okay so this is going to cover gastric motility and it's going to cover all of the different types of laxatives okay so for gastric motility this begins in chapter 51. um when we're speaking about gastric motility we're talking about peristalsis okay that's un undulating movement of the intestinal tract okay it moves contents through the system so we've talked about what peristalsis is already if a patient has increased motility that's equivalent to diarrhea right we have we have too much motility going on in that intestinal tract so the patient has diarrhea if there's a decrease in motility that is basically saying that the patient is constipated so we have slow peristalsis the patient's going to become constipated okay so now we're going to go over all the different types of laxatives so generally speaking we're talking about laxatives the therapeutic effect is that we soften the stool we increase stool formation and then we decrease the straining that occurs when having a bowel movement so for indications indications would be if your patient was constipated or straining to have a bowel movement with that you want to remember so important to remember for that is used to decrease constipation and straining that's why we give laxatives okay we want to avoid it says avoid valsalva what that is is we're going to avoid vasovagaling the patient and what does that mean so we have something called the vagus nerve and that's a cranial nerve that connects the brain to the body okay but it stimulates certain muscles in the heart that help to slow the heart rate so if we stimulate that vagus nerve what happens we have a decrease in blood pressure and decrease in heart rate so the patient who is actually straining to use the bathroom so you might hear this especially if you work in an er but you might hear this frequently or had a family member this has happened to right maybe grandma or grandpa was trying to use the bathroom and then all of a sudden they passed out and now they're in an ambulance on the way to the hospital to get a ct of their head well what happened is that they were straining to use the bathroom probably because they were constipated they stimulated that vagus nerve and it caused a drop in the blood pressure heart rate suddenly again due to that stimulation of that vagus nerve and the result is the patient can faint so we want to avoid doing that precautions and side effects fluid volume status so remember if we're giving a patient a laxative right something to help them eliminate and go to the bathroom could we overkill on that right could they take too much and then they have a lot of elimination a lot of fluid and electrolyte loss through their feces yes they can so those are things that we need to be careful about and monitor a patient for so fluid volume status medications primary medical history we want to know if they've had any history of other gi disorders if the patient's had surgery again fluid loss that fluid loss or that loss of volume is going to cause hypotension nursing actions assessment of therapeutic and side effects and then the appropriateness of the agent okay so now we're going to get into the different types of laxatives okay so bulk forming is our first one mechanism of action water retaining cellulose derivative that's this is the bulk forming laxative and that can either be natural or synthetic so the whole point of this is that it increases water absorption into the intestines right draws the water there and then we have an increase in bulk or total volume and it softens the stool okay increases water absorption into the intestines increases bulk total volume and softens the stool so side and adverse effects it really depends on how what route we're giving the medication so you see here esophageal obstruction or fecal impaction so what can happen is if we're giving the medication orally so you see here the drug example the drug drug example is cylium cylium the trade name is metamucil so you've probably seen metamucil commercials before um i don't know if maybe you've ever had it or had a family member that's had it but it's basically a powder you add water to you mix it up and then you notice it's gonna start to thicken okay so if we give that to the patient and then they swallow it maybe they're taking too long to drink it either way some of that drug can get in that esophagus and basically bulk in the esophagus and then the patient has an obstruction there okay we can also cause a fecal impaction as well and that drug example again is cylium and the trade is medium that silence the only prototype generic name that you will need to know okay so for emollient surfactant mechanism of action this is a softener okay it increases water and fat in the intestines and helps to lubricate the feces this will help the patient evacuate easier so the side and adverse effects would be abdominal cramping and diarrhea and then the drug examples which may look familiar to you possibly is docusate sodium docusite sodium is the generic prototype name you'll need to know the trade name is colace colace is what you've probably seen on the store shelves you're going to see this a lot if you are ever working or help out in a long-term care facility or you'll see it also in the acute care setting on the med search floor a lot of patient a lot of patients end up taking docusate sodium for a few reasons somehow or for whatever reason they have decreased peristalsis right it could be due to uh lack of activity right because we know activity helps increase peristalsis it could be a combination of the medications that they're taking so you see this kind of frequently in those settings and then stimulant so stimulant mechanism of action it does exactly that it stimulates the nerves leading to the intestines which helps to increase peristalsis and then our side or adverse effects could be abdominal cramping and also the patient can develop a possible dependence so the body's gonna end up relying upon the drug to stimulate a bowel movement this is huge especially for our elderly population our elderly population are fixated on having bowel movements fixated on it they don't have their daily bowel movement they're not happy well the problem with that is is as we age and as we've talked about peristalsis slows down right their activity has also slowed down not only that they're not eating as much they've lost their thirst drive and they don't eat as much food so if we're not eating we're not pooping right we're not having those bowel movements if we don't have activity like we should peristalsis against lows normal aging process peristalsis slows so it could be very normal especially for the elderly patient to only have a bowel movement once every few days but they're fixated on the fact that they should be having one daily because that's probably you know as a younger person that's how it was for them so they get to taking some type of stimulant or laxative every day and now they no longer can have a bowel movement because their body has now relied upon the drug to stimulate a bowel movement so it's really important that this is a really um easy class of drug for elderly patients to abuse or anybody for that matter so again so we talked about the side and adverse effects and then the generic prototype name you're going to want to remember for that is bicycle okay so now we're on saline mechanism of action it increases osmetic pressure in the small intestines so it's going to increase water into the stool side and adverse effects is nausea vomiting vomiting sorry abdominal pain electrolyte imbalance and it's contraindicated with renal disease example so the prototype you need to know for that is the magnesium hydroxide or milk of magnesia you've probably heard that name before hyperosmotics when we're saying a hyperosmotic that is a higher concentration of solute so the mechanism of action is going to increase water content in the large intestine and peristalsis side adverse effect is nausea vomiting and hypovolemia because this is a little more concentrated a little more stronger you could think of it as and so we're really gonna stimulate a bowel movement here so it's very possible that we over stimulate right and the patient has diarrhea or they have a lot of fluid and electrolyte loss through their feces so drug examples you have to know these okay these are your star prototypes and we'll talk about each of them so you want to remember all the little tidbits i provide you for these so lactulose okay so laculos we do use that as a laxative okay but it's also used to treat ammonia levels due to liver failure ammonia is a byproduct of protein metabolism which is converted into urea so if our kidneys are having issues as well we might not be able to excrete and eliminate the way we should so what we do is we give the patient lactulose it helps bind to the ammonia and then the patient is able to excrete it through their stool so if you saw a patient on lactulose your first thought should be okay well are they constipated if they're not constipated your second thought should be is they're probably on this because of liver failure let me go check their ammonia level their ammonia levels probably elevated so that's where your thought process should be with lactulose okay go lightly or polyethylene glycol polyethylene glycol is the generic prototype name you would need to know go lightly it's the trade this is actually used as a bowel prep or bowel cleansing prior to surgery or prior to um you know any type of baby gi scoping so if they're gonna have any type of procedure as such they're gonna have to drink this polyethylene glycol it's miserable it's literally like a huge plastic gallon it's full of powder and we set it on the patient's table we fill it with water we shake it up they have to drink like the entire thing it's the most miserable thing ever so typically i give them a cup with ice and a straw so they can just pour it over ice and then just down it as quick as they can because it's not a fun experience sorbitol sorbitol you'll also remember is also a sweetener but it also helps with elimination or stimulating that bowel movement