Diarrhea Flashcards
Is diarrhea a common drug related side effect?
Yes, about 7% of side effects reported by patients on new drugs is diarrhea
It is higher in antibiotics (20%)
When does drug-related diarrhea occur after starting a new medication?
2-3 days
What antibiotics are known to cause C. difficile-associated diarrhea?
clindamycin, ampicillin, and cephalosporins
What are some symptoms of C. diff associated diarrhea?
Watery diarrhea 10-15 times a day
Swollen abdomen
Nausea
Loss of appetite
Pus or blood in the stool
Fever
Weight loss
Kidney failure
What is some symptomatic treatment for diarrhea in drug-related diarrhea?
Consists of changes to diet and oral rehydration therapy
Do pharmacists deal with severe diarrhea?
No, this patient needs to see an MD and take care of massive water loss
In antibiotic-associated diarrhea, what drug decisions are made?
- d/c the causative drug
- Change its dose (very unlikely)
- Keep things the same (add loperamide to counteract s/e is not usually done but it is an option)
Can imodium (loperamide) be used to treat drug-related diarrhea?
Yes, but it is not used commonlly
Can Pepto-Bismol be used to treat drug-related diarrhea?
Not very effective, other agents are better for GI related conditions
Are probiotics useful in antibiotic-associated diarrhea?
Can be given, but efficacy is low for prevention
Can children use imodium (loperamide)?
No dose for kids under 12
What are some foods that are more likely to cause diarrhea?
It is culturally specific
It is due to irritants ir natural laxatives, not bacteria
Can allergies cause diarrhea?
Yes, allergy related diarrhea can occur. It can also be accompanied by a rash
What causes food poisoning?
It is an illness caused by eating food contaminated with bacteria, viruses, parasites, and the toxins they produce can all cause food poisoning
Can the symptoms of food poisoning have onset after multiple days following contact?
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
What is Kaopectate?
It is clay-like and it is meant to adsorp toxins from the gut.
Low efficacy
What is a pharmacists mentality towards recomending imodium (loperamide)?
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
What is the common cause of diarrhea in children?
Viral gastroenteritis (VGE)
Most common in infants 3-24 months
Up to 50% caused by rotaviruses
What is the biggest concern for diarhhea in kids?
Dehydration, especially if diarrhea is coupled with vomiting
How can dehydration be quanitifed?
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)
Are pharmacists responsible for assessing hydration status?
No, more for nursing and MD
What does the skin turgour test assess?
Hydration status (the longer the skin takes to return to normal, greater dehydration)
What is a unique marker for dehydration in infants (up to 18 mo)?
The fontanelle is the “soft bone” in an infant’s skull.
If infant is dehydrated, the fontanelle will be depressed
When should pharmacists refer diarrhea in children?
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
What are some treatment options for viral gastroenteritis (stomach flu)
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)
Is gravol indicated for viral gastroenteritis?
Not officially indicated, but MDs, nurse, and pharmacists use Gravol for VGE.
Safe to use, but specialists do not recommend
Is water better than apple juice for dehydration?
Any fluid is good (especially if kids are picky). Don’t worry about giving too many or little electrolytes
How should food be reintroduced after VGE?
Early feding with age-apropriate diet
If infant is formula fed:
Could switch to lactose-free formula (not required)
What is the BRAT diet?
Bananas
Rice
Apple sauce
Toast
Traditionally thought to help in diarrhea, current thinking is that the BRAT diet has low efficacy
What is the utility of Kaopectate in treating viral gastroenteritis?
It is very safe agent, but likely ineffective
What is the utility of Imodium (loperamide) in treating viral gastroenteritis?
Safe for people over 12(caution in kids under 12, CI in kids under 2)
It is an effectvie treatment for viral gastroenteritis
What is the effect of Imodium (loperamide) on the GI tract?
It slows down GI motility
What is the utility of Pepto-Bismol in treating viral gastroenteritis?
Unclear evidence for safety in children, and it is relatively ineffecttive
Do not reccomend for use in viral gastroenteritis
What pathogen causes traveller’s diarrhea?
E. coli
What are some common symptoms seen in traveller’s diarrhea?
Diarrhea within 3-7 days
Average of 4-5 bowel movements per day
low grade fever
What is Montezuma’s Revenge in the context of Traveller’s diarrhea?
This is a particularly severe presentation of Traveller’s diarrhea
More than 10 bowel movements/day
15% also vomit
10% last a week
Are patients on PPIs or H2 blockers for heartburn, make them more resistant from getting Traveller’s diarrhea?
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
How does prophylaxis for Traveller’s Diarrhea work?
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
What is the utility of Pepto-Bismol in preventing Traveller’s diarrhea?
Low efficacy, but it is better than nothing
2 doses of 262mg QID for 3 weeks max
Review slide 71 for preventative Pepto-Bismol treatment in children
Is loperamide reccomended for prevention for Traveller’s diarrhea?
No, if the patient takes loperamide as a prevention, they will be constipated
What is the efficacy of the Dukoral vaccine?
Travel clinics do not reccomend this product for Traveller’s diarrhea
But Dukoral can be used to prevent cholera
What is the reccomendation for treating Traveller’s Diarrhea?
1-3 days of Rx antibiotic + loperamide
or loperamide alone
or Pepto-Bismol alone (2x262mg tabs every 30 min up to 8 doses)
How exactly are kids at higher risk for Traveller’s Diarrhea?
Higher gastric pH (less acidic)
Less lifelong exposure to pathogens
What are some treatments for Traveller’s Diarrhea in kids?
Focus on fluids (fluid recovery)
loperamide or Pepto-Bismol(bismuth salicylate) have mixed safety or efficacy
Antibiotics are not a priority unless moderate severity
Who can legally reccomend imodium (loperamide) to kids?
In patients under 12: MD advice only
In patients under 2: contraindicated
What is an adult loperamide dose for Traveller’s Diarrhea?
4mg (loading dose), then 2mg after each loose bowel movement
Are ginger-based agents for Traveller’s Diarrhea effective?
No, these agents have low efficacy
What happens when antibiotic therpy for Traveller’s diarrhea fails?
Loperamide
OR
Switch to Pepto-Bismol (every 30min)
What happens when PeptoBismol for Traveller’s Diarrhea fails?
Switch to the following:
Antibiotic (1-3 day series)
OR
Loperamide
What is the best agent for preventing Traveller’s Diarrhea?
PeptoBismol (caution in kids for Reye’s syndrome)
Antibiotics (but, pose concern for antibiotic resistance)
Do not worry about Hepatitis A, B, and Twinrix for the exam
Does imodium (loperamide) have abuse potential?
Yes, loperamide is known as poor-man’s oxycontin
50-300mg/day
Increases risk for ventricular arrythmias
What is the utility of probiotics in diarrhea?
We do not know what species are effective
Some evidence suggests it may help prevent post-antibiotic-induced diarrhea
