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Pharm 154* > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

Is diarrhea a common drug related side effect?

A

Yes, about 7% of side effects reported by patients on new drugs is diarrhea

It is higher in antibiotics (20%)

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2
Q

When does drug-related diarrhea occur after starting a new medication?

A

2-3 days

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3
Q

What antibiotics are known to cause C. difficile-associated diarrhea?

A

clindamycin, ampicillin, and cephalosporins

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4
Q

What are some symptoms of C. diff associated diarrhea?

A

Watery diarrhea 10-15 times a day

Swollen abdomen

Nausea

Loss of appetite

Pus or blood in the stool

Fever

Weight loss

Kidney failure

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5
Q

What is some symptomatic treatment for diarrhea in drug-related diarrhea?

A

Consists of changes to diet and oral rehydration therapy

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6
Q

Do pharmacists deal with severe diarrhea?

A

No, this patient needs to see an MD and take care of massive water loss

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7
Q

In antibiotic-associated diarrhea, what drug decisions are made?

A
  1. d/c the causative drug
  2. Change its dose (very unlikely)
  3. Keep things the same (add loperamide to counteract s/e is not usually done but it is an option)
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8
Q

Can imodium (loperamide) be used to treat drug-related diarrhea?

A

Yes, but it is not used commonlly

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9
Q

Can Pepto-Bismol be used to treat drug-related diarrhea?

A

Not very effective, other agents are better for GI related conditions

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10
Q

Are probiotics useful in antibiotic-associated diarrhea?

A

Can be given, but efficacy is low for prevention

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11
Q

Can children use imodium (loperamide)?

A

No dose for kids under 12

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12
Q

What are some foods that are more likely to cause diarrhea?

A

It is culturally specific

It is due to irritants ir natural laxatives, not bacteria

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13
Q

Can allergies cause diarrhea?

A

Yes, allergy related diarrhea can occur. It can also be accompanied by a rash

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14
Q

What causes food poisoning?

A

It is an illness caused by eating food contaminated with bacteria, viruses, parasites, and the toxins they produce can all cause food poisoning

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15
Q

Can the symptoms of food poisoning have onset after multiple days following contact?

A

Yes, when the symptoms emerge weeks after eating contaminated food, it can be hard for HCPs to determine the link between diarrhea and food poisoning

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16
Q

What is Kaopectate?

A

It is clay-like and it is meant to adsorp toxins from the gut.

Low efficacy

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17
Q

What is a pharmacists mentality towards recomending imodium (loperamide)?

A

Children:
Initial mindset is to not reccomend loperamide to kids (not recomended under 12, and CI in kids under 2)

Adults:
Not worrying too much about downsides. Highest confidence in no adverse effects

Older adult:
A little weary

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18
Q

What is the common cause of diarrhea in children?

A

Viral gastroenteritis (VGE)

Most common in infants 3-24 months

Up to 50% caused by rotaviruses

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19
Q

What is the biggest concern for diarhhea in kids?

A

Dehydration, especially if diarrhea is coupled with vomiting

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20
Q

How can dehydration be quanitifed?

A

Mild: up to 5% of body weight loss (pharmacists can help here)

Moderate: 6-9% weight loss (MD care)

Severe: Over 10% of body weight loss (MD care)

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21
Q

Are pharmacists responsible for assessing hydration status?

A

No, more for nursing and MD

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22
Q

What does the skin turgour test assess?

A

Hydration status (the longer the skin takes to return to normal, greater dehydration)

23
Q

What is a unique marker for dehydration in infants (up to 18 mo)?

A

The fontanelle is the “soft bone” in an infant’s skull.

If infant is dehydrated, the fontanelle will be depressed

24
Q

When should pharmacists refer diarrhea in children?

A

If under 6 months: Refer

1/2 to 1 year: 1 day

1-3: 2 days

Over 3 years: 3 days

Be quicker to refer if the following apply:
Fever

Presence of blood

Vomiting for more than 8 h

25
Q

What are some treatment options for viral gastroenteritis (stomach flu)

A

Mild diarrhea and no signs of dehydration:
Go for regular feedings, rehydration solution is not needed

If dehydration more of a concern:
Plain water and rehydration solutions are appropriate

With concurrent mild vomiting:
Administer small amounts of fluid. MDs can prescribe ondansetron (OTC anti-emetics are not reccomended)

26
Q

Is gravol indicated for viral gastroenteritis?

A

Not officially indicated, but MDs, nurse, and pharmacists use Gravol for VGE.

Safe to use, but specialists do not recommend

27
Q

Is water better than apple juice for dehydration?

A

Any fluid is good (especially if kids are picky). Don’t worry about giving too many or little electrolytes

28
Q

How should food be reintroduced after VGE?

A

Early feding with age-apropriate diet

If infant is formula fed:
Could switch to lactose-free formula (not required)

29
Q

What is the BRAT diet?

A

Bananas
Rice
Apple sauce
Toast

Traditionally thought to help in diarrhea, current thinking is that the BRAT diet has low efficacy

30
Q

What is the utility of Kaopectate in treating viral gastroenteritis?

A

It is very safe agent, but likely ineffective

31
Q

What is the utility of Imodium (loperamide) in treating viral gastroenteritis?

A

Safe for people over 12(caution in kids under 12, CI in kids under 2)

It is an effectvie treatment for viral gastroenteritis

32
Q

What is the effect of Imodium (loperamide) on the GI tract?

A

It slows down GI motility

33
Q

What is the utility of Pepto-Bismol in treating viral gastroenteritis?

A

Unclear evidence for safety in children, and it is relatively ineffecttive

Do not reccomend for use in viral gastroenteritis

34
Q

What pathogen causes traveller’s diarrhea?

A

E. coli

35
Q

What are some common symptoms seen in traveller’s diarrhea?

A

Diarrhea within 3-7 days

Average of 4-5 bowel movements per day

low grade fever

36
Q

What is Montezuma’s Revenge in the context of Traveller’s diarrhea?

A

This is a particularly severe presentation of Traveller’s diarrhea

More than 10 bowel movements/day

15% also vomit

10% last a week

37
Q

Are patients on PPIs or H2 blockers for heartburn, make them more resistant from getting Traveller’s diarrhea?

A

No, these individuals have reduced stomach pH. This means that pathgens are not being denatured in the stomach as effectively. This results in more pathogens getting into the intestinal tract

38
Q

How does prophylaxis for Traveller’s Diarrhea work?

A

Get an Rx antibiotic before you go (start at destinaton for 3 weeks maximum, this is prophylaxis)

This is not recomended for most travellers due to concerns about antibiotic stewardship.

Usually those who are immunosupressed get prophylaxis for Traveller’s diarrhea

39
Q

What is the utility of Pepto-Bismol in preventing Traveller’s diarrhea?

A

Low efficacy, but it is better than nothing

2 doses of 262mg QID for 3 weeks max

40
Q

Review slide 71 for preventative Pepto-Bismol treatment in children

A
41
Q

Is loperamide reccomended for prevention for Traveller’s diarrhea?

A

No, if the patient takes loperamide as a prevention, they will be constipated

42
Q

What is the efficacy of the Dukoral vaccine?

A

Travel clinics do not reccomend this product for Traveller’s diarrhea

But Dukoral can be used to prevent cholera

43
Q

What is the reccomendation for treating Traveller’s Diarrhea?

A

1-3 days of Rx antibiotic + loperamide

or loperamide alone

or Pepto-Bismol alone (2x262mg tabs every 30 min up to 8 doses)

44
Q

How exactly are kids at higher risk for Traveller’s Diarrhea?

A

Higher gastric pH (less acidic)

Less lifelong exposure to pathogens

45
Q

What are some treatments for Traveller’s Diarrhea in kids?

A

Focus on fluids (fluid recovery)

loperamide or Pepto-Bismol(bismuth salicylate) have mixed safety or efficacy

Antibiotics are not a priority unless moderate severity

46
Q

Who can legally reccomend imodium (loperamide) to kids?

A

In patients under 12: MD advice only

In patients under 2: contraindicated

47
Q

What is an adult loperamide dose for Traveller’s Diarrhea?

A

4mg (loading dose), then 2mg after each loose bowel movement

48
Q

Are ginger-based agents for Traveller’s Diarrhea effective?

A

No, these agents have low efficacy

49
Q

What happens when antibiotic therpy for Traveller’s diarrhea fails?

A

Loperamide

OR

Switch to Pepto-Bismol (every 30min)

50
Q

What happens when PeptoBismol for Traveller’s Diarrhea fails?

A

Switch to the following:

Antibiotic (1-3 day series)

OR

Loperamide

51
Q

What is the best agent for preventing Traveller’s Diarrhea?

A

PeptoBismol (caution in kids for Reye’s syndrome)

Antibiotics (but, pose concern for antibiotic resistance)

52
Q

Do not worry about Hepatitis A, B, and Twinrix for the exam

A
53
Q

Does imodium (loperamide) have abuse potential?

A

Yes, loperamide is known as poor-man’s oxycontin

50-300mg/day

Increases risk for ventricular arrythmias

54
Q

What is the utility of probiotics in diarrhea?

A

We do not know what species are effective

Some evidence suggests it may help prevent post-antibiotic-induced diarrhea

Pharm 154* (18 decks)

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