Diarrhea

Question 1

Diarrhea

Answer 1

Excessive volume, fluidity, and/or frequency
Caused by infections, maldigestion, inflammation, functional disorders, drugs, etc.
Untreated and severe cases: Dehydration and electrolyte imbalances. Can lead to death, especially in 3rd world
VERY important to Dx and treat the underlying cause. THEN if persistent, try antidiarrheal

Question 2

Diphenoxylate/Atropine

Answer 2

IND: Diarrhea
MOA: Mu-opioid agonist. Increases fluid out of GI tract and slows motility. A high enough dose would cause euphoria. Co-formulated with Atropine to deter abuse. Controlled substance.
BOX: NONE
CONTRA: Active C. Diff or other enterotoxins d/t the decrease in motility. Could cause death. Not for use in suspicion of infection.
ADRs: Flushing/tachycardia (Atropine) or Constipation (Diphenoxylate)
M/E: NONE

Question 3

Loperamide

Answer 3

IND: Diarrhea OTC
MOA: Mu-opioid agonist
BOX: Torsades and sudden death at higher than recommended dose.
CONTRA: Kids under 2 or infectious diarrhea
ADRs: Abuse potential
M/E: NONE

Question 4

Amitrptyline

Answer 4

(Tricyclic Antidepressants, TCA)
IND: Psych indications and OFF label for diarrhea
MOA: Interacts with brain-gut neuroaxis to restore sensation and innervation in GI and anticholinergic effects
BOX: Antidepressant: May increase risk of suicide thoughts and behaviors
CONTRA: Co-administration within 14 day of MAOIS (Linezolid)
ADRs: Orthostatic hypotension, sedation, anticholinergic, cardiac toxicity, seizures
M/E: NONE

Question 5

Hyoscyamine

Answer 5

(Antispasmodic)
IND: GI disorders (spasms)
MOA: Anticholinergic. Also increases CO, dries secretions, antagonist of histamine and serotonin
BOX: NONE
CONTRA: A lot. Glaucaoma, Obstructive uropathy, Graves Dz, Obstructive GI Dz, Paralytic Ileus, UC, Toxic Megacolon, Unstable C/V status, MI
ADRs: Palpitations, tachycardia. Anti-cholinergic
M/E: NONE

Question 6

Dicyclomine

Answer 6

(antispasmodic)
IND: IBS associated abdominal pain or anything. Lots of use in ER when you don't know whats happening
MOA: Anti-cholinergic
BOX: NONE
CONTRA: Same as Hyoscyamine
ADRs: Same as Hyoscyamine
M/E: NONE

Question 7

Alostron

Answer 7

IND: ONLY Females with Severe IBS-D
MOA: 5HT3 Antagonist
BOX: Serious GI ADRs. Ischemic Colitis, severe constipation with complications (blood Tf, Sx, death)
CONTRA: Any underlying GI issue. Hx of constipation, ischemic colitis, intestinal obstruction, GI perforation, Diverticulitis, Crohn’s, UC, Severe hepatic impairment, hypercoagulable state
ADRs: Constipation
M/E: Contra in Severe hepatic impairment

Question 8

Alosetron REMS

Answer 8

Risk Eval and Mitigation Program
Prescriber must be in REMS program, follow all rules and place a qualification sticker on all prescriptions for Alosetron
Pt must sign an agreement
Pharmicist cannot fill without the qual sticker