC medications she can provide to her child to help resolve diarrhea. What is the nurse's best response?<\/li>\r\n<\/ol>\r\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n

    Laxatives<\/h1>\r\nIn contrast to diarrhea, constipation is when there are too few stools, or stools that require effort to increase elimination.\r\n\r\nThere are five categories of laxative medications commonly used to treat constipation: fiber supplements, [pb_glossary id=\"733\"]stool softeners[\/pb_glossary]<\/strong>, [pb_glossary id=\"731\"]osmotic agent[\/pb_glossary]<\/strong>, lubricants, and [pb_glossary id=\"734\"]stimulants[\/pb_glossary]<\/strong> (See Table 7.6b). Fiber supplements and stool softeners are often used daily to prevent constipation, whereas the other laxative categories are used to treat constipation. Table 7.6b compares the mechanism of action for each laxative category and includes common prototype and OTC brand names.<\/span>[footnote]This work is a derivative of\u00a0Daily Med<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [\/footnote],[footnote]National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. (2018). Treatment for constipation<\/em>.\u00a0https:\/\/www.niddk.nih.gov\/health-information\/digestive-diseases\/constipation\/treatment<\/a>.[\/footnote],[footnote]Drugs.com [Internet]. Fleet mineral oil enema (rectal)<\/em>; \u00a9 1996-2018 [updated 1 October 2019; cited 27 October 2019].\u00a0https:\/\/www.drugs.com\/mtm\/fleet-mineral-oil-enema-rectal.html<\/a>[\/footnote]<\/span>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
    Table 7.6b Categories of Laxatives Used to Treat Constipation<\/caption>\r\n
    Category<\/th>\r\nPrototypes<\/th>\r\nMechanism of Action<\/th>\r\n<\/tr>\r\n
    Fiber supplements<\/th>\r\npsyllium (Metamucil)<\/td>\r\nBulk-forming to facilitate passage of stool through the rectum<\/td>\r\n<\/tr>\r\n
    Stool softeners<\/th>\r\nDocusate (Colace)<\/td>\r\nFacilitates movement of water and fats into stool<\/td>\r\n<\/tr>\r\n
    Osmotic agents<\/th>\r\nMilk of Magnesia; polyethylene glycol (PEG) 3350 (Miralax)<\/td>\r\nCauses water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass<\/td>\r\n<\/tr>\r\n
    Lubricants<\/th>\r\nmineral oil enema (Fleet)<\/td>\r\nCoats the stool to help seal in water<\/td>\r\n<\/tr>\r\n
    Stimulants<\/th>\r\nBisacodyl (Dulcolax)<\/td>\r\nCauses the intestines to contract, inducing stool to move through the colon<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

    Fiber supplements<\/h2>\r\nPsyllium (brand name Metamucil) is an example of a common OTC fiber supplement (see Figure 7.6d)[footnote]\"Metamucil ad (cropped).jpg<\/a>\" by unknown is licensed under CC0<\/a>[\/footnote]).\r\n\r\n[caption id=\"attachment_364\" align=\"aligncenter\" width=\"279\"]\"Photo Figure 7.6d\u00a0Psyllium in powder form[\/caption]\r\n\r\nMechanism of Action<\/strong> Psyllium adds bulk to the stool to facilitate passage through the rectum.\r\n\r\nSpecific Administration Considerations<\/strong> When administering, put one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir. Administer at least 2 hours before or 2 hours after other medications as it can affect absorption. Psyllium usually produces a bowel movement within 12 to 72 hours. It may cause bloating and cramping.\r\n\r\nPatient Teaching & Education<\/strong> When teaching clients how to take psyllium at home, in addition to the above considerations, advise them to start with 1 dose per day but may gradually increase to 3 doses per day as necessary to maintain soft stools.\r\n\r\nStool Softeners\r\n\r\nDocusate is a common OTC stool softener that is also used frequently in health care settings.\r\n\r\nMechanism of Action:<\/strong> Docusate facilitates the movement of water and fats into stool to make it soft and improve the regularity of bowel movements.\r\n\r\nSpecific Administration Considerations:<\/strong> Docusate usually produces a bowel movement in 12 to 72 hours. It may cause stomach cramping.\r\n

    Osmotic Agents<\/h3>\r\nMilk of Magnesia and polyethylene glycol 3350 (brand name Miralax) are examples of common osmotic agents used to promote a bowel movement (see figure 7.6e[footnote]\"MiraLax Mix-In Pax, Unflavored, 20 Little Packets<\/a>\" by Ava Williams<\/a> is licensed under CC0<\/a> and \"Phillips' Milk of Magnesia, 1910's<\/a>\" by Roadsidepictures<\/a> is licensed under CC BY-NC 2.0<\/a>[\/footnote].\r\n\r\n[caption id=\"attachment_364\" align=\"alignleft\" width=\"379\"]\"Photo Figure 7.6e Miralax & Milk of Magnesia[\/caption]\r\n\r\n\"Photo\r\n\r\nMechanism of Action<\/strong> Osmotic agents cause water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass.\r\n\r\nSpecific Administration Considerations<\/strong> Polyethylene glycol 3350 has a bottle top that can be used as a measuring cap to contain 17 grams of powder when filled to the indicated line. Fill to top of clear section in cap, which is marked to indicate the correct dose (17 g); stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room temperature), and then administer.\r\n\r\nPatient Teaching & Education<\/strong> In addition to the administration considerations above, teach clients that polyethylene glycol usually produces a bowel movement in 1-3 days. It may cause loose, watery stools.\r\n

    Lubricants<\/h3>\r\nA mineral oil enema (brand name Fleet enema) is an example of a lubricant laxative (see Figure 7.6f[footnote]\"fleet_enema<\/a>\" by Logesh79<\/a> is licensed under CC BY-NC 2.0<\/a>[\/footnote]).\r\n\r\n[caption id=\"attachment_364\" align=\"aligncenter\" width=\"323\"]\"Photo Figure 7.6f\u00a0Mineral oil enema[\/caption]\r\n\r\nMechanism of Action<\/strong> Mineral oil coats the stool to help seal in water.\r\n\r\nSpecific Administration Considerations<\/strong> Read drug label for children as some brands can be used in children aged 2 or older, whereas others are not intended for children.\r\n\r\nPatient Teaching<\/strong> & Education<\/strong> A mineral oil enema generally produces a bowel movement in 2 to 15 minutes. It may cause stomach cramps, bloating, upset stomach, or diarrhea.\r\n

    Stimulants<\/h3>\r\nBisacodyl is an example of a stimulant laxative.\r\n\r\nMechanism of Action<\/strong> Bisacodyl causes the intestines to contract, inducing the stool to move through the colon.\r\n\r\nSpecific Administration Considerations<\/strong> Oral dosage or rectal suppositories are available. See instructions for how to insert a rectal suppository. Instruct client to retain suppository for about 15 to 20 minutes (see Figure 7.6g[footnote]\"Administering-med-rectally-2.png<\/a>\" by British Columbia Institute of Technology (BCIT) is licensed under CC BY 4.0<\/a>[\/footnote]).\r\n\r\n[caption id=\"attachment_364\" align=\"aligncenter\" width=\"611\"]\"Illustration Figure 7.6g Administering a rectal suppository[\/caption]\r\n\r\nPatient Teaching<\/strong> & Education<\/strong> A bowel movement is generally produced in 15 minutes. Bisacodyl may cause stomach cramps, dizziness, or rectal burning.\r\n\r\nNow let\u2019s take a closer look at the medication grids comparing medications used to treat diarrhea Table 7.6a[footnote]Lilley, L., Collins, S., & Snyder, J. (2014).\u00a0Pharmacology and the Nursing Process.<\/em>\u00a0pp. 782-862. Elsevier.[\/footnote],[footnote]McCuistion, L., Vuljoin-DiMaggio, K., Winton, M, & Yeager, J. (2018).\u00a0Pharmacology: A patient-centered nursing process approach.<\/em>\u00a0pp. 443-454. Elsevier.[\/footnote]<\/span>\r\n\r\nMedication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
    Table 7.6c Comparing Medications Used to Treat Constipation [footnote] This work is a derivative of\u00a0 Daily Med <\/a>by\u00a0U.S. National Library of Medicine<\/a>\u00a0in the\u00a0public domain<\/a>. [footnote]Drugs.com [Internet]. Metamucil<\/em>; \u00a9 2000-2019 [reviewed 20 November 2017; updated 1 October 2019; cited 27 October 2019].\u00a0https:\/\/www.drugs.com\/mtm\/metamucil.html<\/a>[\/footnote][footnote]RNPedia. (2021). https:\/\/www.rnpedia.com[\/footnote][footnote]OpenMD.Com at openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral[\/footnote]<\/caption>\r\n
    Prototype\/Generic<\/th>\r\nAdministration Considerations<\/th>\r\nTherapeutic Effects<\/th>\r\nAdverse\/Side Effects<\/th>\r\n<\/tr>\r\n
    psyllium (Metamucil)<\/a><\/th>\r\nPut one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir.\r\n\r\nUsually produces a bowel movement within 12 to 72 hours.\r\n\r\nAdminister at least 2 hours before or 2 hours after other medications as it can affect absorption.\r\n\r\nStart with 1 dose per day; may gradually increase to 3 doses per day as necessary.<\/td>\r\nImproves regularity of bowel movements.<\/td>\r\nMay cause bloating and cramping.<\/td>\r\n<\/tr>\r\n
    docusate<\/a><\/th>\r\nUsually produces bowel movement in 12 to 72 hours.<\/td>\r\nSoftens stool and improves regularity of bowel movements.<\/td>\r\nMay cause abdominal cramping.<\/td>\r\n<\/tr>\r\n
    polyethylene glycol 3350<\/a> (Miralax)<\/th>\r\nUsually produces a bowel movement in 1-3 days.\r\n\r\nThe bottle top is a measuring cap marked to contain 17 grams of powder when filled to the indicated line.\r\n\r\nFor adults and children 17 years of age and older:\r\n
      \r\n \t
    • fill to top of clear section in cap, which is marked to indicate the correct dose (17 g)<\/li>\r\n \t
    • stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room temperature) and then drink<\/li>\r\n \t
    • use once a day<\/li>\r\n \t
    • use no more than 7 days<\/li>\r\n<\/ul>\r\n<\/td>\r\n
    		Softens stool and improves regularity of bowel movements.<\/td>\r\nMay cause loose, watery stools.<\/td>\r\n<\/tr>\r\n
    Mineral oil enema<\/a><\/th>\r\nRead drug labels for children as some brands can be used in children aged 2 or older, whereas others are not intended for children.\r\n\r\nGenerally produces bowel movement in 2 to 15 minutes.<\/td>\r\nBowel movement within 15 minutes.<\/td>\r\nStomach cramps, bloating, upset stomach, or diarrhea.<\/td>\r\n<\/tr>\r\n
    bisacodyl<\/a><\/th>\r\nOral dosage or rectal suppositories are available.\r\n\r\nTo administer a rectal suppository: Position client on left side with the right knee up towards the chest. In the presence of anal fissures or hemorrhoids, suppositories should be coated at the tip with petroleum jelly. Remove foil and insert suppository well into rectum touching the bowel wall. Instruct client to retain suppository for about 15 to 20 minutes. A bowel movement is generally produced in 15 minutes to one hour. For children, read drug labels for dosage.<\/td>\r\nBowel movement within one hour.<\/td>\r\nStomach cramps, dizziness, or rectal burning.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
    \r\n

    \u00a0Interactive Activity<\/h3>\r\n[h5p id=\"21\"]\r\n\r\n<\/div>\r\n
    Clinical Reasoning and Decision-Making Activity 7.6b\"Image\r\n\r\n<\/header>\r\n
    \r\n\r\nA client who underwent hip surgery two days ago has not had a bowel movement since before admission. The client is receiving oxycontin ER 10 mg every 12 hours and oxycodone 5 mg every 4 hours for pain. The client describes abdominal discomfort and the nurse finds decreased bowel sounds in all quadrants. The nurse notifies the physician, follows the bowel protocol, and administers docusate sodium to the client.\r\n
      \r\n \t
    1. What are the potential causes of constipation that should be addressed for this client?<\/li>\r\n \t
    2. What is the mechanism of action for docusate?<\/li>\r\n \t
    3. The client asks how quickly the medication will work. What is the nurse's best response?<\/li>\r\n \t
    4. What other preventative measures for constipation should the nurse teach the client?<\/li>\r\n \t
    5. If docusate is not effective within 24 hours, what other medications can the nurse anticipate to be ordered?<\/li>\r\n<\/ol>\r\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>","rendered":"

      There are three common mechanisms of action of antidiarrheal<\/a>\u00a0<\/strong>medications: adsorbents, which help eliminate the toxin or bacteria from the GI tract; antimotility<\/a><\/strong> agents, which slow peristalsis; and probiotics, which help to restore the normal bacteria found in the lower intestine. Nurses should closely monitor for dehydration; oral rehydration agents may be needed to replace fluid and electrolyte loss, but they do not treat diarrhea. Antibacterial agents may also be used to treat diarrhea caused by specific infections, such as campylobacter or giardia, but they are not routinely needed.[1]<\/sup><\/a><\/p>\n

      When administering antidiarrheals, the nurse should document an abdominal assessment, frequency of bowel movements and stool characteristics, and if there is skin breakdown in the anal area. The nurse should also keep in mind that antidiarrheals should be used very cautiously with children because some categories are contraindicated.<\/p>\n

      Adsorbents<\/h1>\n

      Adsorption<\/a><\/strong> is the adhesion of molecules to a surface. This process differs from absorption, where a substance is dissolved or penetrates into a surface. Bismuth subsalicylate (brand name Pepto Bismol) is an example of an adsorbent (see Figure 7.6a[2]<\/sup><\/a>).<\/p>\n

      \"Photo
      Figure 7.6a Bismuth Subsalicylate<\/figcaption><\/figure>\n

      Mechanism of Action<\/strong> Adsorbent medications work by coating the walls of the GI tract and binding the causative bacteria or toxin for elimination from the GI tract through the stool.[3]<\/sup><\/a> Bismuth subsalicylate also decreases the flow of fluids and electrolytes into the bowel, reducing inflammation within the intestine.[4]<\/sup><\/a><\/p>\n

      Specific Administration Considerations <\/strong>Bismuth subsalicylate contains salicylate. It should be avoided if the client has an allergy to salicylates (including aspirin) or if the client is taking other salicylate products such as aspirin. It should not be used if the client has an ulcer, a bleeding problem, or bloody or black stool. For more information on salicylates, read Chapter 10.6.<\/a> Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use this product. When using this product, if changes in behavior with nausea and vomiting occur, consult a doctor because these symptoms could be an early sign of Reye’s syndrome, a rare but serious illness. Liquid products should be shaken well before use. Tablets should be swallowed whole and not chewed unless they are a chewable tablet. Medication can cause a black or darkened tongue. If symptoms worsen, a fever, or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours, contact the provider. [5]<\/sup><\/a>,[6]<\/sup><\/a><\/p>\n

      Client Teaching & Education<\/h2>\n

      Clients should be advised to take medication as directed.\u00a0 They should be aware of potential color changes to stool that may occur and that the medication contains aspirin.\u00a0 They should discontinue the medication if tinnitus occurs.[7]<\/sup><\/a><\/p>\n

      Antimotility<\/h1>\n

      Antimotility medications help to treat diarrhea by slowing peristalsis. There are two categories of antimotility medication: anticholinergics and opiate-like medication.<\/p>\n

      Anticholinergics<\/em><\/h2>\n

      Mechanism of Action<\/strong> Hyoscyamine is an anticholinergic that works on the smooth muscle of the GI tract to inhibit propulsive motility, and decreases gastric acid secretion.<\/p>\n

      Specific Administration Considerations<\/strong> Read drug label information for all contraindications, including but not limited to glaucoma, myasthenia gravis, and paralytic ileus. Diarrhea may be an early symptom of incomplete intestinal obstruction, and the use of this drug would be inappropriate and possibly harmful. CNS symptoms and other adverse effects that are common with anticholinergic medications may occur.[8]<\/sup><\/a>,[9]<\/sup><\/a><\/p>\n

      Patient Teaching & Education<\/h2>\n

      Clients should receive instruction that these medications may cause dizziness and drowsiness.\u00a0 If clients experience dry mouth, frequent oral hygiene may alleviate discomfort.[10]<\/sup><\/a><\/p>\n

      Opioid-like medication<\/em><\/h1>\n

      Mechanism of Action<\/strong> Loperamide has an opioid-like chemical structure but causes fewer CNS effects. It works by decreasing the flow of fluids and electrolytes into the bowel and by slowing down the movement of the bowel to decrease the number of bowel movements (see Figure 7.6b[11]<\/sup><\/a>).<\/p>\n

      \"Photo
      Figure 7.6b Loperamide<\/figcaption><\/figure>\n

      Specific Administration Considerations<\/strong> Loperamide should not be given to a child younger than two years of age because of the risk of serious breathing and heart problems. Taking more than the prescribed dose can cause a serious abnormal heart rhythm that can lead to death. Read the drug label carefully for information about interaction with other medications, especially antidysrhythmics and antipsychotics.[12]<\/sup><\/a>,[13]<\/sup><\/a><\/p>\n

      Patient Teaching & Education<\/h2>\n

      Clients should take medications as directed.\u00a0 They should also avoid alcohol and other CNS depressants.\u00a0 The medications may cause drowsiness.[14]<\/sup><\/a><\/p>\n

      Probiotics<\/h1>\n

      Probiotics are used for the prevention and treatment of diarrhea. They are often used concomitantly with antibiotics to prevent the common associated side effects of diarrhea (see Figure 7.6c[15]<\/sup><\/a>). An example of a probiotic is lactobacillus.<\/p>\n

      \"Photo
      Figure 7.6c Probiotics come in several forms<\/figcaption><\/figure>\n

      Mechanism of Action<\/strong> Probiotics help replenish normal bacterial flora in the gastrointestinal tract.<\/p>\n

      Specific Administration Considerations\/ Patient Teaching<\/strong> & Education<\/strong> Side effects of probiotics, such as gas and bloating, are mild. Probiotics are safe for use in children.[16]<\/sup><\/a>,[17]<\/sup><\/a><\/p>\n

      Now let\u2019s take a closer look at the medication grids comparing medications used to treat diarrhea, in Table 7.6a[18]<\/sup><\/a>[19]<\/sup><\/a>[20]<\/sup><\/a>.<\/p>\n

      Medication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.<\/p>\n\n\n\n\n\n\n\n
      Table 7.6a Comparing Medications Used to Treat Diarrhea [21]<\/sup><\/a>[22]<\/sup><\/a>[23]<\/sup><\/a><\/caption>\n
      Class<\/th>\nPrototype\/Generic<\/th>\nAdministration Considerations<\/th>\nTherapeutic Effects<\/th>\nAdverse\/Side Effects<\/th>\n<\/tr>\n
      Adsorbents<\/th>\nbismuth subsalicylate<\/a> (Pepto Bismol)<\/td>\nAvoid if taking other salicylates. Do not use in children or teenagers recovering from chickenpox or flu-like symptoms as may cause Reye's syndrome. Do not use if the client has an ulcer, bleeding problem, or bloody or black stool.<\/td>\nDecreased diarrhea symptoms<\/td>\nMay cause black or darkened tongue. Contact provider if symptoms worsen, a fever or ringing in the ears occurs, or if diarrhea lasts longer than 48 hours.<\/td>\n<\/tr>\n
      Anticholinergic<\/th>\nhyoscyamine<\/a><\/td>\nContraindicated in glaucoma, myasthenia gravis, or paralytic ileus.<\/td>\nDecreased diarrhea symptoms<\/td>\nMay cause CNS and other adverse effects associated with anticholinergic medication.<\/td>\n<\/tr>\n
      Opiate-like medication<\/th>\nloperamide<\/a> (Imodium)<\/td>\nContraindicated in children younger than 2 and with several other medications; read drug label information before administering.<\/td>\nDecreased diarrhea symptoms<\/td>\nBlack Box Warning: May cause abnormal heart rhythm.<\/td>\n<\/tr>\n
      Probiotics<\/th>\nlactobacillus<\/a><\/td>\nPediatric dosing is age-based and varies by product.<\/td>\nPrevention of diarrhea or decreased symptoms of diarrhea<\/td>\nMild, such as gas and bloating.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
      \n
      Clinical Reasoning and Decision-Making Activity 7.6a\"Image<\/p>\n<\/header>\n
      \n
        \n
      1. A client has been prescribed loperamide for diarrhea associated with gastroenteritis. The client begins to complain of \"heart palpitations.\" What is the nurse's next best response?<\/li>\n
      2. A child, aged 6, has diarrhea. The mother asks the nurse what OTC medications she can provide to her child to help resolve diarrhea. What is the nurse's best response?<\/li>\n<\/ol>\n

        Note: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n

        Laxatives<\/h1>\n

        In contrast to diarrhea, constipation is when there are too few stools, or stools that require effort to increase elimination.<\/p>\n

        There are five categories of laxative medications commonly used to treat constipation: fiber supplements, stool softeners<\/a><\/strong>, osmotic agent<\/a><\/strong>, lubricants, and stimulants<\/a><\/strong> (See Table 7.6b). Fiber supplements and stool softeners are often used daily to prevent constipation, whereas the other laxative categories are used to treat constipation. Table 7.6b compares the mechanism of action for each laxative category and includes common prototype and OTC brand names.<\/span>[24]<\/sup><\/a>,[25]<\/sup><\/a>,[26]<\/sup><\/a><\/span><\/p>\n\n\n\n\n\n\n\n\n
        Table 7.6b Categories of Laxatives Used to Treat Constipation<\/caption>\n
        Category<\/th>\nPrototypes<\/th>\nMechanism of Action<\/th>\n<\/tr>\n
        Fiber supplements<\/th>\npsyllium (Metamucil)<\/td>\nBulk-forming to facilitate passage of stool through the rectum<\/td>\n<\/tr>\n
        Stool softeners<\/th>\nDocusate (Colace)<\/td>\nFacilitates movement of water and fats into stool<\/td>\n<\/tr>\n
        Osmotic agents<\/th>\nMilk of Magnesia; polyethylene glycol (PEG) 3350 (Miralax)<\/td>\nCauses water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass<\/td>\n<\/tr>\n
        Lubricants<\/th>\nmineral oil enema (Fleet)<\/td>\nCoats the stool to help seal in water<\/td>\n<\/tr>\n
        Stimulants<\/th>\nBisacodyl (Dulcolax)<\/td>\nCauses the intestines to contract, inducing stool to move through the colon<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        Fiber supplements<\/h2>\n

        Psyllium (brand name Metamucil) is an example of a common OTC fiber supplement (see Figure 7.6d)[27]<\/sup><\/a>).<\/p>\n

        \"Photo
        Figure 7.6d\u00a0Psyllium in powder form<\/figcaption><\/figure>\n

        Mechanism of Action<\/strong> Psyllium adds bulk to the stool to facilitate passage through the rectum.<\/p>\n

        Specific Administration Considerations<\/strong> When administering, put one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir. Administer at least 2 hours before or 2 hours after other medications as it can affect absorption. Psyllium usually produces a bowel movement within 12 to 72 hours. It may cause bloating and cramping.<\/p>\n

        Patient Teaching & Education<\/strong> When teaching clients how to take psyllium at home, in addition to the above considerations, advise them to start with 1 dose per day but may gradually increase to 3 doses per day as necessary to maintain soft stools.<\/p>\n

        Stool Softeners<\/p>\n

        Docusate is a common OTC stool softener that is also used frequently in health care settings.<\/p>\n

        Mechanism of Action:<\/strong> Docusate facilitates the movement of water and fats into stool to make it soft and improve the regularity of bowel movements.<\/p>\n

        Specific Administration Considerations:<\/strong> Docusate usually produces a bowel movement in 12 to 72 hours. It may cause stomach cramping.<\/p>\n

        Osmotic Agents<\/h3>\n

        Milk of Magnesia and polyethylene glycol 3350 (brand name Miralax) are examples of common osmotic agents used to promote a bowel movement (see figure 7.6e[28]<\/sup><\/a>.<\/p>\n

        \"Photo
        Figure 7.6e Miralax & Milk of Magnesia<\/figcaption><\/figure>\n

        \"Photo<\/p>\n

        Mechanism of Action<\/strong> Osmotic agents cause water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass.<\/p>\n

        Specific Administration Considerations<\/strong> Polyethylene glycol 3350 has a bottle top that can be used as a measuring cap to contain 17 grams of powder when filled to the indicated line. Fill to top of clear section in cap, which is marked to indicate the correct dose (17 g); stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room temperature), and then administer.<\/p>\n

        Patient Teaching & Education<\/strong> In addition to the administration considerations above, teach clients that polyethylene glycol usually produces a bowel movement in 1-3 days. It may cause loose, watery stools.<\/p>\n

        Lubricants<\/h3>\n

        A mineral oil enema (brand name Fleet enema) is an example of a lubricant laxative (see Figure 7.6f[29]<\/sup><\/a>).<\/p>\n

        \"Photo
        Figure 7.6f\u00a0Mineral oil enema<\/figcaption><\/figure>\n

        Mechanism of Action<\/strong> Mineral oil coats the stool to help seal in water.<\/p>\n

        Specific Administration Considerations<\/strong> Read drug label for children as some brands can be used in children aged 2 or older, whereas others are not intended for children.<\/p>\n

        Patient Teaching<\/strong> & Education<\/strong> A mineral oil enema generally produces a bowel movement in 2 to 15 minutes. It may cause stomach cramps, bloating, upset stomach, or diarrhea.<\/p>\n

        Stimulants<\/h3>\n

        Bisacodyl is an example of a stimulant laxative.<\/p>\n

        Mechanism of Action<\/strong> Bisacodyl causes the intestines to contract, inducing the stool to move through the colon.<\/p>\n

        Specific Administration Considerations<\/strong> Oral dosage or rectal suppositories are available. See instructions for how to insert a rectal suppository. Instruct client to retain suppository for about 15 to 20 minutes (see Figure 7.6g[30]<\/sup><\/a>).<\/p>\n

        \"Illustration
        Figure 7.6g Administering a rectal suppository<\/figcaption><\/figure>\n

        Patient Teaching<\/strong> & Education<\/strong> A bowel movement is generally produced in 15 minutes. Bisacodyl may cause stomach cramps, dizziness, or rectal burning.<\/p>\n

        Now let\u2019s take a closer look at the medication grids comparing medications used to treat diarrhea Table 7.6a[31]<\/sup><\/a>,[32]<\/sup><\/a><\/span><\/p>\n

        Medication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.<\/p>\n\n\n\n\n\n\n\n\n
        Table 7.6c Comparing Medications Used to Treat Constipation [33]<\/sup><\/a>[34]<\/sup><\/a>[35]<\/sup><\/a>[36]<\/sup><\/a><\/caption>\n
        Prototype\/Generic<\/th>\nAdministration Considerations<\/th>\nTherapeutic Effects<\/th>\nAdverse\/Side Effects<\/th>\n<\/tr>\n
        psyllium (Metamucil)<\/a><\/th>\nPut one dose into an empty glass and mix with at least 8 ounces of water or other fluid. Taking this product without enough liquid may cause choking. Stir briskly and drink promptly. If mixture thickens, add more liquid and stir.<\/p>\n

        Usually produces a bowel movement within 12 to 72 hours.<\/p>\n

        Administer at least 2 hours before or 2 hours after other medications as it can affect absorption.<\/p>\n

        Start with 1 dose per day; may gradually increase to 3 doses per day as necessary.<\/td>\n

        		Improves regularity of bowel movements.<\/td>\nMay cause bloating and cramping.<\/td>\n<\/tr>\n
        docusate<\/a><\/th>\nUsually produces bowel movement in 12 to 72 hours.<\/td>\nSoftens stool and improves regularity of bowel movements.<\/td>\nMay cause abdominal cramping.<\/td>\n<\/tr>\n
        polyethylene glycol 3350<\/a> (Miralax)<\/th>\nUsually produces a bowel movement in 1-3 days.<\/p>\n

        The bottle top is a measuring cap marked to contain 17 grams of powder when filled to the indicated line.<\/p>\n

        For adults and children 17 years of age and older:<\/p>\n

          \n
        • fill to top of clear section in cap, which is marked to indicate the correct dose (17 g)<\/li>\n
        • stir and dissolve in any 4 to 8 ounces of beverage (cold, hot or room temperature) and then drink<\/li>\n
        • use once a day<\/li>\n
        • use no more than 7 days<\/li>\n<\/ul>\n<\/td>\n
        		Softens stool and improves regularity of bowel movements.<\/td>\nMay cause loose, watery stools.<\/td>\n<\/tr>\n
        Mineral oil enema<\/a><\/th>\nRead drug labels for children as some brands can be used in children aged 2 or older, whereas others are not intended for children.<\/p>\n

        Generally produces bowel movement in 2 to 15 minutes.<\/td>\n

        		Bowel movement within 15 minutes.<\/td>\nStomach cramps, bloating, upset stomach, or diarrhea.<\/td>\n<\/tr>\n
        bisacodyl<\/a><\/th>\nOral dosage or rectal suppositories are available.<\/p>\n

        To administer a rectal suppository: Position client on left side with the right knee up towards the chest. In the presence of anal fissures or hemorrhoids, suppositories should be coated at the tip with petroleum jelly. Remove foil and insert suppository well into rectum touching the bowel wall. Instruct client to retain suppository for about 15 to 20 minutes. A bowel movement is generally produced in 15 minutes to one hour. For children, read drug labels for dosage.<\/td>\n

        		Bowel movement within one hour.<\/td>\nStomach cramps, dizziness, or rectal burning.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
        \n

        \u00a0Interactive Activity<\/h3>\n
        \n