2. Laxatives are used
1) To treat constipation
2) To avoid undue straining at defecation
3) Before or after any anorectal surgery
4) In bedridden patients
Laxatives have mild activity and are usually stool
softeners.
2Dr Anuj
3. Purgatives are used for complete colonic cleansing
prior to GI endoscopic procedures, pre-post MI
bed ridden patients , also to prepare bowel before
surgery or abdominal X-ray, may be needed for
neurologically impaired patients.
Purgative either provide semisolid stool or lead to
watery evacuation
In low doses these can be used as laxative also
3Dr Anuj
5. Bulk forming
Luminally active, hydrophilic indigestible vegetable fibres
Stimulates peristalsis and defecation reflexes by increasing
faecal bulk
Adequate water must be taken with all Bulk forming agents
Effect appears within 1-3 days
S/E Bloating and flatus causing abdominal discomfort
5Dr Anuj
6. Stool softener : Docussates(Dioctyl sodium sulfosuccinate)
Also known as surfactant laxatives
Luminally active agents , an anionic surfactant , softens
stool by decreasing surface tension of fluids in the bowel.
100-400 mg oral per day in divided doses
Indicated when straining at defecation is avoided
Latency period 1-3 day
Bitter in taste can cause nausea
Cramps and abdominal pain may occur
Hepatotoxicity may occur after prolonged use
Increases absorption of liquid paraffin , hence should not
be given together
6Dr Anuj
7. Stimulant purgative
Stimulate peristalsis by irritant action on intestinal mucosa
Also stimulate colonic electrolyte and fluid secretion by altering
absorptive and secretory activity of mucosal cells.
Inhibit Na+ K+ ATPase at the bosolateral membrane of villous
cells
Secretion is enhanced by activation of cAMP in crypt cells as well
as by increasing PG synthesis
Laxative action of bisacodyl and cascara is dependent upon NO
synthesis/action in colon
Larger dose of stimulant purgative can lead to purgation
resulting in fluid and electrolyte imbalance, hypokalemia.
Regular and long term use – colonic atony
Can reflexly stimulate gravid uterus- C/I in Pregnancy
Oter C/I- Subacute or Chronic intestinal obstruction
7Dr Anuj
8. Bisacodyl: (DULCOLAX 5 mg)
Partly absorbed and reexcreted in bile.
Activated in intestine by deacetylation.
Primary site of action is colon- Irritate mucosa,
produce inflammation & increase secretion
Effect appears within 6-8 hrs.
8Dr Anuj
9. Anthraquinones: Senna, Cascara sargada
Senna : Leaves and pods of Cassia spp.
Cascara sargada: bark of buck thorne tree
Degraded by colonic bacteria to liberate anthrol form
which either acts locally or absorbed into circulation and
excreted in bile to act on small intestine
Takes 6-8 hrs to produce action
Active principle of these drugs act on myenteric plexus to
increase peristalsis and decrease segmentation
Senna has been found to stimulate PGE2 secretion in rats
9Dr Anuj
10. Prucalopride :- selective 5HT4 receptor agonist
for tt of chronic constipation in women
Tegaserod :- 5HT4 receptor partial agonist ,
Used for tt of constipation predominant IBS
Withdrawn from market due to cardiovascular risk
Lubiprostone: PG analogue, activates Chloride channel in
small intestine to promote intestinal secretions and
motility
used for tt of constipation predominant IBS
10Dr Anuj
11. Osmotic purgatives
These are soluble inprganic salts , that increases the faecal
bulk by retaining water osmotically and distend the bowel
increasing peristalsis indirectly.
Act on small as well as large intestine
Magnesium salts release Cholecystokinin which further
helps in increasing intestinal secretions and peristalsis.
Milk of Magnesia is most commonly used , other salts have
an unpleasant taste
30 ml of its 8% w/w suspension is given in morning, effects
comes within 2-3 hrs.
11Dr Anuj
12. Usually preferred for bowel preparation before surgery,
colonoscopy, in food/drug poisoning and as after purge in
tt of tapeworm infestation
Should not be used for prolonged period in pt with renal
insufficiency due to risk of hypermagnesaemia.
12Dr Anuj
13. Lactulose(DUPHALAC 10gm/15ml syp)
Semisynthetic disaccharide of fructose and lactose, neither
digested nor absorbed in small intestine-retains water
Broken down in the colon by bacteria to osmotically more
active product
Produces soft, formed stool in 1-3 days.
Flatulence and flatus is common , cramps occur in
few,some pt may feel nauseated due to peculiar sweet taste
Also used for tt of hepatic encephalopathy in dose of 20gm
TDS orally
Lactulose is degraded to lactic acid and converts NH3 to
ionised NH4+ salts which is then excreted.
13Dr Anuj
14. Questions
Active principle of these drug act on myenteric plexus
Anthraquinones (Senna & cascara sargada)
Lactulose is used in tt of
Hepatic encephalopathy
It turns urine pink if alkaline
Phenolphthalein
Cholecystokinin is release by
Magnesium salts
14Dr Anuj
15. Alvimopan
peripherally acting μ opioid receptor antagonist for the
tt of postoperative ileus and constipation after surgery
15Dr Anuj
16. TREATMENT OF DIARRHOEAS
Too frequent, often too precipitate passage of poorly
formed stool
WHO “ 3 or more loose or watery stools in a 24 hr
period”
Cause
↓ed electrolyte and water absorption
↑ed secretion by intestinal mucosa
↑ed luminal osmotic load
Inflmm of mucosa & exudation into lumen
16Dr Anuj
17. 1. Treatmrnt of fluid depletion, shock and acidosis
2. Maintainance of Nutrition
3. Drug therapy
Oral rehydration if fluid loss is mild 5-7%BW
IV rehydration only when fluid loss is > 10% of BW
Dhaka fluid
NaCl -85 mM=5gm
KCl- 13mM=1gm,
NaHCO3 48mM =4gm in 1 ltr of water
17Dr Anuj
18. New formula WHO-ORS
NaCl: 2.6g
KCl: 1.5g
Trisod. Citrate : 2.9 g
Glucose : 13.5 g
Water : 1 L
Total osmolarity 245 mOsm/L
Zinc in pediatric diarrhea
Maintainance of nutrition
18Dr Anuj
19. Drug Therapy
1. Special antimicrobial drug
2. Probiotics
3. Drugs for Inflammatory bowel disease
4. Nonspecific antidiarrhoeal drug
19Dr Anuj
20. antimicrobial drug are of no value in diarrhoea due to
noninfectious causes
1. IBS
2. Coeliac disease
3. Pancreatic enzyme deficiency
4. Tropical Sprue
5. Thyrotoxicosis
20Dr Anuj
21. antimicrobial drug are useful in severe cases of
1. Travellers diarrhoea :- Cotrim, Norflox, Doxy, Rifaximin
2. EPEC :- Cotrim, FQ
3. Shigella enteritis :- Cipro norflox
4. Nontyphoid salmonella :- FQ Cotrim
5. Yersinia :- Cotrim Cipro
Antimicrobial drug are regularly useful in
1. Cholera :- Fluid replcement, Tetracyclin, Cotrim,
2. C. jejuni:- Norflox and other FQ
3. Clostridium difficile:- Metronidazole, Vancomicin
4. Amoebiasis, giardiasis :- Metron , Dilox furoate
21Dr Anuj
22. •Drugs for IBD(Inflammatory bowel disease)
chronic relapsing inflammatory disease of ileum colon or both a/w
systemic manifestation
Drugs used can be grouped in
5-ASA compounds
Corticosteroids
Immunosuppressants
TNF-α inhibitors
A. Ulcerative colitis:- Aminosalicylates(sulfasalazine),glucocorticoids,
cyclosporine,azathioprine , 6-mercaptopurine
B. Crohn’s disease :-
AntiTNF-α drugs( Infliximab adalimumab, Certolizumab),
Methotrexate, Antibiotics( metron cipro), Anti integrin monoclonal
antibody (Natalizumab)
22Dr Anuj
23. 5-ASA compounds( Sulfasalazine)
Azo bond split by colonic bacteria to release 5-ASA & sulfapyridine
5-ASA :- exerts antiinflammatory effect
sulfapyridine :- serves to carry 5-ASA to colon without being
absorbed proximally.
Mesalazine
Olsalazine
Balsalazide
Corticosteroid :- 40-60 mg/day
Immunosoppressant :- Azathioprine (purine antimetabolite)
Methotrexate(DHFRase inhibitor)
Cyclosporine
TNF-α inhibitors :- Infliximab
23Dr Anuj
28. Drug used for tt of dirrhoea in diabetic pt
Clonidine
Drug used to treat secretary diarrhoea
Octreotide
Variceal blleeding can be controlled by
Octreotide
Alosetron ,a drug useful in pt of Irritable bowel
syndrome with diarrhea acts through
5-HT3 receptor antagonist
An effective antidiarrhoeal agent that inhibits
peristalsis movt
Diphenoxylate
28Dr Anuj
