Diarrhea

Question 1

diarrhea is a symptom of _______, not a ______

Answer 1

underlying problem/disease

Question 2

diarrhea management

Answer 2

examine patient’s lifestyle & meds regimen

many meds cause diarrhea; eval if the offending therapy is necessary before treating the condition

Question 3

nonpharmacological approaches

Answer 3

always 1st

goal: prevent dehydration and fluid & electrolyte imbalances

Question 4

diarrhea +
risk of toxemia or septicemia from infectious agents

avoid?

Answer 4

anti-motility agents

Question 5

empiric antimicrobial therapy

Answer 5

reserve for infectious diarrhea or vulnerable patients

Question 6

goal treatments

Answer 6

1. identify and treat primary cause
2. manage secondary causes
3. prevent electrolyte & acid/base disturbances
4. hydrate
5. provide symptomatic relief

Question 7

nonpharmacological tx

Answer 7

-rehydrate (oral preferred) …avoid soda products, gatorade, chicken broth, tea
-diet (after rehydrated)

Question 8

secondary causes (meds) causing diarrhea

Answer 8

-magnesium containing antacids
-metformin (1/3)
-antibiotics (25% incidence)
-antiinflammatory/antigout agents

Question 9

pharmacological agents

Answer 9

1. opiates and derivatives
2. adsorbents
3. bismuth subsalicylate
4. octreotide
5. crofelemr
6. probiotics
7. digestive enzymes

Question 10

opiates & derivates

Answer 10

for non-infectious diarrhea (acute/chronic)

Question 11

adsorbents

Answer 11

works through non-selective adsorption, providing bulk in digestive tract

also used in constipation

Question 12

bismuth subsalicylate

Answer 12

contraindication:
ASA
nursing or preggo
GI bleeding
immunocompromised pts

drug interactions:
-decreases protein binding of warfarim
-decreases absorption of TCN, quinolones

Question 13

octreotide

Answer 13

prevents the release of secretory substances; stimulates intestinal absorption

-symptomatic tx of carcinoid tumors & VIPomas that produce violent watery diarrhea

Question 14

crofelemer

Answer 14

for symptomatic relief of non-infectious diarrhea in pts w/ HIV/AIDS on anti-retroviral therapy

Question 15

probiotics

Answer 15

help maintain normal GI flora, reduce colonization of disease-causing bacteria

Question 16

digestive enzymes

Answer 16

for lactase deficiency pts

Question 17

types of infectious diarrhea

Answer 17

C. diff & traveler’s

Question 18

initial step for C. diff tx

Answer 18

stop antibiotic that’s causing it

Question 19

therapy for non-severe C. diff

Answer 19

oral metronidazole&raquo_space; oral vancomycin

Question 20

s/e metronidazole

Answer 20

N & metalic taste

Question 21

non-severe disease, pregnant, breastfeeding, or intolerant to metronidazole …Rx

Answer 21

oral vanc

Question 22

sequential therapy with vanc (for C. diff) …Rx

Answer 22

rifaximin

Question 23

traveler’s diarrhea

Answer 23

due to enterotoxigenic E. choli (ETEC); produces malaise, anorexia, abd cramps followed by sudden watery diarrhea (lasts 1-5 days)

tx if more than 4 unformed stools, fever, or bloody/mucus/pus in the stool

Question 24

for mild to moderate diarrhea treat

Answer 24

with monotherapy

Question 25

for severe diarrhea

Answer 25

anti-motility (loperamide)
combine w/ simethicone `

Question 26

1st choice of therapy for diarrhea

Answer 26

fluroquinolones (eg. cipro)

Question 27

if traveling in Asia, Rx

Answer 27

azithromycin (due to increasing resistance to fluroquinolones)

also preferred for pregnant and children

Question 28

if fluroquionolone or azithromycin is not available for traveler’s diarrhea, tx w/

Answer 28

rifaximin