**8.3 Constipation and hypomotility**

Anticholinergic drugs are responsible of constipation as well as other adverse reactions in patients, particularly elderly patients. Also opioids prescribed for cancer patients, chronic pain, etc are responsible of constipation which can produce paralitic ileum. In the setting of ICU patients hipomotility and constipation appears in 50-80 % of patients, particularly those with mechanically ventilated.

#### **8.3.1 Hypomotility**

**Hypomotility** is produced mainly abnormalities in propulsive motility, disturbances in esophageal and gastric motility, reduction in lower esophageal sphincter pressure. Exogenous cathecolamines can reduce antral contractions and small bowel peristalsis and alter motility patterns. Opioids inhibit neurotransmitters release and altering water and electrolyte absorption.

#### **8.3.2 Constipation**

**Constipation** is produced by changes in neuronal or motor function in the intestine. The most common cause is opioids. They inhibit the release of acetylcholine from the myenteric plexus and promote in the opioid receptors in the intestine a decreased motility and increase in intestinal fluid absorption. Other drugs implicated in constipation are antihistamines, calcium channel blockers, diuretics, tricyclic antidepressants.

#### **8.4 Pancreatitis**

Drug induced pancreatitis accounts for 0.1-2% of pancreatitis. Between 1968 and 1993 a total of 525 different drugs from many different substance classes have been reported to the WHO because they were suspected to induce pancreatitis as an unwanted side effect, The three drugs that are responsible of more cases of pancreatitis are mesalazine, azathioprine and simvastatine. Previously recognized patients with more risk of pancreatitis are pediatric and elderly patients, women, advanced HIV disease and inflammatory bowel disease. The

Mechanisms of drugs producing diarrhoea are multiple: osmotic, secretory, motor, exudative, malabsorptive, infectious/inflammatory, and others. Examples of osmotic diarrhoea are enteral nutrition feeding, magnesium salts, etc. Examples of secretory diarrhoea (increase in intestinal ion secretion or diminution in intestinal ion absorption) are digoxin, quinidine, propafenone and theophiline. Examples or rapid intestinal transit are procinetic and macrolids. Exudative diarrhoea (changes in permeability and integrity of intestinal mucosa) are NSAIDs and antineoplastic. Drug-related malabsorption of fats, carbohydrates, and/or bile can also lead to diarrhea. Examples include octreotide (at high doses), highly active antiretroviral therapy, tetracycline, NSAIDs, and antineoplastic agents. Drug-induced infectious/inflammatory diarrhea includes microbial proliferation, pseudomembranous colitis, and histologic colitis. The risk of antibiotic associated diarrhea is higher with broad-spectrum agents (particularly those with antianaerobic activity and activity against Enterobacteriaceae), agents with high luminal concentrations (although oral/enteral administration is not necessarily a risk), longer duration of therapy, and use of

Anticholinergic drugs are responsible of constipation as well as other adverse reactions in patients, particularly elderly patients. Also opioids prescribed for cancer patients, chronic pain, etc are responsible of constipation which can produce paralitic ileum. In the setting of ICU patients hipomotility and constipation appears in 50-80 % of patients, particularly those

**Hypomotility** is produced mainly abnormalities in propulsive motility, disturbances in esophageal and gastric motility, reduction in lower esophageal sphincter pressure. Exogenous cathecolamines can reduce antral contractions and small bowel peristalsis and alter motility patterns. Opioids inhibit neurotransmitters release and altering water and

**Constipation** is produced by changes in neuronal or motor function in the intestine. The most common cause is opioids. They inhibit the release of acetylcholine from the myenteric plexus and promote in the opioid receptors in the intestine a decreased motility and increase in intestinal fluid absorption. Other drugs implicated in constipation are antihistamines,

Drug induced pancreatitis accounts for 0.1-2% of pancreatitis. Between 1968 and 1993 a total of 525 different drugs from many different substance classes have been reported to the WHO because they were suspected to induce pancreatitis as an unwanted side effect, The three drugs that are responsible of more cases of pancreatitis are mesalazine, azathioprine and simvastatine. Previously recognized patients with more risk of pancreatitis are pediatric and elderly patients, women, advanced HIV disease and inflammatory bowel disease. The

calcium channel blockers, diuretics, tricyclic antidepressants.

multiple antibiotics.

**8.3.1 Hypomotility** 

electrolyte absorption.

**8.3.2 Constipation** 

**8.4 Pancreatitis** 

**8.3 Constipation and hypomotility** 

with mechanically ventilated.

interesant review from Balani (2008) showed a table with drugs commonly implicated in pancreatitis: ACE inhibitors, ARA-2, loop diuretics and thiazides, statins, bezafibrate, some antibiotics, pentamidine, azathioprine, mercaptopurine, aminosalicylates, anticonvulsivants and antipsychotics, estrogens, carbimazole, some antineoplastics, codeine, sulindac.

In critically ill patients there's also a review of drugs implicated in pancreatitis (Lat, 2010):
