Diarrhea Flashcards
What are the 3 types of diarrhea
Acute <14 days
Persistent 14 days up to 4 weeks
Chronic >4 weeks but symptoms less severe
Diarrhea is a change in normal bowel movements with the following characteristics
1.
2.
3.
- increased water content
- increased volume
- increased frequency, > or equal to 3 loose stools/day
List some examples of drug related signs and symptoms of diarrhea
1.
2.
3.
- recent abc use
- PPI
- Laxative use
Magnesium based antacids, sorbitol containing drugs, orlistat, motility agents ex domperidone
3 Common risk factors ?
- Travel
- Age ( very old or <3)
- Recent abx use or unsafe sexual practice
Some red flags for any type of diarrhea?
- signs and symptoms of dehydration
- severe diarrhea (> 6 loose stools per day) for > 48 hrs (adults) and > 24 hours (children)
- blood
- pain
- fever >38.5
- persistent or chronic diarrhea
- vomiting >4hrs
recent abx use associated with C.Diff (Clindamycin, ampicillin, cephalosporins) - Immunocompromised
- PREGNANCY
- < 2 YO
What are some signs of dehydration in children?
- dry mouth
- little or no tears
- <4 wet diapres in 24 hours
- sunken eyes or cheeks
- tired irritable
- decreased skin turgor
Non-Pharm options for any type of diarrhea?
- ORT
- Avoid caffeine, alcohol, sugary beverages
- if infectious avoid loperamide (prevents removal of toxin from bowel)
- report outbreaks
- prevention via vaccine, frequent hand wash, traveler diarrhea education
What are the treatment options for acute diarrhea?
- Bismuth subsalicylate
- Loperamide
Acute diarrhea should not be treated with _________ unless travellers’ diarrhea
empiric abx
Bismuth subsalicylate should be avoided in
1.
2.
3.
- children <12
- pregnancy
- breastfeeding
in patients taking anticoagulants, methotrexate, and salicylates
Caution if someone has a true allergy to ASA, they could develop an allergic response to ______
Pepto Bismol (Bismuth Subsalicylate)
Bismuth subsalicylate can cause ______ stools
black tarry
Loperamide is not recommended for use in patients with ______ or ______
bloody diarrhea or fever
Loperamide should be avoided in children _____
< 2 years of age
Loperamide can be used in _______ and _______ (a certain population)
pregnancy and breastfeeding
Loperamide dosing:
4 mg STAT, 2 mg after each loose BM, max 16 mg /day
Loperamide should be discontinued if diarrhea persists > ____ hours
48 hours
Common side effects of loperamide
1
2
3
1 cramps
2 dry mouth
3 drowsiness
The options for chronic diarrhea treatment include:
1 opioids (loperamide well tolerated, lowest abuse)
2 psyllium (limited roll)
3
4
5
3 cholesteryamine
4 clonidine
5 octerotide
Clonidine is used for diarrhea associated with ______
opioid withdrawal
Octerotide is used for diarrhea caused by ______
neuroendocrine tumors
Cholesterymaine is useful for ________ induced diarrhea secondary to malabsorption of ______
bile acid
Other medications should be administered 1 hour before or 4-6 hours after this drug (ensure adequate hydration)
Cholesterymine
First line treatment of diarrhea in pregnancy
- Bulk forming agents
2nd line loperamide
DO NOT USE _________ & __________ in pregnancy or breastfeeding
diphenoxylate/atropine (lomotil) & bismuth subsalicylate
The following are safe in diarrhea treatment in breastfeeding:
1
2
loperamide or bulk forming agents
Infectious diarrhea is defined as diarrhea + >1 of the following:
1
2
3
4
1 nausea/vomiting
2 fever
3 abdominal cramps
4 blood in stools
5 ++ WBC count
6 fecal urgency
7 tenesmus (need to pass stools constantly even when bowels empty)
Travellers diarrhea can be characterized by the following severities:
1
2
3
4
mild (non-distressing)
moderate (distressing)
severe (incapacitating)
persistent (>2 weeks of diarrhea)
Non bloody enteric infection in neonates (6-18 months) is often caused by this virus:
ROTAVIRUS
Non bloody enteric infections for Travellers’ diarrhea is most commonly caused by:
ETEC
Bloody enteric infections for Travellers’ diarrhea is most commonly caused by the following pathogens:
Salmonella, Shigella, Campylobacter, Enterohemorrhagic E.Coli (EHEC/STEC)
Infectious diarrhea should be treated only after fecal sample is obtained, EXCEPT in _________
travellers’ diarrhea (toxigenic E.Coli)
Empiric treatment of infectious diarrhea in adults includes
1.
2.
- FQ’s
- Macrolide (Azithromycin)
Empiric treatment of infectious diarrhea in children includes
1.
2.
- Macrolide (Azithromycin)
- TMP-SMX
Loperamide should only be used to treat infectious diarrhea in adults with _____, ________
mild, non-bloody diarrhea
Avoid using loperamide for treating infectious diarrhea in patients with _____ and/or _____ to ______ diarrhea
bloody and or moderate to severe
MILD Travellers’ diarrhea should be treated with the following
1
2
3
1 ORT
2 Bismuth subsalicylate
3 loperamide (not recommended if bloody or fever >38.5)
Antibiotics in travellers diarrhea are used for _____ to _____ travellers’ diarrhea
MODERATE TO SEVERE
This antibiotic, used in the treatment of travellers’ diarrhea is preferred in children and pregnant/breastfeeding women
AZITHROMYCIN (Asia / Mexico)
Assess the following if antibiotic therapy was used in last 3 months and no travel history with signs of diarrhea
C.DIFF
Dukoral is used for
prevention of TD caused by ETEC diarrhea, not for all travellers but those with health complication risks
Azithromycin is the antibiotic of choice for areas where Campylobacter predominates, which areas?
Mexico and Asia
FQs are effective options in countries where ETEC predominates, those areas are:
Latin America and Africa
