Antidiarrheals

Question 1

Opiates and opiate-related agents antidiarrheals (2)

Answer 1

1. diphenoxylate with atropine (OTC or Rx)

2. loperamide OTC

Question 2

Adsorbents antidiarrheals (2)

Answer 2

1. bismuth subsalicylate (OTC)

2. cholestyramine (Rx)

Question 3

Probiotic antidiarrheals (1)

Answer 3

1. lactobacillus acidophilus

Question 4

causes of diarrhea that we need to know for this class (3)

Answer 4

1. Drug side effects (antibiotics => loss of normal flora)
2. laxative abuse
3. c. diff bacterial infection

Question 5

complications with diarrhea and nursing along with them

Answer 5

1. hypovolemia / electrolyte loss
   - increase fluid and electrolyte intake (PO or IV)
   - monitor chemistry panel (CMP) and report/replace (PO or IV)
2. metabolic acidosis
   - monitor ABG and report
3. life-threatening for high risk patients
   - pediatrics or geriatrics

Question 6

non-pharm 1st supportive treatments for diarrhea

Answer 6

do this while determining the cause

• Encourage clear liquid diet such as sports drinks
  
  • Oral solutions (Gatorade; Pedialyte or Rehydralyte)
• IV fluid and electrolyte replacement
• Avoid dairy products, caffeine

Question 7

non-pharm 2nd supportive treatments for diarrhea

Answer 7

determine the underlying cause BEFORE treatment
- prior to administering antidiarrheal: collect a stool sample to rule of C.diff, OB (occult blood), C&S (culture & sensitivity), O&P (Ova and parasite)

Question 8

contraindications for antidiarrheals !!!

Answer 8

1. using antidiarrheals longer than 2 days
2. if fever with unknown etiology is present
3. if the etiology of diarrhea

Question 9

diphenoxylate with atropine and loperamide MOA

Answer 9

decrease peristalsis by activating opioid receptors in the GI

Question 10

diphenoxylate with atropine and loperamide side effects

Answer 10

• CNS depressant
• resp depressant
• physical dependence, short-term use only

Question 11

diphenoxylate with atropine and loperamide contraindications

Answer 11

• avoid ETOH

- avoid other CNS depressants

Question 12

diphenoxylate with atropine specifically contraindication

Answer 12

avoid with glaucoma/BPH

• added to discourage abuse since diphenoxylate is a synthetic opioid
• also for its anticholinergic effects on GI

Question 13

bismuth subsalicylate and cholestyramine MOA

Answer 13

1. coat the wall of the GI tract

2. adsorb bacteria/toxins

Question 14

lactobacillus acidophilus route

Answer 14

PO

Question 15

lactobacillus acidophilus MOA (2)

Answer 15

1. replacing normal flora of the GI tract

2. reduces colonization by pathogenic bacteria

Question 16

lactobacillus acidophilus indications

Answer 16

1. antibiotic use (loss of normal flora)
   - administer at least 2hrs apart from Abx
2. IBS, UC, C.diff infection (prophylactically!)

Question 17

antidiarrheal nursing

Answer 17

1. assessment: BM consistency, frequency, and quantity, listen to bowel sounds
2. prior to administering antidiarrheal
   
   • collect a stool sample to rule out C. diff by doing OB, C&S, O&P
3. monitor VS trend for hypovolemia and shock
   
   • low BP
   • tachycardia
4. educate
   
   • only short term drugs (only for 48 hours)
   • increase fluid intake (PO/IV)