acute diarrhoea

Question 1

how long does acute diarrhoea last

Answer 1

<14 days
symptoms usually improve within 2-4 days

Question 2

red flag symptoms

Answer 2

• 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)

Question 3

management of patients with severe dehydration and unable to drink

Answer 3

immediate hospital admission and urgent replacement treatment with IV rehydration fluid

Question 4

what is the mainstay of treatment of acute diarrhoea

Answer 4

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

Question 5

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

Answer 5

ciprofloxacin

Question 6

what is the standard treatment for diarrhoea

Answer 6

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

Question 7

MOA loperamide

Answer 7

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

Question 8

Dose of loperamide for 12+

Answer 8

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)

Question 9

max dose loperamide daily OTC vs prescription in 24hours

Answer 9

POM: 16mg (8 caps)

OTC: 12mg (6 caps)

Question 10

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

Answer 10

can lead to paralytic ileus and in turn toxic megacolon

Question 11

antidote for loperamide if overdose

Answer 11

naloxone

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

Question 12

uses of loperamide

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

true

Question 15

Use of racecadotril

Answer 15

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

Question 16

use of loperamide in under 12

Answer 16

not recommended

Question 17

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

Answer 17

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

Question 18

contraindications for loperamide

Answer 18

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

Question 19

side effects of loperamide

Answer 19

• GI disorders
• headache
• nausea

Question 20

what indications can loperamide be sold OTC

Answer 20

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

Question 21

how many days can you use loperamide for

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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?

Answer 23

adults 200mg every 8 hours for 3 days

Question 24

loperamide 3 common SE

Answer 24

Gastrointestinal disorders; headache; nausea

Question 25

loperamide can be used from this age range (rx)

Answer 25

4 onwards

Question 26

2 indications and age ranges for OTC loperamide

Answer 26

acute diarrhoea: 12+

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