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PPNP drugs > Antidiarrhoeals: drugs used in diarrhoea > Flashcards

Antidiarrhoeals: drugs used in diarrhoea Flashcards

1
Q

List out ACUTE antidiarrhoeal agents

A
  • opioid agonists
  • colloidal bismuth compounds
  • intestinal adsorbents
  • lyophilizate of killed Lactobacillus acidophilus
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2
Q

List out CHRONIC antidiarrhoeal agents

A
  • bile salt-binding resins

- somatostatin-like peptides

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3
Q

What type of antidiarrhoeal agents is usually used for Traveler’s diarrhoea?

A

acute antidiarrhoeal agents

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4
Q

What type of drug is 1st line for rapid symptomatic relief of diarrhoea?

A

opioid agonists

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5
Q

Examples of opioid agonists

A
  • loperamide

- diphenoxylate + atropine

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6
Q

Mechanism: Opioid agonists increase _________

A

colonic transit time (the amt of time that it takes for a substance to move through your colon)

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7
Q

Main concerns of opioid agonists

A
  • diphenoxylate: potential for CNS effects including addiction & abuse —long term use can lead to dependence
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8
Q

To discourage diphenoxylate overdose, use ______

A

atropine

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9
Q

When tongue & stools turn black, what type of drug did the patient most likely take?

A

colloidal bismuth compounds

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10
Q

Examples of colloidal bismuth compounds

A
  • bismuth subsalicylate

- bismuth subcitrate potassium

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11
Q

Mechanisms of colloidal bismuth compounds

  • bismuth compounds:
  • also used as

bismuth subsalicylate:

A
  • bismuth has antimicrobial effect & binds enterotoxins which has benefit for treating traveller’s diarrhoea
  • also used as mucosal protective agents in acid-peptic diseases (eg. peptic ulcers)

bismuth subsalicylate:

  1. rapid dissociation in stomach allowing absorption of salicylate
  2. salicylate inhibits intestinal prostaglandin production & chloride secretion
  3. reduces stool frequency & liquidity in acute infectious diarrhoea
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12
Q

Examples of intestinal adsorbents and elab

A
  • kaolin: naturally occurring hydrated Mg aluminium silicate clay
  • diosmectite: a Mg and Al silicate clay
  • pectin: indigestible carbohydrate derived from apples
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13
Q

Mechanisms of intestinal adsorbents

A
  • absorb bacteria, bacterial toxins, fluid

- decrease stool liquidity (forms solid stool mass)

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14
Q

Major concerns of intestinal adsorbents

A
  • constipation

- can bind to and inhibit absorption of other meds: should not be taken within 2hrs of other meds

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15
Q

Example of lyophilizate of killed Lactobacillus acidophilus

A

lacteol fort (oral capsule or powder mixed with water)

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16
Q

For lyophilizate of killed Lactobacillus acidophilus, preparation contains __________ Lactobacillus acidophilus

A

heat-inactivated

17
Q

Mechanism of lyophilizate of killed Lactobacillus acidophilus

A
  • adheres onto the surface of intestinal cells and normalises intestinal flora by competitively excluding invasive bacteria
18
Q

Main concerns of lyophilizate of killed Lactobacillus acidophilus

A
  • important to maintain hydration

- contraindicated in patients with lactose intolerance as formulation contains lactose monohydrate

19
Q

Examples of bile salt-binding resins

A
  • colestyramine
  • colestipol
  • colesevelam
20
Q

Mechanisms of bile salt-binding resins

  • they are normally absorbed in the __________
  • Crohn’s disease leads to _______ of bile salts, and thus results in _________________
  • they bind to bile salts alleviating diarrhoea caused by _____________
A
  • bile salts are normally absorbed in the terminal ileum
  • Crohn’s disease leads to malabsorption of bile salts resulting in colonic secretory diarrhoea
  • bind to bile salts alleviating diarrhoea caused by excess fecal bile salts
21
Q

Main concerns of bile salt-binding resins

A
  • bloating, flatulence, constipation, fecal impaction
  • exacerbation of malabsorption of fat if underlying deficiency is present
  • can bind to and inhibit absorption of other meds: should not be given within 2hrs of other drugs
22
Q

Examples of somatostatin-like peptides

A
  • octreotide

- subcutaneous injection and IM depot formulations

23
Q

Mechanisms of somatostatin-like peptides:
1. mimics _________ released in the GI tract, pancreas and from the hypothalamus in the brain

  1. wide- spread physiological effects:
    - _________ of release of various transmitters & hormones (eg. gastrin, VIP, 5-HT)
    - reduces ___________
    - slows ______ and inhibits _________
  2. use for secretory diarrhoea caused by GI and neuroendocrine tumours
    eg. ______ and ___________
A
  1. mimics sometostatin hormone
  2. wide- spread physiological effects:
    - inhibition of release of various transmitters & hormones (eg. gastrin, VIP, 5-HT)
    - reduces intestinal and pancreatic secretions
    - slows GI motility and inhibits gallbladder contraction
  3. use for secretory diarrhoea caused by GI and neuroendocrine tumours
    eg. carcinoid tumour and vasoactive intestinal peptide-secreting (VIP) tumour
24
Q

Major concerns of somatostatin-like peptides:

  • impaired pancreatic secretion can cause _______, which can lead to __________
  • symptoms:
  • formation of __________ in 50% of pts, rarely leading to ___________
  • bradycardia
A
  • impaired pancreatic secretion can cause steatorrhea, which can lead to fat-soluble vitamin deficiency
  • symptoms: nausea, abdominal pain, flatulence & diarrhoea
  • formation of gall sludge or gallstones in 50% of pts, rarely leading to acute cholecystitis
25
Q

Prolonged treatment with somatostatin-like peptides can result in _________

A

hypothyroidism

26
Q

When is activated charcoal used?

and how does it help?

A

emergency;
certain types of poisoning;

helps to prevent poison from being absorbed from the stomach into the body

27
Q

Activated charcoal should not be used long-term as in interferes with _____________ and __________.

A

absorption of nutrients and absorption of other drugs

28
Q

Main concerns of colloidal bismuth compounds

A
  • harmless blackening of stools– which may be confused for GI bleeding
  • prolonged use may rarely produce bismuth toxicity, leading to encephalopathy (ataxia, headaches, confusion, seizures)
  • avoid in patients with renal insufficiency

PPNP drugs (7 decks)

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