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PHAR154 > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What % of adverse drug effects does diarrhea account for?

A

7%

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2
Q

Roughly how many drugs are implicated in drug-induced diarrhea?

A

~700

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3
Q

Which antibiotics are the main culprits of drug-induced diarrhea?

A

fluoroquinolones
penicillins
cephalosporins

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4
Q

How long after starting an antibiotic does the diarrhea tend to appear?

A

2-3 days after starting
resolves once its dc

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5
Q

How is C.difficile-associated diarrhea characterized?

A

received antibiotic within past 3 months
significant loss of fluid, fever, and abdominal pain

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6
Q

What are the three options we have when a patient is experiencing drug-induced diarrhea?

A

withdrawal
continuing (especially antibiotics)
adjustment of dosage

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7
Q

What is the basis of treating drug-induced diarrhea?

A

diet and oral rehydration therapy
+/- anti-diarrheal agent (loperamide) if mild cases
-loperamide should be avoided in patients with severe diarrhea

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8
Q

What are some symptoms that could be suggestive of C.diff diarrhea?

A

watery diarrhea for 10-15 days
pus or blood in the stool
fever
weight loss
dehydration
loss of appetite

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9
Q

What is a pharmacological option we have to treat drug-induced diarrhea?

A

loperamide

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10
Q

True or false: Pepto-Bismol has an indication for drug-induced diarrhea

A

false

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11
Q

What is the verdict on using probiotics when put on an antibiotic to try counteract diarrhea?

A

its complete guess work
we dont know which flora are being lost so how do we know which to replace?
could be worth a try but looks iffy
well tolerated, minor adverse effects (dyspepsia, nausea, etc)
remember probiotics are only a move if the diarrhea is from ANTIBIOTICS, not agents like SSRIs or NSAIDs

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12
Q

Is loperamide or probiotics an option for drug-induced diarrhea in kids?

A

loperamide: off label and use and will be more of a concern
probiotics: an option only if antibiotic-induced

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13
Q

What can be used for diarrhea from disagreeable foods?

A

loperamide or Pepto

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14
Q

True or false: the incidence of true food allergies is very high

A

false
true incidence is less than perceived causes

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15
Q

True or false: food allergy incidence decreases with age

A

true

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16
Q

What are the symptoms of a food allergy?

A

can be a rash, GI symptoms, all the way to anaphylaxis

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17
Q

How severe are most cases of food poisoning?

A

most often, food poisoning is mild and resolves without treatment

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18
Q

What are the symptoms of food poisoning?

A

nausea
vomiting
watery or bloody diarrhea
abdominal pain and cramps
fever

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19
Q

How fast do the symptoms of food poisoning appear after eating contaminated food?

A

may start within hours or they may begin days or even weeks later

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20
Q

How long does sickness caused by food poisoning last?

A

few hours to several days

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21
Q

What are the agents we can use for diarrhea from food poisoning?

A

loperamide
Pepto: maybe? (think more so TD)

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22
Q

When would probiotics be used for food poisoning?

A

after the fact

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23
Q

What is the concern that people have with using loperamide for diarrhea from food poisoning?

A

slowing the gut and holding the pathogens in longer

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24
Q

What is the main ingredient in Pepto-Bismol?

A

bismuth subsalicylate
-works by protecting your stomach and is a mild antacid

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25
Q

Which agents would be better than Pepto for discomfort from large meals or spicy foods?

A

H2 receptor antagonists
-famotidine, ranitidine
they work slower than Pepto

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26
Q

Describe kaopectate.

A

almost gone from the market
API is supposed to have adsorbing potential
likelihood of value is low
disagreeable foods-might be soothing to gut, could help

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27
Q

Are probiotics good for food poisoning?

A

food poisoning is bacterial, so it could help
-the situation will be strain-specific
not commonly used for this
NO help for food intolerance

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28
Q

What is the most common cause of diarrhea in pediatrics?

A

viral gastroenteritis

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29
Q

Which group of kids most commonly experiences VGE?

A

3-24 months old
-daycare-itis
-often in winter months

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30
Q

How is VGE transmitted?

A

fecal-oral route

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31
Q

Which pathogen causes VGE?

A

up to 50% via rotavirus
norovirus too

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32
Q

What are the symptoms of VGE?

A

vomiting
watery diarrhea
low grade fever
WATCH FOR DEHYDRATION

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33
Q

How long does VGE last?

A

1-3 days is typical, but need ~1 week for gut to normalize

34
Q

How is the Rotavirus vaccine administered?

A

given by mouth (liquid drops)

35
Q

When should babies get their Rotavirus vaccine?

A

first dose: 2 months old
second dose: 4 months old

36
Q

Describe mild diarrhea in pediatrics.

A

up to 5% body weight loss
increased thirst
slightly dry mucous membranes
active, alert
pinched skin springs back
mild is the only severity we can deal with

37
Q

Describe moderate diarrhea in pediatrics.

A

6-9% body weight loss
irritable, alert, thirsty
dry mucous membranes
pinched skin tents briefly
reduced urine outflow
MD CARE

38
Q

Describe severe diarrhea in pediatrics.

A

> 10% body weight loss
lethargic, looks sick
parched mucous membranes
sunken eyes
pinched skin shows prolonged tenting
continuation of moderate symptoms and:
-no urine output
-cold extremities
-CNS symptoms
MEDICAL EMERGENCY

39
Q

What are some signs that a person is dehydrated?

A

sunken eyes
pinched skin has prolonged tenting
urine flow is reduced
weight loss
lethargic
fast pulse
dry mucous membranes

40
Q

What is the urine colour of someone who is extremely dehydrated?

A

brown
urine becomes darker as we become more dehydrated

41
Q

What is an obscure sign of dehydration in babies younger than 18 months?

A

depressed fontanelle

42
Q

When do we refer for pediatrics and diarrhea?

A

for any situation beyond mild dehydration
<6 months

43
Q

For mild situations, when would we refer the following age groups?
1/2-1 year
1-3 years
>3 years

A

1/2-1 year: 1 days duration
1-3 years: 2 days duration
>3 years: 3 days duration
quicker with other symptoms: fever, presence of blood, vomiting >8h

44
Q

What is the focus on with treating VGE at home?

A

rehydration

45
Q

What do we do for VGE if its mild diarrhea and no signs of dehydration?

A

commercial rehydration solution is not required
go with regular feedings (breastfeeding or usual diet for older kids)

46
Q

What do we do for VGE if dehydration is more of a concern?

A

Gastrolyte (powder_
Pedialyte (solution and freezer pops)
water is fine

47
Q

What do we do for VGE with concurrent mild vomiting?

A

administer small amounts of fluid frequently
anti-emetics not recommended

48
Q

True or false: Gravol is indicated for VGE

A

false

49
Q

Is there any issue with the following for mild dehydration?
water
apple juice
Pedialyte
Gatorade

A

no they are all fine

50
Q

What was the old thinking regarding re-introducing foods with VGE in the past?

A

rest the gut (no food during 1st 24 hours)
if an infant is formula fed:
-stop x 24 hours
-then go lactose-free formula x few weeks (allow lactase to re-
generate)

51
Q

What is the new thinking regarding re-introducing foods with VGE?

A

early feeding with age-appropriate diet actually helps the gut recover
if an infant is breastfeeding, continue to do so
if formula:
-gradual re-introduction of milk-based formula not required
-switching to lactose-free formula not required

52
Q

What is the BRAT diet?

A

bananas, rice, applesauce, and toast
was once recommended to treat diarrhea but its really not needed

53
Q

True or false: anti-diarrheal agents are recommended for VGE

A

false
kaopectate: totally safe but ineffective
loperamide: safe but CI under 2, effective
Pepto: safety is probably fine, likely not effective

54
Q

What can be used for VGE in adults?

A

fluids and loperamide

55
Q

Which organism most commonly causes travelers diarrhea?

A

ETEC

56
Q

What do most people who get TD experience?

A

diarrhea within 3-7 days arrival
average of 4-5 BMs per day
low grade fever

57
Q

True or false: TD is usually self-limiting

A

true
can last up to 7 days

58
Q

What is Montezuma’s Revenge?

A

~3% have >10 BM per day
~15% also vomit
~10% last >1 week

59
Q

When are the chances of getting TD the highest during your vacation?

A

during 1st week
backpackers>resorts
PPI/H2 blocker users have increased risk by 12-fold

60
Q

What are the preventive methods for TD?

A

get an Rx antibiotic before going (start at destination for 3wks max)
Pepto: 2 x 262mg QID for 3 weeks max
-label dosing down to 3y but that is for acute diarrhea, not
prevention dose
-less effective than antibiotics
-unknown MOA

61
Q

Why is antibiotic prophylaxis for TD not ideal?

A

concern for resistance and that treatment is effective and pretty fast if TD does occur

62
Q

What is the dosing of Pepto for TD prevention in the following groups?
>14yr
10-14yr
5-9yr
2-4yr
<2yr

A

> 14yr: 524mg QID
10-14yr: 262mg QID
5-9yr: 131mg QID
2-4yr: 88mg QID
<2yr: consult physician
start 1 day before travel and continue until 2 days after leaving destination

63
Q

True or false: loperamide is a good option for prevention of TD

A

false

64
Q

What is the Dukoral vaccine used for?

A

helps prevent cholera
not recommended for routine use in all travellers

65
Q

What are the treatment options for TD?

A

1-3 days of Rx antibiotic + loperamide
-antibiotic used if it reaches moderate severity
or loperamide alone
or Pepto alone (now active treatment dosing)
-2 x 262mg tabs q1/2hr up to 8 doses

66
Q

What are the different severities of TD?

A

mild: tolerable, not distressing, not interfering with activities
moderate: distressing, interferes with activities
severe: incapacitating, prevents activities, bloody stools
-no loperamide for severe
persistent: lasting >2 weeks

67
Q

What is an antibiotic that has been shown to be effective in the treatment of travelers diarrhea?

A

rifaximin
-poorly absorbed (favourable safety profile)
-resistance is unlikely

68
Q

Which group of patients are more at risk for TD?

A

kids
-higher gastric pH
-less lifelong exposure to pathogens
-similar etiology as adults

69
Q

What is the treatment of TD in kids?

A

focus on fluids
antibiotics not a priority unless moderate severity

70
Q

What are the legal ages of use for loperamide?

A

2-12: MD advice only
<2: contraindicated
probably safe

71
Q

What is the dosing of loperamide for anyone older than 12?

A

4mg stat then 2mg after each loose BM
16mg max per day

72
Q

What is the verdict on the use of probiotics for TD?

A

have low expectations

73
Q

What do we do if someone was taking an antibiotic for 3 weeks as TD prevention, but it didnt work?

A

switch to Pepto (q1/2hr dosing)
or loperamide
clinical tip: the diarrhea could be from the antibiotic

74
Q

What do we do if someone was taking the prevention dosing of Pepto for TD, but it didnt work?

A

switch to antibiotic (1-3) days +/- loperamide

75
Q

What age does the Pepto dosing go down to?

A

3yrs

76
Q

True or false: TD from a cruise ship is likely bacterial

A

false
likely viral so no antibiotics

77
Q

What is the treatment of TD from a cruise ship?

A

fluids
adults: loperamide or BSS
kids: loperamide (caution) or BSS
*if viral, we should question the value of BSS=loperamide makes the most sense in this situation**

78
Q

List off all the different presentations of diarrhea that loperamide has an indication for.

A

acute non-specific diarrhea
acute-drug induced diarrhea (but not commonly done)
IBS (helpful for IBS-D)
TD (treatment not prophylaxis)
VGE (adults, not kids under 2)
food poisoning (not if bloody)
IBD (if mild and on other meds)
food intolerance

79
Q

What is the new concern with loperamide in adults?

A

poor-mans oxycontin
self-treatment of opiate withdrawal symptoms
50-300mg/day–>ventricular arrhythmias

80
Q

Which bacteria are in yogurt?

A

lactobacillus bulgaricus
streptococcus thermophilus
they have to add lactobacillus acidophilus

81
Q

What are the many indications that the manufacturers put on the label of Pepto?

A

indigestion
upset stomach
nausea
heartburn
diarrhea
same dosing for each of the above

82
Q

What is the risk of Reyes syndrome with Pepto?

A

extremely unlikely

PHAR154 (18 decks)

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