Diarrhea Flashcards
RED FLAGS
- signs of dehydration
- severe diarrhea (>6 per day) for > 48 hrs in adults, or > 24 hrs in children and no improvement
- blood/abnormal mucous in stool
- excessive abd cramping/pain
- fver >38.5C
- persistent/chronic diarrhea
- persistent vomiting > 4 hrs
- recent use of antibiotics
- immunocompromised
- pregnant
- age < 2
What foods can exacerbate diarrhea?
alcohol
caffeine
sugary drinks
prune juice
lactose (if lactose intolerance)
If c. diff, should loperamide be used?
NO - it prevents removal of toxin from bowel, increases toxicity
Therapy for acute diarrhea (<4 weeks)
Bismuth subsalicylate
Opioids (codeine, diphenoxylate, loperamide)
T/F - if someone has a true allergy to ASA, they can develop an allergic response to bismuth subsalicylate.
True
What pt population can take bismuth subsal?
Age > 12 years old
Pregnant, breastfeeding
Which population should avoid OR be cautious when taking bismuth subsalicylate?
Caution: renal impairment
AVOID: if taking anticoagulants, MTX, salicylates
Drug options for CHRONIC diarrhea + indications?
Loperamide (symptom relief)
Psyllium (limited)
Cholestyramine (for bile-acid induced diarrhea 2ary to malabsorption of bile acid)
Clonidine (diarrhea from opioid withdrawal)
Ocreotide (diarrhea caused by neuroendocrine tumours)
How to separate other medications from psyllium?
2 hrs apart
How to separate other meds from cholestyramine?
take other meds 1 hr before or 4-6 hrs AFTER cholestyramine
Common AEs of cholestryramine?
Nausea
Fat-soluble vitamin deficiencies (ADEK)
At what age can pts take loperamide?
Age 12+
(Avoid in children <12, CI in children < 2)
Counselling points for loperamide
-discontinue if symptoms persist > 48 hrs
-2 tabs stat (4 mg), then 1 tab PO after each BM (max 16 mg/day = 8 tabs)
-AEs: cramps, dry mouth, drowsy, dysrhythmias (at high doses)
Can pregnant and breastfeeding patients take loperamide?
yes
1st choice in pts with uncomplicated chemo-related diarrhea?
loperamide (imodium)
When should you NOT give loperamide?
bloody diarrhea or fever
Can pregnant and breastfeeding patients take pepto bismol?
NO
Signs of infectious diarrhea?
Diarrhea + 1 or more of:
-n/v
-fever
-abd cramps
-bloody stool
-high WBC count
-fecal urgency
-tenesmus: need to pass stool constantly, even when bowel is empty + cramping, straining, pain.
Tenemus
need to pass stool even if bowel is empty
+ cramping
+ straining
+ pain
all signs of inflammation in the bowel
