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N U T R IT IO N

ANTIDIARRHEAL

MECHANISM OF ACTION AND DRUG EFFECTS

INDICATIONS
CONTRAINDICATIONS
ADVERSE EFFECTS
INTERACTIONS
DOSAGES

MECHANISM OF ACTION AND DRUG EFFECTS

Absorption
Refers
to
penetration of a
substance
into
the
interior
structure of the
absorbent.

Adsorption
Similar to Adsorbent
but it involves in
chemical binding with
substances (e.g. ions &
bacterial toxins)
Act by coating the
walls of the GI tract.
It will bind with those
causative bacteria or
toxin for elimination
through the stool.

In contrast, adsorption refers to

penetration into substance for
interior structure (e.g. absorption of
dietary nutrients into intestinal villi)
Adsorbent, the uptake of substances
across a surface

Anti-cholinergic drugs
Intestinal flora modifiers
Works to slow
down
the From bacterial cultures. Opiates
peristalsis
by
reducing rhythmic
contractions
and
smooth muscle tone
of the GI tract.
Often used combine
with adsorbents and
opiates.

Most
commonly;
Lactobacillus
organisms.
Most
commonly
destroyed
by
antibiotics.
Works by exogenously
replenishing bacteria,
restore normal flora
and
suppress
the
growth of diarrheacausing bacteria.

Reduce bowel
motility.
Secondary
effect, reduction
of pain a/w
diarrhea
by
relief of rectal
spasms.

HOW OPIATES WORKS

Increase the transit time of food through the GI tract.

Permit longer contract of the intestinal contents with the

absorptive surface of the bowel.
Increase the absorption of water, electrolytes, and other nutrients from the
bowel and reduces stool frequency and net volume.

INDICATIONS
CONTRAINDICATIONS
Antidiarrheal

drugs indicated for treatment of diarrhea from various

types and levels od severity.

Adsorbents most likely to be used in milder cases.

Anticholinergics and opiates tend to be used in severe cases.
Intestinal flora modifiers helpful in patients with antibiotic-induced
diarrhea.

Drug allergy
Major acute

GI condition; intestinal obstruction or colitis (unless

prescribed by patients physicians after careful considerations of
specific cases.

ADVERSE EFFECTS OF ANTIDIARRHEAL

Drugs

Body System

Adverse Effects

Adsorbents
(bismuth subsalicylate)

Hematologic

Increased bleeding

Gastrointestinal

Constipation, dark stools

CNS

Confusion, twitching

Other

Hearing loss, tinnitus, metallic taste, blue gums

Genitourinary

Urinary retention and hesitancy, impotence

CNS

Headache, dizziness, confusion, anxiety, drowsiness

Cardiovascular

Hypotension, hypertension, bradycardia, tachycardia

Integumentary

Dry skin, rash, flushing

Eye, ear, nose,

throat

Blurred vision, photophobia, increased pressure in the eye

Anticholinergics
(atropine, hyoscyamine,
hyoscine)

ADVERSE EFFECTS OF ANTIDIARRHEAL

Drugs

Opiates
(codeine)

Body System

Adverse Effects

CNS

Drowsiness, sedation, dizziness, lethargy

Gastrointestinal

Nausea, vomiting, anorexia, constipation

Respiratory

Respiratory depression

Cardiovascular

Bradycardia, palpitations, hypotension

Genitourinary

Urinary retention

Integumentary

Rash, flushing, urticaria

DRUG PROFILES
Dosages

Pharmacokinetics

Age 3-5 years old = 5mL

Age 6-9 years old = 10mL
Age 10-12 years old= 15mL

Adsorbents
Life span considerations

Bismuth subsalicylate
*available OTC for oral use

Caution for children and teenagers due to the

risk of Reyes syndrome
Immediate report if abdominal distension, firm
abdomen, painful abdomen, worsening or no
improvement of diarrhea 24 to 48 hours after
medication administered.

Half-life = 24-33 hr.

Onset = 0.5-2 hr.
Peak
= 2-5 hr.
Duration
= variable
*for uncomplicated diarrhea
Adverse effect

Two alarming but harmless adverse

effects are temporary darkening of
tongue and/or stool.

DRUG PROFILES
Dosages

Adult

Pharmacokinetics

= 5-10mL 2 caps or tabs

Anticholinergics
Contraindications

Atropine, hyoscyamine, hyoscine

a.k.a belladonna alkaloids
*only by prescription

Toward pt. who have shown a

hypersensitivity to anticholinergics.
Pt. with glaucoma, GI obstruction,
myasthenia gravis, paralytic ileus and
toxic megacolon.

Half-life = unknown
Onset = 1-2 hr.
Peak
= 2-3 hr.
Duration
= 6-8 hr.
*for anticholinergic effects
Combinations of

Four different alkaloids; atropine,

hyoscymine,
phenobarbital
&
scopolamine = donnatal

DRUG PROFILES

Dosages
Pediatric 2-5 yr. = 1 mg (liquid only)
Pediatric 6-8 yr. = 2 mg
Pediatric 9-12 yr. = 2 mg
Adult
= 4 mg followed by 2mg
after each BM (not exceed
16mg/day)

*BM- bowel movement

Diphenoxylate with
atropine

Pharmacokinetics*

Opiates

Codeine, diphenoxylate with

atropine, paregoric, tincture of
opium (prescription only)
Loperamide (OTC)

Synthetic opiates agonist

Acts on smooth muscle of the intestinal tract,
inhibiting GI motility and excessive GI propulsion.
Little or no analgesic activity.
If taken in large dosages, result in extreme
anticholinergic effects (e.g. dry mouth, abdominal
pain, tachycardia, blurred vision)

Half-life = 2.5-4 hr.

Onset = 40-60 min.
Peak
= 2-3 hr.
Duration
= 3-4 hr.
*Diphenoxylate component
Loperamide

Inhibits both peristalsis in the intestinal wall and

intestinal secretion, thereby decrease the number
of stools and its water content
Contraindicated toward pt. with severe ulcerative
colitis, pseudomembranous colitis and acute
diarrhea d/t Escherichia coli

DRUG PROFILES

LAXATIVES

MECHANISM OF ACTION AND DRUG EFFECTS

INDICATIONS
CONTRAINDICATIONS
ADVERSE EFFECTS
INTERACTIONS
DOSAGES

MECHANISM OF ACTION AND DRUGS EFFECT

Treatment for constipation; abnormally infrequent and difficult passage of feces through the lower GI
tract.

Common causes of constipation are noted in Table 7.3

Laxatives act as
a. Affecting fecal consistency
b. Increasing fecal movement through the colon
c. Facilitating defecation through the rectum

CAUSE OF CONSTIPATION
Cause of constipation
Cause

Examples

Adverse drug effects

Analgesics, antivholinergics, iron supplements, opiates, ca+ channel

blockers

Lifestyles

Poor bowel movement habits: voluntary refusal to defecate

Diet: poor fluid intake or excessive consumption of dairy products
Physical inactivity: lack of proper exercise, especially in elderly
individuals
Psychological factors: anxiety, stress, hypochondria

Metabolic and endocrine

disorders

DM, hypothyroidism, pregnancy, hypercalcemia, hypokalemia

Neurogenic disorders

MS, intestinal pseudo-obstruction, spinal cord lesions, parksons

disease, stroke
Table 7.3 Cause of constipation

MECHANISM OF ACTION AND DRUGS EFFECT

Bulk-forming
laxatives

Emollient
laxatives

Hyperosmotic
laxatives

Similar to fiber
containing diet.
Absorb water into
the
intestine,
which
increase
bulk and distends
the
bowel
to
initiate
reflex
bowel activity

Referred to stool
softeners
and
lubricant laxatives
Lowering
the
surface tension of
GI fuids
So
that
more
water & fats are
absorbed into the
stool
and
intestines.
Lubricant
type,
lubricate the fetal
material
and
intestinal wall and
prevent
water
absorption into the
intestines

Increasing water
content, results in
distension,
increased
peristalsis,
and
evacuation.
Site
of
action
limited to the large
intestine.

Saline laxatives
Increase osmotic
pressure in the
small intestine by
inhibiting
water
absorption
and
increasing
both
water
and
electrolyte
(salt)
secretion
from
bowel wall into the
bowel lumen.
Results
watery
stool.
Increased
distention
promotes
peristalsis
and
evacuation.

Stimulant
laxatives
Stimulate
the
nerves
that
innervate
the
intestines
Increased
peristalsis
Also increase fliud
in colon, which
increases the bulk
and soften stools.

INDICATIONS

CONTRAINDICATIONS
Drug allergy; caution if presence the following of,
a. Appendicitis symptoms (such as abdominal pain, nausea, and vomiting)

Fecal impaction
Intestinal obstruction
Undiagnosed abdominal pain

ADVERSE EFFECT
Categories

Adverse Effects

Bulk forming laxatives

Emollient

Skin rashes
Decreased absorption of vitamins
Lipid pneumonia

Hyperosmotic

Abdominal bloating
Rectal irritation

Saline

Cramping
Diarrhea

Stimulant

Melanosis coli (buku 2nd)

Chronic administration lead to cathartic colon; a progressive
deterioration of colon function that can exacerbate an existing bowel
dysfunction.

Impaction above strictures

Fluid disturbances
Gas formation
Esophageal blockage
Allergic reaction

DRUG PROFILES
All OTC

Half-life

Unk.

Onset

12-24 hr

Peak

Unk.

Duratio
n
Unk.

Pharmacokinetics

Contraindicated with pt. having intestinal

obstruction or fecal impaction, abdominal
pain and/or nausea and vomiting

Bulk
-formin
g

Psyllium

Methylcellulose

Attracts water into

the
intestines
&
absorbs
excess
water into the stool
Stimulates
intestines
&
increase peristalsis

DRUG PROFILES
Half-life

Unk.

Onset

1-3 days

Peak

Unk.

Duratio
n
1-3 days

Contraindicated with
pt. having intestinal
obstruction or fecal
impaction, abdominal
pain and/or nausea
and vomiting

Lubricate the stool

& the intestines, as
with mineral oil
OR
Fecal softener

ANTIEMETIC &
ANTINAUSEA DRUG

MECHANISM OF ACTION AND DRUG EFFECTS

INDICATIONS
CONTRAINDICATIONS
ADVERSE EFFECTS
INTERACTIONS
DOSAGES

NAUSEA AND VOMITING

Nausea; an unpleasant feeling that precedes vomiting.
Vomiting also known as emesis; the forcible emptying or expulsion of gastric and
occasionally, intestinal contents through the mouth
Neurotransmitter

Site in the vomiting pathway

Acetylcholine

VC in brain; vestibular and labyrinthine pathway in inner ear

Dopamine D2

GI tract and CTZ in brain

Histamine H1

VC in brain; vestibular and labyrinthine pathways in inner ear

Prostaglandins

GI tract

Serotonin

GI tract; CTZ and VC brain

CTZ, chemoreceptor trigger zone; VC, vomiting center

MECHANISM OF ACTION
Anticholinergic drug; bind to and blocking acetylcholine (ACh) receptor in vestibular nuclei, also dry the
GI secretions and reduce smooth muscle spasms

Antihistamines; HI blockers, bind primarily H1 receptor. Prevent cholinergic stimulation in both vestibular
and reticular systems.

Neuroleptic drug; prevent

nausea and vomiting by blocking dopamine receptor on CTZ. Benefits in

calming the CNS.

Prokinetic drugs; in particular metoclopramide, acts as antiemetics by blocking dopamine receptors in

CTZ, which desensitize CTZ to impulses it receives from the GI tract

Serotonin blockers; blocking serotonin receptors. Located throughout the body, CNS, smooth muscles,
platelets and GI tract.

Tetrahydrocannabinol (THC); inhibitory effects on reticular formation, thalamus and cerebral cortex. Cause
an alteration in mood and the bodys perception of its surrounding thus relieve nausea and vomiting.

MINERALS

CALCIUM

MAGNESIUM

PHOSPHORUS
ZINC

Mineral
Types

Mechanism of Action

Cofactor in clotting reactions;

conversion of prothrombin to
thrombin by thromboplastin and
fibrinogen to fibrin
Maintenance and function of the
nervous, muscular and skeletal
systems and for cell membrane
and capillary permeability.
Transmission of nerve impulse
Contraction of cardiac, smooth
Calcium
and skeletal muscles
Renal function
Respiration
Plays a regulatory roles in release
and storage of neurotransmitter
and hormones
Uptake and binding of amino
acids
Intestinal absorption of
cyanocobalamin (vitamin b12) and
gastrin secretion

Indications

Menopause
Pancreatitis
Pregnancy
and lactation
PMS
Vitamin D
deficiency
Adult
osteomalaci
a
Muscle
cramps

Contraindications

Hypercalcemia
Ventricular fibrillation
of heart
Allergy

Adverse
effects

Interactions

Hypercalce
mia can
occur
Symptom:
Anorexia
Nausea
Vomiting
constipatio
n

Calium salts
will chelate
(bind) with
tetracyclines
to produce
an insoluble
complex

Mineral
Types

Mechanism of Action

Cofactor for many enzyme

systems.
Required for muscle contraction
Magnesi
and nerve physiology
um
Produces an anticonvulsant effect
by inhibiting neuromuscular
transmission for selected
convulsive states

Indications

Magnesium
deficiency
Preeclampsi
a and
eclampsia
Inhibition of
uterine
contractions
in premature
labor
Cardiac
arrhythmias
Short-term
constipation

Contraindications

Drug product allergy

Heart block
Renal failure

Adverse
effects

Interactions

Hypercalce
mia can
occur
Symptom:
Anorexia
Nausea
Vomiting
constipatio
n

Calium salts
will chelate
(bind) with
tetracyclines
to produce
an insoluble
complex