anti-diarrhea

Question 1

Loperamide

Answer 1

Immodium

Opioid agonist - modulates cholinergic + VIP connections in submucosal + myenteric plexuses –> deceases intestinal contraction, increases colonic transit time (slow motility), and increases fecal water absorption

Question 2

Diphenoxylate

Answer 2

Opioid agonist - modulates cholinergic + VIP connections in submucosal + myenteric plexuses –> deceases intestinal contraction, increases colonic transit time (slow motility), and increases fecal water absorption

CNS effects @ high dose (mixed with atropine to reduce effects)

Opioid dependence

Question 3

Eluxadoline

Answer 3

Opioid agonist - modulates cholinergic + VIP connections in submucosal + myenteric plexuses –> deceases intestinal contraction, increases colonic transit time (slow motility), and increases fecal water absorption

Don’t give to patient w/o gallbladder (severe pancreatitis)

Delta receptor antagonist + acts locally on ENS

Question 4

Lotronex

Answer 4

Serotonin antagonist - slows motility + enhances absorption of fecal water

Can cause life threatening ischemic colitis + perforation

ONLY IN IBS-D IN WOMEN

Question 5

Kaopectate

Answer 5

Naturally occurring (Kaolin + pectin)
Absorbs bacteria, toxins, + fluid --> decreases stool volume + number 

Use for acute diarrhea (not w/in 2 hours of other meds)

Can cause constipation

Question 6

Bismuth

Answer 6

Pepto-Bismol

Colloidal salt - binds toxins, enhances water absorption

Antacid, antibacterial, anti-inflammatory

Cause cause black stools + tongue, Reye’s Syndrome, toxicity via accumulation

Avoid in kids after viral infection + nursing moms

Question 7

Cholestyramine

Answer 7

Bile acid sequestrant - binds bile acids + excretes them in stool
Use for diarrhea + hypercholesterolemia, pruritis from biliary obstruction

Can cause steatorrhea, constipation, vitamin A, D, E, and K deficiency (don’t take w/in 4 hours other drugs)

Question 8

Octreotide

Answer 8

Synthetic somatostatin

Inhibits GI hormones, slows GI motility, inhibits gallbladder contraction

Use: secretory diarrhea from neuroendocrine tumor, esophageal variceal bleeding, short bowel syndrome

Can cause headache, dizziness, nausea, cramps, gas; long term can cause gallstones; decreases cyclosporine levels