BISACODYL and LACTULOSE

BISACODYL

It is a laxative that irritates.

Mechanism of Action

• Peristalsis is triggered by bisacodyl.
• Additionally, it affects the transport of fluid and electrolytes, resulting in fluid accumulation in the colon.

Indications

• Treatment for constipation in the short term
• Colon extraction for bowel and rectal examinations
• Preparing for an operation or delivery.

Dose

By mouth:

• Adult: 10mg-20 mg prn (max: 30 mg for special procedures/supp)
• Child: more than 6 years: 5-10mg prn

By PR:

• Adult: 10 mg prn
• More than 2 years: 5mg

Contraindication

Dehydration, lactating mothers, ulcerative hemorrhoids, rectal fissures, nausea, vomiting, or other appendicitis symptoms.

Side Effect

Dizziness, fainting. griping, diarrhea, nausea, vomiting, bloating, abdominal colic, flatulence, abdominal cramping, hypokalaemia, electrolyte imbalance.

Nursing Consideration

• One hour after having an antacid or milk or any other dairy product, bisacodyl should not be taken.
• For a quick effect, administer Bisacodyl with a glass of water on an empty stomach.
• Due to the required action time, oral doses should be administered in the evening or before breakfast. Cut, chew, or crush enteric-coated pills not recommended. Give preferably with a full glass of water in hand.
• When a bowel movement is wanted, the suppository may be inserted. Your finger should be used to push the suppository through the muscular sphincter of the rectum, which is approximately 1/2 to 1 inch in infants and 1 inch in adults. (If the suppository is not inserted past this sphincter, it could pop out.)
• Use steady pressure and a small side-to-side movement to carefully enter the enema tip into the rectum with the tip pointing toward the navel. Because doing so helps to relax the muscles surrounding the anus, inserting may be made simpler if you bear down as though having a bowel movement. Squeeze the bottle until almost no more liquid remains. The bottle already holds more liquid than is required, thus it is not necessary to empty it completely. Remove the enema from the rectum and hold the position until a strong urge to urinate arises.

LACTULOSE 

It is a semi-synthetic fructose and lactose disaccharide that neither gets digested nor gets absorbed in the small intestine, so it holds onto water. Lactulose lowers blood NH3 levels, particularly in patients with hepatic encephalopathy.

Mechanism of Action:

It cannot be broken down by digestive enzymes and is not well absorbed. Local bacteria in the colon break down lactulose to produce lactic, formic, and acetic acids. This acid produces soft stools in one to three days and has a mild osmotic effect. Additionally, it increases intestinal ammonia excretion, and this beneficial property has been used to reduce blood ammonia levels in patients with portal hypertension and hepatic encephalopthy.

Indication:

• Constipation
  Hepatic coma: Hepatic encephalopathy (portal systemic encephalopathy)

Dose:

• Constipation: 15 ml bid
• Hepatic encephalopathy: 30 to 50 mL (average 40ml) three times a day

Contraindication:

Galactose and lactose are readily available, which causes diabetes melitus.

Side Effect:

Flatulence, abdominal distention and cramping, hyper neutremia, hypokalaemia, dehydration

Nursing Consideration

• Effects appear between 24 to 48 hours.
• It should not be used as an over-the-counter laxative.
• Be alert! It is additionally employed in hepatic encephalopathy.
• Patients must drink water. The usual dosage is one dose per day (15-30 ml)
• If diarrhea lasts for more than 24 hours, call your doctor.
• Not always to be taken
• To make the oral dose more palatable, it should be administered with fruit juice, water, or milk.
• A rectal balloon catheter should be used to administer the rectal dose as a retention enema.
• If diarrhea (defined as more than two or three soft stools per day) lasts longer than 24 to 48 hours, contact your doctor. Overdosage is indicated by diarrhea. Dose adjustment might be necessary.
• If the first dose in children results in diarrhea, the dosage must be immediately decreased. If the diarrhea doesn't improve, stop.