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afsha - GI > acute diarrhoea > Flashcards

acute diarrhoea Flashcards

1
Q

how long does acute diarrhoea last

A

<14 days
symptoms usually improve within 2-4 days

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2
Q

red flag symptoms

A
  • unexplained weight loss
  • rectal bleeding or blood in stools
  • persistent diarrhoea
  • systemic illness
  • recent hospital treatment or abx treatment
  • following foreign travel (other than to Western Europe, North America, Australia, New Zealand)
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3
Q

management of patients with severe dehydration and unable to drink

A

immediate hospital admission and urgent replacement treatment with IV rehydration fluid

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4
Q

what is the mainstay of treatment of acute diarrhoea

A

ORT
this prevents or corrects diarrhoea dehydration
maintains appropriate fluid intake once rehydration is achieved

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5
Q

this abx is occasionally used for prophylaxis against travellers diarrhoea, but routine use is not recommended

A

ciprofloxacin

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6
Q

what is the standard treatment for diarrhoea

A

loperamide - opioid derivative but doesnt cause SE like euphoria and is thus less prone to abuse

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7
Q

MOA loperamide

A

binds to opioid receptors in gut ell, reducing intestinal motility/peristalsis
this slows transit time, allowing more water and electrolytes to be reabsorbed from stools and helps them to be well formed and less watery

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8
Q

Dose of loperamide for 12+

A

4mg stat, then 2mg after each loose stool for up to 5 days
max 16mg daily

If selling OTC, 48 hours only! Max 12mg (6 caps daily)

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9
Q

max dose loperamide daily OTC vs prescription in 24hours

A

POM: 16mg (8 caps)

OTC: 12mg (6 caps)

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10
Q

why is loperamide CI in active UC and abx-associated colitis

A

can lead to paralytic ileus and in turn toxic megacolon

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11
Q

antidote for loperamide if overdose

A

naloxone

may need repeated admin bc loperamide has longer duration of action
monitor pt closely for at least 48h to detect possible CNS depression

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12
Q

uses of loperamide

A

diarrhoea
mild to moderate travellers diarrhoea (e.g. where toilet amenities limited)

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13
Q

in the following cases, suspect inflammatory diarrhoea and therefore do not take give loperamide

A

bloody or suspected inflammatory diarrhoea (febrile pt) and in cases of significant abdominal pain (which also suggests inflammatory diarrhoea)

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14
Q

true or false - loperamide is 1st line for pt with faecal incontinence (unlicensed) after underlying cause of incontinence has been addressed

A

true

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15
Q

Use of racecadotril

A

licensed as adjunct to rehydration for symptomatic treatment of uncomplicated acute diarrhoea in adults and children over 3 months

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16
Q

use of loperamide in under 12

A

not recommended

17
Q

MHRA safety info loperamide - reports of serious cardiac adverse reactions with high doses of loperamide associated with abuse or misuse

A
  • serious CV events e.g. TDP, QT prolongation, cardiac arrest
  • associated with large overdoses
18
Q

contraindications for loperamide

A
  • active UC
  • abx associated colitis
  • bacterial enterocolitis
  • conditions where abdominal distention develops
  • conditions where inhibition of peristalsis should be avoided
19
Q

side effects of loperamide

A
  • GI disorders
  • headache
  • nausea
20
Q

what indications can loperamide be sold OTC

A
  • acute diarrhoea in over 12s
  • acute diarrhoea associated with IBS (after inital diagnosis by doctor) in over 18s
21
Q

how many days can you use loperamide for

A

max 2 days otc for acute diarrhoea
max 14 days otc for ibs >18s

22
Q

codeine used for treatment of diarrhoea - doses in 12-17 yr olds and adults

A
  • Child 12-17 years: 15-60mg 3-4 times a day
  • Adult: 15-60mg 3-4 times a day
23
Q

Rifaximin - abx that is indicated for travellers diarrhoea not associated with fever, bloody diarrhoea, blood or leucocytes in the stool, or 8 or more unformed stools in the previous 24 hours. Dose?

A

adults 200mg every 8 hours for 3 days

24
Q

loperamide 3 common SE

A

Gastrointestinal disorders; headache; nausea

25
Q

loperamide can be used from this age range (rx)

A

4 onwards

26
Q

2 indications and age ranges for OTC loperamide

A

acute diarrhoea: 12+

acute diarrhoea associated with IBS after initial diagnosis by a doctor: 18+

afsha - GI (31 decks)

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