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Therapeutics II > Block 1: Diarrhea > Flashcards

Block 1: Diarrhea Flashcards

1
Q

On Bristol stool chart what is diarrhea?

A

5-7

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2
Q

What is diarrhea?

A

Decreased frequency and decreased consistency of fecal discharge

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3
Q

What is acute diarrhea?

A

Less than 14 day duration

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4
Q

What is chronic diarrhea?

A

Greater than 14 day duration

Usually secondary

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5
Q

RF of diarrhea?

A
  1. Day care
  2. Food handlers or caregivers
  3. Congregate living conditions
  4. Consumption of unsafe foods
  5. Diverticulitis, immunocompromised
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6
Q

What is viral GEitis?

A

Norovirus: transmitted by contaminated water or food, people, surfaces
Rotavirus: common in infants and children (seasonal Nov-Fev) - PO vaccines

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7
Q

What is bacterial GEitis?

A

Food borne trasmission

Campylobacter, E.coli, Salmonella

Water diarreha or bloody

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8
Q

Foodbourne GEitis?

A

Norovirus

Linked to poor sanitation and manufacturing practices in food facilities

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8
Q

What is traveler’s diarrhea?

A
  1. Acquired mainly by ingestion of contaminated food or water
  2. Fruits, vegetables, raw meat, seafood, water, ice cubes
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9
Q

What is food induced diarrhea?

A

Provoked by food intolerance or foods that are excessively spicy, fatty, or high fiber

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10
Q

What is protozoal diarrhea?

A

Cryptosporidium, Entamoeba histolytica

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11
Q

When would diarrhea become fatal?

A
  1. Lack of access to clean water in natural disasters
  2. prolonged or voluminous diarrhea
  3. Dehydration and electrolyte imbalances
  4. Develoiping countries
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12
Q

How can you prevent diarrhea?

A
  1. Food handling
  2. Handwashing
  3. Water santitation
  4. Environmental cleaning
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13
Q

Meidcation that induce diarrhea?

A
  1. Mag
  2. Laxatives
  3. Antibiotics
  4. Metformin
  5. PPI/H2RA
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14
Q

How do you prevetn traveler’s diarrhea?

A
  1. Bottled water or treatment of tap water
  2. Caution with consumption of fresh fruits/vegetables
  3. Prophylactic antibitoics not recommended
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15
Q

What are tx of Traveler’s diarrhea?

A
  1. Antibiotics or Bismuth subsalicylate
  2. Azithromycin 1g po x 1 dose
16
Q

What are the tx goals of diarrhea?

A
  1. Mild easy digestible diet
  2. Oral Rehydration Solutions (ORS)
  3. Provide symptomatic relief: EXCEPTIONS: Toxic/warning signs (blood, severity, excessive fever, dehydration)
    Opioids, Bismuth subsalicylate
  4. Reverse/Treat curable causes
17
Q

How do you treat toxic patients?

A

require hospitalization, IV fluids and electrolyte administration, and empiric antibiotic therapy waiting for culture and sensitivity results

18
Q

What are the exclusions for diarrhea self-treatment?

A
  1. Young age
  2. Persistent fever
  3. Visible blood, pus, or mucus in stool
  4. Vomiting
  5. High output
  6. Dehydration
  7. Mental changes
  8. Abdominal distress
  9. Pregnancy
  10. Chronic
  11. Nonresponsive to ORS
19
Q

How do you treat acute diarrhea?

A
20
Q

What is ORS?

A

Rehydration using ORS is preferred for mild-moderate diarrhea

21
Q

What are the pahses of ORS?

A
  1. Rehydration-over 3-4 hours quickly replaces water and electrolytes to restore normal body composition
  2. Maintenance-given to maintain normal body composition until adequate dietary intake is reestablished
22
Q

What is loperamide? MOA?

A

Synthetic opioid agonist that lacks central nervous system effects

Slows intestinal motility and allows absorption of electrolytes and water

Helps reduce daily fecal volume, increased viscosity and bulk volume, and reduced fluid and electrolyte loss

Use in 6+

23
Q

ADR for loperamide? CI?

A

DZ and constipation

CI: invasive bacterial diarrhea

Concerns for abuse at high doses (euphoria)

24
Q

What is MOA of bismuth ssubsalicylate?

A

Reduce frequency of unformed stools, increase stool consistency, relieve abdominal cramping, decrease nausea and vomiting

25
Q

CI in pepto?

A
  1. Patients taking aspirin
  2. Approved for acute diarrhea in children 12 years and older
  3. Children with chicken pox or flu -> Reyes
  4. Antibiotics
26
Q

ADR of pepto?

A

Black stained stool not melena

27
Q

What is diphenoxylate?

A

Tablet or solution

Opiate derivative - small dose of atropine is included in medication to discourage abuse

Dosed 3-4 times per day

28
Q

ADR of diphenoxylate? CI?

A

Atropinism (blurred vision, dry mouth, and urinary hesitancy

Not for patients at risk of infection (e coli, shigella, salmoneella)

29
Q

MOA and indication of Octreotide?

A

Mimics natural somastatin

Oral or injectable – given IV push, IV infusion, or Subq

Chemotherapy induced diarrhea, dumping syndrome, and treatment for some carcinoid tumors

30
Q

ADRs of octreotide?

A
  1. Abdominal pain
  2. Nausea
  3. Diarrhea
  4. Gallbladder and billiary tract complication
31
Q

What are pharm tx for diarrhea?

A
  1. Loperamide
  2. BSS
  3. Diphenoxylate
  4. Octreotide
  5. Vaccines
32
Q

What are the vaccines to prevent diarrhea?

A
  1. Vaxchora: (PO for cholera, traveling rec)
  2. Typhoid: Parenteral inactivated whole cell vaccine, PO live attenuated vaccine
  3. Rotavirus: Prevent gastroenteritis in infants and children (RotaTeq and Rotairx)
33
Q

Diarrhea tx in children?

A
  1. Children ≤ 5 years, limited to ORS.
  2. Antidiarrheal medications are not recommended
  3. Pre-mixed solutions are preferred
  4. If symptoms persist, recommend PCP
34
Q

Tx of diarrhea in elderly?

A

PCP

35
Q

Tx of diarrhea in pregnancy?

A
  1. PCP
  2. BSS is CI
36
Q

Tx of diarrhea in lactation?

A

BSS is CI

Therapeutics II (30 decks)

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