ANTI INFECTIVE AGENTS BACTERICIDAL

 Drugs that are designed to act  Kill bacteria or microorganisms

selectively on foreign organisms that
have invaded and infected the body of a NARROW SPECTRUM
human host  Antibacterial drugs which are effective
only to a few groups of microorganisms
Goal: To reduce microbes to a point at which
the human immune response can take care of BROAD SPECTRUM
the infection.  Antibacterial drugs that are effective
agaisnts several groups of
ANTI INFECTIVE microorganisms.
 Or anti microbial
 Drugs used to prevent or treat
infections cause by pathogenic CLASSIFICATION OF BACTERIA
microorganisms
 Antibacterial GRAM POSITIVE
 Antiviral  organisms are usually community-
 Antifungal acquired pathogens
include:
ANTIVIRAL  Streptococcal organisms
 Drugs used to treat viral infections  Staphylococcal organisms

ANTIFUNGAL GRAM NEGATIVE

 Drugs used to treat fungal infections  infections are potentially life
threatening
ANTIPARASITIC  Usually nosocomial in origin
 Drugs used to treat parasitic infections
or infestations Gram negative organisms include:
 Escheria Coli (E. coli)
ANTIBACTERIAL  Pseudomonas salmonella
 or ANTIBIOTICS  Enterococcus
 Usually refer only to drugs used in  Klebsiella
bacterial infections  Shigella
 substances that inhibit bacterial growth  Bacteroides
or kill bacteria.
MECHANISM OF ACTION
INDICATIONS FOR USE Most act on specific target in the BACTERIAL
CELL WALL by:
1. To treat already existing infections 1. Inhibition of bacterial wall synthesis.
2. To prevent development of infections 2. Inhibition of protein synthesis.
(called prophylactic therapy) 3. Disruption of microbial cell membrane.
4. Inhibition of organism production by
ANTI INFECTIVE ACTIVITY interfering nucleic acid synthesis.
BACTERIOSTATIC 5. Inhibition of cell metabolism and
 Inhibit the growth of bacteria or growth.
microorganisms
CATEGORIES OF ANTI INFECTIVE AGENTS 2. Caution about the risk of
photosensitivity reactions
AMINOGLYCOSIDES “mycins”
 Group of powerful antibiotics used to MACROLIDES “mycins”
treat serious infections caused by gram-  Interfere with protein synthesis
negative aerobic bacilli
EXAMPLES
o Pseudomonas aeruginosa  Erythromycin (E-mycin)
o E. coli  Clarithromycin (Biaxin)
o Proteus species  Azithromycin (Zithromax)
o Klebsiella-Enterobacter-Serratia group
o Staphylococcus Nursing Responsibility:
o Citrobacter species  monitor for nausea and vomiting,
diarrhea, dizziness, and other CNS
 Bactericidal – inhibit protein synthesis effects
 Poorly absorbed from GIT; rapidly
absorbed after IM injection LINCOSAMIDES
 Most of these drugs have potentially  similar to the macrolides but are more
serious adverse effects toxic

EXAMPLES: EXAMPLES
 Amikacin (Amikin)  Clindamycin (Cleocin)
 Gentamycin (Garamycin)  Lincomycin (Lincocin)
 Kanamycin (Kantrex)
 Neomycin (Mycifradin) Nursing Responsibility:
 Tobramycin (Tobrex) 1. monitor for pseudomonas colitis, Bone
Marrow Depression, pain, Central
Nursing Responsibility: Nervous System effects
1. Monitor for ototoxicity, renal toxicity,
GI disturbances, BMD, super-infections MONOBACTAM ANTIBIOTICS
1. Aztreonam
FLUOROQUINOLONES “oxacin”  the only
 relatively new class of antibiotics with a monobactam antibiotic
broad spectrum of activity currently available
 all made synthetically but with  effective against
relatively mild adverse reactions gram – enterobacteria
 no effect on
EXAMPLES: gram+ or anaerobic
 Ciprofloxacin (Cipro)  disrupts cell wall
 Levofloxacin (Levaquin) synthesis which promotes
 Ofloxacin (Floxin) leakage of cellular contents
 Sparfloxacin (Zagam)  Urinary Tract
 Moxifloxacin (Avelox) Infections, Systemic Infections,
intra-abdominal infections
Nursing Responsibility:
1. Monitor for headache, dizziness, GI Nursing Responsibility:
upsets & BMD
 1. monitor for GI problems, liver toxicity,
pain at the injection site
. PENICILLINS EXAMPLES:
1. Penicillins G benzathine 1. Cotrimoxazole (Septra, Bactrim)
 Systemic Infections, Erysipeloid  a combination drug that
infections contains sulfamethoxazole and
2. Penicillin G potassium trimethoprim
 Severe infections  effective in OM, UTI, bronchitis,
3. Penicillin G procain pneumonitis
 Moderately severe infections 2. Sulfadiazine - with broad use in
4. Penicillin V infections
 Prophylaxis for bacterial endocarditis, 3. Sulfisoxazole (Gantrisin) - includes
Lyme disease, Urinary Tract Infections various STDs

EXTENDED-SPECTRUM PENICILLIN Nursing Responsibility

1. Amoxicillin 1. Monitor for CNS toxicity, N/V, diarrhea,
 broad spectrum of uses for liver injury, renal toxicity, BMD
adults and children
2. Ampicillin TETRACYCLINES “cycline”
 switch from parenteral to  Developed as semisynthetic antibiotics
oral monitor for nephritis based on the structure of a common
3. Carbenicillin soil mold
 Urinary Tract Infection in adults  Inhibit protein synthesis
 Not used in children  Composed of four rings

Nursing Responsibility: EXAMPLES:

1. Monitor for N/V, diarrhea, 1. Doxycycline (Periostat)
superinfections,  Recommended for traveller’s diarrhea,
hypersensitivity reactions periodontal disease, acne, some STDs
2. Minocycline (Minocin)
PENICILLINASE-RESISTANT ANTIBIOTICS  Drug of choice in treating
1. Dicloxacillin – must be taken x 10 days meningococcal carriers
RTC 3. Oxytetracycline (Terramycin)
2. Nafcillin – DOC if switch to oral form is  Also used as an adjunctive therapy in
needed acute intestinal amoebiasis.
3. Oxacillin – DOC if switch to oral form is 4. Tetracycline (Sumycin)
needed  Oral & topical & opthalmic
 Acne vulgaris & minor skin infections
SULFONAMIDES “sulfa”
 Sulfa drugs inhibit folic acid synthesis Nursing responsibilities:
 Folic acid is necessary for the synthesis 1. Monitor for GI effects, BMD, rash,
of purine and pyrimidines, which are superinfections
precursors of DNA and RNA 2. Caution women that these may make
 Not used much anymore, however, they oral contraceptives ineffective
remain inexpensive and effective for
UTI.
 6. delay the emergence of resistant strains
– TB
Acquiring Resistance
1. Producing an enzyme that deactivates Adverse Reactions to Infective Therapy:
the drug KIDNEY DAMAGE
Ex. penicillinase  most frequently with drugs that are
2. Changing cellular permeability to metabolized and excreted by the
prevent the drug from entering the cell kidney
or altering transport systems to exclude Ex. aminoglycosides
the drug from active transport into the  Stay well hydrated throughout the
cell. course of therapy
3. Altering binding sites on the
membranes or ribosomes, which then GI TOXICITY
no longer accept the drug.  N/V, stomach upset, diarrhea
4. Producing a chemical that acts as an Ex. Meropenem – used to treat intra-
antagonist to the drug abdominal infections & some cases of
meningitis
Preventing Resistance
1. Doses should be high enough and long NEUROTOXICITY
enough to eradicate even slightly  Can damage or interfere with the
resistant microbes. function of nerve tissue, usually in
2. Correct timing – maintain a constant areas where drugs tend to
therapeutic level accumulate in high concentrations
3. Avoid indiscriminate use of anti- Ex. aminoglycosides – collect in the
infectives – identify first the causative 8th CN  dizziness, vertigo, loss of
organism hearing
Ex. Chloroquine for malaria – can
COMBINATION THERAPY accumulate in the retina & optic
- Combination of 2-3 antibiotics nerve  blindness
is suggested in severe
infections. HYPERSENSITIVITY REACTIONS
 Induce antibody formation in
EFFECTS of COMBINATION Therapy: susceptible people
1. smaller dosage of each drug is used
fewer adverse effects SUPERINFECTIONS
2. SYNERGISM – more powerful when  Destruction of normal flora – broad
given in combination spectrum
3. POTENTIATIVE – occurs when one  Opportunistic pathogens have the
antibiotics potentiates the effect of the opportunity to invade tissues & cause
2nd antibiotics. infections
4. ADDICTIVE- effect is equal to the sum Ex. vaginal or GI yeast infections
of the effects of 2 antibiotics.
5. ANTAGONISTIC- result is a combination
of bacteriostatic and bactericidal. When
these 2 drugs are used together, the
desired effect may be greatly REDUCED.
.
 5. Monitor for therapeutic serum
theophylline level of 10-20ug/ ml.
DRUGS USED TO TREAT OBSTRUCTIVE
PULMONARY DISORDERS SYMPATOMIMETICS
 are drugs that mimics the effect of the
BRONCHODILATORS/ ANTIASHMATICS sympathetic nervous system.
 are medications used to facilitate  One of the action of SNS- dilate the
respirations by dilating the airways. airways of the respiratory tree, making
 They are helpful in symptomatic relief air exchange and respirations easier for
or prevention of bronchial asthma and the client, and relax the smooth muscle
for bronchospasm associated with of the brochi.
COPD.
 Other medications are administered 1. Albuterol (Proventil)
directly into the airways by nebulizers. 2. Bitolterol (Tornalate)
These medications have the advantages 3. Epinephrine
of a decreased of systemic adverse 4. Formoterol (Foradil)
reactions. 5. Isoproterenol (Isoprel)
6. Levalbuterol (Xopenex)
DESCRIPTION 7. Terbutaline (Brethaire)
1. Sympathomimetic bronchodilators
2. Xanthine bronchodilators IMPLEMENTATION
3. Anticholinergic brochodilators 1. Reassure the patient that the drug of
4. Corticosteroids choice will vary with each individual.
5. Leukotriene receptor antagonist 2. Teach the patient to use one of these
6. Lung surfactant drugs for exercise induced asthma to
use it 30-60 minutes before exercising
XANTHINES to ensure peak therapeutic effect.
 Including caffeine and theophylline 3. Provide safety measures.
come from a variety of naturally 4. Provide small, frequent feeding and
occurring sources. nutritional consultation if GI effects
 Stimulate the central nervous system interfere with eating to ensure proper
and respiration, dilate coronary and nutrition.
pulmonary vessels, cause diuresis and 5. Provide thorough health teachings .
relax smooth muscle.
 Peak level : 2 hours SIDE EFFECTS
1. Palpitations and tachycardia
1. Aminophylline (Truphylline) 2. Restlessness, nervousness, tremors
2. Theophylline (Slo- bid, Theo-Dur) 3. Anorexia, nausea and vomiting
3. Oxtrophylline (Choledyl) 4. Headaches and dizziness
5. Hyperglycemia
IMPLEMENTATION 6. Mouth dryness and throat irritations
1. Administer with food or milk. with inhalers
2. Monitor patient response to drug
3. Assess for cough, wheezing, decreased
breath sounds and sputum production.
4. IV preparations should be administered
slowly and always via an infusion pump.
  LUNGS – has two effect – promote
smooth muscle relaxation and inhibit
bronchoconstriction.

ANTICHOLINERGIC
 used as bronchodilators because of  Decreased swelling associated with
their effect on the vagus nerve, which is inflammation.
to block or antagonize the action of the
neurotransmitter acetylcholine at vagal- VIA NOSE
mediated receptor site.  Beclomethasone dipropionate
 Ipratropium is the only anticholinergic  Budesonide
recommended fro brochodilation.  Flunisonide
 Onset of action: 15 minutes  Fluticasone propionate
 Peak effect: 1 to 2 hours  Triamcinolone acetonide
 Duration effect: 3-4 hours
VIA MOUTH
Adverse reactions  Prednisolone
 Nervousness  Prednisone
 Tachycardia
 Nausea and vomiting VIA VEIN
-methyprednisolone sodium succinate
IMPLEMENTATION - Hydrocortisone sodium succinate
 ensure adequate hydration and provide
environmental controls, such as use of a ADVERSE REACTION
humidifier.  Mouth irritation
 Ensure the patient to void before each  Oral candidiasis
dose of medication.  URTI
 Provide safety measures
 Provide health teachings IMPLEMENTATION
1. Do not administer the drug to treat an
 Monitor the medication regimen. acute asthma attack.
Total inhalation should not exceed 2. Have the patient use decongestant
in 12-24 hours and total nasay drops before using the inhaled steroid
sprays shouldn’t exceed 8 in each 3. Have the patient rinse the mouth after
nostrils in 24 hours. using the inhaler.
 If more than one inhalation is 4. Monitor the patient for any sign of
ordered, 2 minutes should elapse respiratory infection.
between inhalations. If more than 5. Health teachings
one type of inhalant is ordered,
always gve bronchodilator first and LEUKOTRIENE RECEPTOR ANTAGONIST
wait 5 minutes before 1. Zafirlukast (Accolate)
administering the other. 2. Montelukast (Singulair)
3. Zileuton (Zyflo)
CORTICOSTEROIDS
 Used to decrease the inflammatory
response in the airway.
  work to breakdown mucus in order to
aid the high risk respiratory patient in
coughing up thick, tenacious secretions.
 Maybe administered by nebulization or
DRUGS ACTING ON THE UPPER by direct instillation into the trachea via
an endotracheal tube or tracheostomy.
RESPIRATORY TRACT 1. Acetylcysteine (Mucomyst)
2. Dornase alfa (Pulmozyme)
ANTITUSSIVES- which blocks the cough reflex.
IMPLEMENTATIONS
DECONGESTANTS- which decrease the blood
 Instruct the patient to avoid combining
flow to the upper respiratory tract and decrease
with other drugs in the nebulizer to
the overproduction of secretions.
avoid formation of drug can be
administered via nebulizers with the
ANTIHISTAMINES- which block the release or
drug diluted with sterile water.
action of histamine, a chemical release during
 Remind the patient that the drug may
inflammation that increases secretions and
irritate the respiratory mucosa
narrows airways.
ANTITUSSIVES
EXPECTORANTS- which increase productive
 Act on the cough control center in the
cough to clear the airways
medulla to suppress the cough reflex.
 Used for cough that is non productive
MUCOLYTICS- which increase or liquefy
and irritating
respiratory secretions to aid the clearing of the
1. Benzonatate= narcotic anti-tussive
airways.
2. Butamirate citrate= non-narcotic
3. Codeine= narcotic
EXPECTORANT
4. Dextromethorphan= non-narcotic
 liquefy the lower respiratory tract
5. Hydrocodone= narcotic
secretions, reducing the viscosity of
these secretions and making it easier
Contraindications and Indications for use of
for the patient to cough them up.
antitussives These agents are NOT given to
 Guaifenesin (Anti-tuss, Glycotuss,
patients who have undergone thoracic and
Humibid, Robitussin)
abdominal surgeries because they need to
cough to maintain airway patency.
IMPLEMENTATION
Precautions are instituted when giving to
1. Instruct the client to take medication
patients with asthma, emphysema or COPD
with a full glass of water to loosen
because an accumulation of secretions may
mucus
occur
2. Maintain an adequate fluid intake
3. Encourage the client to cough and deep
IMPLEMENTATION
breath
 Emphasize that the drug should be
4. Caution the client not to use these
taken only on a specified time frame as
drugs for longer 1 week and seek
ordered
medical attention if cough still persists.
 Provide other measures to relieve
cough like provide humidified oxygen,
MUCOLYTICS
cool temperatures, fluids and use of
lozenges
  Caution that alcohol, narcotics, 3. Provide safety measures if drowsiness
sedatives-hypnotics can cause CNS may occur. Side rails up, assist in
depression when used with ambulation, and advise not to drive or
antitussives. operate dangerous machineries or
delicate tasks.

4. Increase humidity in the room by

utilizing nebulizers and provide
ANTIHISTAMINES adequate hydration
 Also called H1 blockers or H1
antagonists, these are agents designed 5. Caution the patient against use of OTC
to relieve respiratory symptoms and to drugs, alcoholic beverages and
treat allergic conditions. sedatives because they may cause
 The ANTIHISTAMINES The anti- extreme sedation.
histamines are group according to the
“generation”.
 The FIRST GENERATION agents have
greater anticholinergic effects and can
cause more sedation and drowsiness!
These agents cause drowsiness .
 The SECOND GENERATION agents have
fewer anticholinergic effects that is why
they cause less sedation.
FIRST GENERATION ANTIHISTAMINES
 1. Azatadine
 2. Dimenhydrinate
 3. Azelastine
 4. Diphenhydramine
 5. Brompheniramine
 6. Chlorpheniramine
 7. Promethazine
SECOND GENERATION ANTIHISTAMINES
 Loratidine
 Cetirizine

IMPLEMENTATIONS

1. The nurse should administer the drug

on an EMPTY stomach, or 1 hour before
or 2 hours after meals to increase the
absorption.

2. Give with food if GI upset occurs Offer

sugarless lozenges or hard candy to
counteract dryness of the mouth. Give
frequent oral care
  Inhibits the hydrogen potassium
adenosine triphosphatase enzyme
system on the secretory surface of the
gastric parietal ceells. This action blocks
the final step of acid production,
lowering the acid levels in the stomach.
DRUGS ACTING ON  Suppress the secretion of hydrocholoric
acid into the lumen of the stomach.
GASTROINTESTINAL SYSTEM
ADVERSE EFFECTS
H2 BLOCKERS 1. Dizziness, headaches
 Blocks the release of hydrocholoric acid 2. Asthenia
in response to gastrin. 3. Vertigo, insomia, dream abnormalitis
 Blocks the H2 receptors located in the 4. Diarrhea, abdominal pain, nausea and
parietal cells. vomiting, dry mouth.
 H2 receptors can also found in the 5. Cough, stuffy nose, hoarseness and
heart and high levels of this drugs can epistaxis
cause cardiac arrythmias.
implementation
CONTRAINDICATIONS 1. Administer before meals
1. Allergy 2. Ensure that the patient does not open,
2. Pregnancy and lactation chew or crush capsules, they should be
3. Hepatic and renal dysfunction that swallowed whole.
could interfere with drug metabolism 3. Provide safety measures
and excretion 4. After 4- 8 weeks of therapy should
4. Care should be taken if prolonged or consult the physician
continual use of this drugs is necessary. 5. Health teachings
6. Support and encouragement
ADVERSE EFFECTS
1. Diarrhea or constipation ANTIPEPTIC AGENTS
2. Dizziness, headaches, confusion and  Given to protect eroded ulcer sites in
even hallucination the GI tract from further damage by
3. Cardiac arrythmias and hypotension acids and digestive enzymes
4. Gynecomastia and impotence.
SUCRALFATE
IMPLEMENTATIONS  Forms an ulcer adherent complex at
 Administer with or before meals and at duodenal ulcer sites ->protects the sites
bedtime against acid, pepsin and bile salts
 Arrange for decrease dosage in cases of ->prevents further breakdown of the
hepatic or renal problem area ->promoters ulcer healing.
 Monitor patient continually if giving
intravenous dosage contraindications
 Provide comfort and safety measures 1. Allergy
 Health teachings 2. Renal failure or dialysis
 Offer support and encouragement. 3. Pregnancy and lactation
4. Adverse effects
PROTON PUMP INHIBITORS 5. Constipation- most common
 6. Nausea, indigestion, gastric discomfort  Can interfere with sucralfate
and dry mouth
7. CNS stimulation MAJOR SIDE EFFECTS
1. Constipation
2. Diarrhea
3. Alkalosis
4. Reduce absorption of calcium and iron

implementation NURSING CARE

1. Administer drug in to an empty  Instruct the client regarding:
stomach,1 hour before meals and at  prevention of overuse of antacids
bedtime. which can result in rebound
2. Monitor patient from GI pain hyperacidity.
3. Administer antacids between doses of  Need for continous supervision
sucralfate, not with in 30 minutesof a  Foods high in calcium and iron
sucralfate dose bec. Sucralfate can  Dietary restrictions related to
interfere with the absorption of oral gastric distress
agents. ANTIEMETICS
4. Provide safety measures  Alleviate nausea and vomiting.
5. Frequent mouth car, sugarless lozenges  Prevent and control emesis and motion
to suck sickness
6. Health teachings  Available in oral, parenteral, rectal and
7. Support and encouragement transdermal preparations.

ANTACIDS 1. Metoclopramide (Plasil, Reglan)

 Provide a protective coating on the 2. Dronabinol (Marinol)
stomach lining and lower the gastric 3. Ondansetron (Zofran)
acid level; allows more rapid
movement of stomach contents MAJOR SIDE EFFECTS
into duodenum  Drowsiness
 Neutralize gastric acid; effective in  Hypotension
the treatment of ulcers.  Dry mouth
 Available in oral preparations.  An EPS symptom due to dopamine
EXAMPLES antagonism
1. Aluminum hydroxide gel (Amphogel)
2. Al and MgOH (Maalox) NURSING CARE
3. Sodium bicardonate  Observe occurence and
4. Calcium bicarbonate (Tums)- may cause charateristics of vomitus.
hypercalcemia and hypophosphatemia.  Provide oral hygiene
 Caution the client to avoid engaging
 Caution client on a sodium-restricted in hazardous activities
diet that many antacid contains sodium  Offer sugar free chewing gum or
 Shake oral suspension well before hard candy to promote salivation.
administrations  Instruct client to change position
 Administer with small amount of water slowly.
to ensure passage to stomach
 2. Abdominal distention and constipation
EMETICS (decrease peristalsis)
 Stimulate the vomiting center and 3. Dry mouth
induce vomiting 4. CNS disturbance
 Use to treat acute poisoning. 5. Blurred vision

NURSING CARE
EXAMPLES  Provide dietary counseling with
emphasis on bland foods
APOMORPHINE  Provide oral hygiene
- Given subQ.  ANTISECRETORY AGENTS
- Emesis occurs 5-15 mins after sub q  Inhibit gastric acid secretion.
administrations  Act at the H2 receptors of the stomach
- Do not give to patient who is allegic to parietal cells to limit the gastric
morphine or other opiates secretion (H2 ANTAGONIST)
 Inhibit hydrogen/ potassium ATPase
ADVERSE EFFECTS enzyme system to block acid production
 DEPRESSION (proton pump inhibitors)
 EUPHORIA  Available in oral and parenteral (IM, IV)
 Respiratory depression preparations
 Orthostatic hypotension
MAJOR SIDE EFFECTS
IPECAC SYRUP  CNS disturbances
- 30 cc or less cause no systemic, adverse  Blood dyscrasias
effects  Skin rash
- Emesis occurs after 20- 30 mins
- 200-300 ml of water may facilitate the NURSING CARE
emetic action. 1. Do not administer at the same time as
DO NOT give to patients who: antacids; allow 1 to 2 hour between
 Have altered LOC drugs
 Have seizures 2. Administer oral preparation with meals.
 Ingested corrosives 3. Assess for potentiation of oral
 Ingested petroleum distillates anticoagulant effect.
4. Instruct client to follow prescription
ANTICHOLINERGICS exactly.
 Inhibit smooth muscle contraction in 5. Administration should not exceed 8
the GI tract weeks without medical supervision.
 Alleviate pain associated with peptic
ulcer ANTIDIARRHEALS
 Available in oral and parenteral  Promote the formation of formed stools
 Alleviate diarrhea.
MAJOR SIDE EFFECTS  Available in oral and parenteral
1. All related to decreased (IM)preparations
parasympathetic stimulation.
  Intestinal lubricants: use peripad to
protect clothing.
MAJOR SIDE EFFECCTS  Bulk forming laxatives: mix thoroughly
1. Fluid absorbents: GI disturbances, CNS in 8 oz of fluid and follow with another
disturbance. 8 oz of fluid to prevent obstruction
2. Enteric bacteria replacements:  Administer at bedtime to promote
excessive flatulence; abdominal cramps defecation in the morning.
3. Motility suppressants: urinary
retention. Tachycardia, dry mouth
sedation, respiratory depression.
NURSING CARE
 Monitor bowel movement for color,
characteristics and frequency. PANCREATIC ENZYMES
 Assess for fluid and electrolytes  Replace natural endogenous pancreatic
imbalance enzyme; promote the digestion of
 Assess and eliminate cause of protiens, fats and carbohydrates
diarrhhea.  Available in oral preparations
 Motility suppressants
- Warn client of interfere with the ability to MAJOR SIDE EFFECTS and Nursing CARE
perform hazardous activities and risk of physical  Nausea and diarrhea
dependence with long term use.  Administer with meals
- Offer sugar free chewing gum and hard candy  Avoid crushing preparations that are
to promote salivation. enteric coated.
 Provide a balances diet to prevent
CATHARTICS/ LAXATIVES indigestion
 Alleviate or prevent constipation and
promote evacuation of stool. ANTI SPASMODICS
 Available in oral and rectal preparations  Relax smooth muscle of the GI.
 MAJOR SIDE EFFECTS
 Laxative dependence with long term Side effects:
use 1. Constipation
 GI disturbances 2. Rash
Intestinal Lubricants: inhibit absorption of fat 3. Euphoria
soluble vitamins A, D, E,K can cause anal leaking 4. Dizziness
of oil
EXAMPLE:
Saline Cathartics: dehydration, hypernatremia - HNBB - Buscopan
 BILE ACID SEQUESTRANTS
NURSING CARE  Treat pruritus associated with biliary
 Instruct the client regarding: overuse of disease
cathartics and intestinal lubricants;  Act by absorbing and combining with
increasing intake of fluids and dietary intestinal bile salts.
fibers; increasing activity level;  Take with flavoured products or juice to
compliance with vowel- retaining mask bad taste.
program.
 Monitor bowel movements for SIDE EFFECTS
consistency and frequency of stool.  Constipation
 Bloating
  Flatulence
 Nausea
 Decreased vitamin absorptio
 HEPATIC ENCEPHALOPATHY

LACTULOSE (Duphalac)
- Reduces ammonia level.
- Improves protein tolerance in client
with advanced hepatic cirrhosis
- Lowers colonic pH from 7 to 5:
acidification pulls ammonia into the
bowel to be excreted in the feces, thus
lowering the ammonia level.

NEOMYCIN (Mycifradin)
-reduces the number of colonic bacteria that
normally convert urea and amino acids into
ammonia.