Chapter 26

Laxatives and
Antidiarrheals

Laxative Classifications

Stimulant
Saline
Bulk-forming
Lubricant

Stool softeners
Suppositories

Lactulose
Enemas

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Stimulant Laxatives

Action

Chemical irritation

Increase motility of the GI tract

Increase secretion of water into large and

small intestine

Example: bisacodyl

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Saline Laxatives

Increase osmotic pressure within the

intestinal tract

Cause more water to enter the intestines

Result in:

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Bowel distention, increased peristalsis, and

evacuation

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(continued)

Saline Laxatives

Contain salt
Unpleasant taste
Systemically absorbed
Result in:

Poor client compliance

Risk for dehydration
Risk for congestive heart failure

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Bulk-Forming Laxatives

Safest form

Absorbs water to increase bulk

Distends bowel to initiate reflex bowel activity

High fiber
Natural or semisynthetic

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Not systemically absorbed

Examples: psyllium hydrophilic muciloid

(Metamucil), methylcellulose (Citrucel), and
polycarbophil (Fibercon)

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(continued)

Bulk-Forming Laxatives

Must be followed with a large amount of

fluid

If chewed or taken in dry powder form, these

agents can cause esophageal obstruction
and/or fecal impaction.

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Lubricant Laxatives

Oils lubricate the fecal material and

intestinal walls, thereby promoting fecal
passage:

Prevent fat-soluble vitamins from being

absorbed

Popular lubricant

Mineral oil (liquid petroleum)

Not digested or absorbed

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Stool Softeners

Detergent-like drugs:

Permit mixing of fats and fluids with the

fecal mass
Stool becomes softer and is passed much
easier
Takes several days to work

Example: docusate salts (Colace and

Surfak)

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Suppositories

Usually in a wax base

Administered rectally
Absorbed systemically
Available containing stimulant drugs

Glycerin

Absorbs water from tissues, creating more mass

Bisacodyl

Induces peristaltic contraction by direct stimulation

of sensory nerves

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Lactulose Laxatives

Two monosaccharides that are not

digested or absorbed
Digested in the colon by bacteria to
form acids substances

Acid substances cause water to be drawn

into the colon

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GoLYTELY

Polyethylene glycol (electrolyte

solution and salt)

Must consume 4 liters within 3 hours

Causes a large volume of water to be
retained in the colon
Acts within one hour

Produces a diarrheal state

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Enemas

Hyperosmotics

Solution contain salts (e.g., Fleet enema)

Administered rectally and cause a laxative

effect by osmotically drawing fluid into the
colon to initiate defecation

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Long-Term Use

Long-term use of laxatives often results

in decreased bowel tone and may lead to
dependency.
Encourage

A healthy, high-fiber diet

Increased fluid intake

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Adsorbents

Most commonly used

Claylike materials administered in a tablet
or liquid suspension form after each loose
bowel movement
Bind to the causative bacteria or toxin,
and are eliminated through the stool
Little scientific proof that they work

Examples: kaolin-pectin, attapulgite

(Kaopectate)

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Antidiarrheals

Reduce GI motility
Opium is a narcotic.

Decreases bowel motility and rectal spasms

Depresses the CNS; monitor closely
Decreases transit time through the bowel;
more time for water and electrolytes to be
absorbed

Paregoric is an opium tincture.

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May cause physical dependence

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(continued)

Loperarmide HCl (Imodium)

Antidiarrheals

Made from chemicals related to meperidine,

a narcotic

Diphenoxylate HCl and atropine sulfate

(Lomotil)

Narcotic and anticholinergic drug

Reduces GI motility

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Anticholinergics

Decrease intestinal muscle tone and

peristalsis of GI tract
Result: slows the movement of fecal
matter through the GI tract

Example: belladonna alkaloids (Donnatal)

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Nursing Implications

Monitor for therapeutic effect

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