Ned Tijdschr Geneeskd. 1994 May 28;138(22):1122-6.
[Changes in drug use during a stay in a psychogeriatric nursing home]
[Article in Dutch]
Koopmans RT, de Vaan HH, van den Hoogen HJ, Gribnau FW, Hekster YA, van Weel C.
Verpleeghuis Joachim en Anna, Nijmegen.
OBJECTIVE. To describe the changes in drug intake during institutionalization in a Dutch psychogeriatric nursing home. SETTING. Psychogeriatric nursing home Joachim en Anna in Nijmegen, the Netherlands. DESIGN. Retrospective analysis of medical charts. PATIENTS AND METHODS. In 390 patients drug intake (sixteen drug groups) at admission, after six weeks, at half yearly intervals and on the day of death was recorded in a longitudinal fashion, as were side effects. Increase or decrease in drug intake was tested by means of linear regression analysis. RESULTS. After an initial decrease there was a gradual increase in mean drug intake during institutionalization. Laxatives and to a lesser degree drugs for the respiratory tract and heart were mostly responsible for this increase. In the other groups no change or even decrease was noted. The degree of dependency and the type of dementia had an influence on these changes. At the day of death analgesics, morphinomimetics and bronchodilators were the most frequent drugs. Neuroleptics caused most of the side effects observed. CONCLUSION. Prescription of laxatives is mostly responsible for the increase in mean drug intake in this Dutch psychogeriatric nursing home.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8008126&dopt=Abstract constipation laxative
Aust Fam Physician. 1994 Jul;23(7):1248-53.
The management of constipation in end-stage disease.
Bethlehem Hospital, Caulfield, Victoria.
A rectal examination may be considered an invasive intervention in a frail patient, but it is preferable to a blanket approach to treatment, which may be ineffective or do more harm than good, for example, giving antidiarroeals when the diarrhoea is spurious secondary to impaction, or continuing to soften soft faeces when in fact a stimulant laxative is required. The rectal examination can be modified to a gentle inspection. It should not need to be performed repeatedly if the regular regimen is altered according to the findings. This approach prevents the need for routine suppositories, enemas or manual evacuation. However, on the occasions that the above measures are unsuccessful, an enema may need to be employed. Microlax (containing osmotic agents such as sorbitol) is relatively well tolerated. Intractable cases may require a Clezy enema (a large volume enema that is prepared by a hospital pharmacist and contains the softeners: Paraffin oil 30 mL, Glycerine 30 mL, Enema soap 30 mL, and olive oil 60 mL, made up to 400 mL with water). If manual evacuation is contemplated, a pre-medication with midazolam 5 mg subcutaneously will give short sedation for this procedure.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8060271&dopt=Abstract constipation laxative
Cancer Lett. 1994 Aug 15;83(1-2):43-9.
Cell proliferation induced by laxatives and related compounds in the rat intestine.
Toyoda K, Nishikawa A, Furukawa F, Kawanishi T, Hayashi Y, Takahashi M.
Division of Pathology, National Institute of Health Sciences, Tokyo, Japan.
Induction of cell proliferation by laxatives and related compounds in rat intestines was analysed by BrdU-labelling and compared with histopathological changes in the mucosa and findings for feces. Male F344 rats were fed a diet containing danthron, sennosid A, bisacodyl, 1-hydroxyanthraquinone (1-HAQ), magnesium sulfate (MgSO4), dextran sulfate sodium (DSS), pectin, carboxymethylcellulose sodium (CMC-Na) or sodium chloride (NaCl) for 7 days. The stimulant laxatives, danthron, sennosid A and bisacodyl, significantly induced cell proliferation in almost the entire intestinal epithelia in a clear dose-dependent manner. DSS also induced cell proliferation in some portions at high doses. Increase in BrdU-labelling indices was correlated well with the severity of inflammatory changes in the intestinal mucosa as well as with purging effects of stimulant laxatives and DSS. In contrast, the bulk-forming laxative CMC-Na did not consistently enhance cell proliferation nor cause apparent cytotoxicity in the intestine despite exerting remarkable purging effects. 1-HAQ and MgSO4 slightly induced cell proliferation in the cecum and the colorectum, although there was little or no intestinal cytotoxicity. Pectin and NaCl did not influence cell kinetics of the epithelia, nor cause any inflammatory changes in the mucosa. Our results thus indicate that diarrhea caused by laxatives is not necessarily correlated with induction of cell proliferation, as in the intestinal mucosa, and that inflammatory changes followed by regenerative process could be responsible for enhancing cell kinetics. Although the precise significance of cell proliferation in carcinogenesis remains unclear, it is crucial for setting doses of carcinogenicity testings that ch
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