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Clinical Pharmacy > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is the definition of diarrhea?

A
  • a symptom characterized by increased frequency of defecation, with the stools being loose and watery
  • 3 or more loose stools during a limited time period (24 hours) perceived to be diarrhea
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2
Q

What are the complications that are often associated with diarrhea?

A
  • electrolyte imbalances
  • risk of dehydration
  • hemorrhoids
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3
Q

What is acute diarrhea?

A
  • diarrhea lasting under than 14 days
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4
Q

What is chronic diarrhea?

A
  • lasts more than 14 days or recurring diarrhea lasting under 14 days each
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5
Q

What are some examples of foods to avoid while travelling?

A
  • unpeeled or uncooked veggies and fruits, unpasteurized, milk or egg based, water or ice
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6
Q

What are some of the most common reasons that a patient has acute diarrhea?

A
  • infections (this is the most common cause of diarrhea, typically transmitted via oral/fecal routes)
  • medications
  • diet/nutrition
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7
Q

How long does acute diarrhea usually last?

A
  • usually only about 2-3 days and is self limiting

- symptoms usually being abruptly

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8
Q

What is the most common viral cause of all gastroenteritis?

A
  • noroviruses
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9
Q

What is norovirus usually transmitted by?

A
  • usually transmitted by contaminated water or food (also person to person)
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10
Q

What is the result of the norovirus infection?

A
  • 24 hour stomach flu
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11
Q

What is the result of the rotavirus?

A
  • causes severe diarrhea
  • highest incidence in children between 3-24 months of age
  • peak infectious period if during the winter months (November to february)
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12
Q

What route is rotavirus spread by?

A
  • spread by the focal oral route
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13
Q

What different bacterial species are diarrhea most commonly caused by?

A
  • Campylobacter sp, Salmonella sp, and E. coli
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14
Q

What part of the bacterial species causes diarrhea?

A
  • can cause diarrhea through the enterotoxin or by directly invading the mucosal epithelial cells
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15
Q

What food products is salmonella typically ingested in?

A
  • infected poultry, eggs, beef, juice, raw fruits and veggies and milk
  • typically lasts for 1 to 7 days
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16
Q

What are the symptoms of salmonella species?

A
  • nausea, vomiting, abdominal pain, fever and passage of blood and mucous
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17
Q

What food products do campylobacter bacteria come from?

A
  • undercooked chicken, unpasteurized milk or contaminated water
  • lasts for 1-10 days
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18
Q

What are the typical places that e.coli can be found?

A
  • ingestion of contaminated food or water, recent travel

- lasts 3-5 days for example, or can be 5-10 days

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19
Q

What are the symptoms associated with an E.coli infection?

A
  • watery diarrhea
  • fever
  • abdominal cramps
  • bloating
  • malaise
  • occasional vomiting
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20
Q

What are the symptoms associated with shigatoxin?

A
  • watery, often bloody diarrhea, abdominal cramps, hemolytic uremic syndrome
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21
Q

What are the parasites that diarrhea can be caused by?

A
  • may be caused by G. lambda, E. histolytica, Isospora belli and Crystosproriduim sp
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22
Q

How is giardia spread?

A
  • by ingestion of water or for contaminated with animal of human species containing system
  • may be infected by drinking water from sources with inadequate purification systems
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23
Q

How is E. histolytica spread?

A
  • spread by ingestion of contaminated food or water
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24
Q

What are the medications used to treat acute diarrhea?

A
  • penicillins, cephalosporins, erythromycins - these alter the normal bacterial flora in the gut
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25
Q

What is the pseudomonas colitis?

A
  • c. diff
  • treat mainly with clindamycin, fluoroquinolones, penicillins and cephalosporins, but can occur with any antimicrobial agent
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26
Q

What are some of the examples of medications that cause diarrhea?

A
  • laxatives
  • antacids
  • metoclopramide
  • orlistat
  • acarbose
  • misoprostal
  • antineoplastics
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27
Q

What are some common foods that are associated with intolerances to food components or food allergies?

A
  • most common: gluten and lactose
  • foods containing large amounts of sorbitol or mannitol may cause osmotic diarrhea
  • fatty, spicy, highly salted foods
  • may occur when there is rapid increases in dietary fibre
  • food poisoning (important to focus on prevention)
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28
Q

Chronic diarrhea is when symptoms are present for ______

A

more than a month

29
Q

Chronic diarrhea is often indicative of what?

A
  • of an inflammatory process (IBD, UC, Crohn’s)

- can also be tumours, chemotherapy, malabsorption of carbs and diabetes

30
Q

Why should we always refer chronic diarrhea?

A
  • for an unknown/known underlying cause
31
Q

What are some of the main is factors for infectious diarrhea?

A
  • attendance or employment at a day care centre
    (most infectious causes are via the fecal oral route)
  • occupation as a food handler or caregiver
  • congregate living conditions (nursing homes, prisons, etc)
  • consumption of unsafe foods
  • presence of certain medical conditions
32
Q

What are some of the important questions that we should be asking to gather information about diarrhea?

A
  • age of the patients
  • how long have they had sx
  • ask for description
  • recent food intake or change in diet
  • sorbitol, gluten, lactose, mannitol containing items
  • allergies
  • possible food poisoning
  • any family history of crohn’s, IBS, cancer
  • recent travel
  • complications
  • any medical conditions or new medications
33
Q

What are the red flags for diarrhea?

A
  • fever > 38.5, extensive abdominal pain or cramping
  • blood or abnormal mucous in stool
  • signs of debilitating dehydration or weight loss due to diarrhea
  • vomiting > 4 hours
  • age < 2 years or frail elderly
  • severe diarrhea > 6 loose stools/day for > 48 hours
  • chronic medical conditions
  • suspected laxative abuse
  • pregnancy
  • immunocompromised patients
  • recent antibiotic use (particularly those associated with C.diff such as clindamycin, ampicillin and cephalosporins
  • worsening or persistent or chronic diarrhea
34
Q

What are the main signs and symptoms of dehydration?

A
  • dry mouth, tongue, increased thirst
  • decreased urination
  • weakness, lightheadedness
35
Q

What are the signs and symptoms of dehydration in children?

A
  • dry mouth, tongue and skin (skin turgor or greyish skin color)
  • few or no tears when crying; irritability
  • listlessness, sunken eyes, cheeks and abdomen
  • under 4 wet diapers/ 24 hours
36
Q

What are the goals of self treatment in diarrhea?

A
  • determine the specific etiology and recommend appropriate treatment
  • relieve symptoms and re-establish normal stools
  • prevent or correct fluid and electrolyte loss or imbalances (dehydration)
  • prevent complications (hemorrhoids)
37
Q

What are the appropriate non-pharms to recommend in diarrhea prevention?

A
  • encourage hand washing before preparing and eating food, as well as after going to the toilet or changing a diaper
  • prevent food poisoning
    (avoid unpasteurized milk and fruit juice, cook red meat, poultry and eggs thoroughly, keep foods hot and cold foods cold, rinse foods that are cooked before they are eaten under running water use separate cutting boards for ray meats and veggies, reheat foods)
  • oral rehydration therapy (replaces H2O and electrolyte deficit to restore normal body function over about 3-4 hours)
38
Q

What is oral rehydration therapy?

A
  • solution that has balances contents of glucose and electrolytes
  • – glucose provides calories, as well as aiding in the absorption of sodium and water
  • – glucose to sodium ratio should be 1:1
  • – important aspect of the solutions is osmolality
  • – sports drinks are not recommended due to high sugar and low amount of electrolytes
39
Q

What is gastrolyte?

A
  • oral rehydration salts (should be rank freely and frequently only when diarrhea continues/persists)
40
Q

What is pedialyte?

A
  • prevents dehydration and restores fluid and minerals lost in patients with mild or moderate diarrhea
  • products have correct balances of electrolytes, sugar and water
41
Q

Dosing of pedialyte is based on what?

A
  • weight
42
Q

What is the timeline of use when using pedialyte in the big bottle?

A

needs to be used within 48 hours

43
Q

What is the action of electrolyte gastro?

A
  • restores body water and minerals lost in mild/moderate diarrhea
  • can be used in children and adults
44
Q

What is the dose of electrolyte gastro that should be given to small children and infants?

A
  • small frequent amount, slowly administered (150 mL/kg per day). Max dose is 2.4 L per day
  • solution is offered every 3-4 hours
45
Q

What are some of the non-pharms that can be used to manage diarrhea?

A
  • early re-feeding and maintenance of hydration is encouraged
  • follow age appropriate diet (combination of complex carbs, yogurt, lean meat, frui and veggies, etc)
  • if breastfeeding an infant with diarrhea, continue breastfeeding
  • avoid fatty foods and simple sugars- to avoid osmotic diarrhea
  • avoid spicy foods that may cause GI upset
  • avoid caffeine containing beverages
46
Q

What is the MOA of loperamide?

A
  1. synthetic opioid agonist
  2. slows intestinal motility allowing absorption of electrolytes and water through intestine
  3. decreases GI secretion
  4. reduction of daily fecal volume, increase viscosity and bulk volume, reduce fluid and electrolyte loss
47
Q

What is the indication for use of loperamide?

A
  • nonspecific acute diarrhea, traveler’s diarrhea, chronic diarrhea associated with IBS, afebrile or low grade fever in the absence of bloody stool
  • used as an adjunct to rehydration therapy
  • most references state that this agent is not recommended for children under the age of 12 w/o medical supervision
  • pregnancy risk factor- should only be used if it is recommended by a physician
48
Q

What are the adverse drug effects of loperamide?

A
  • abdominal pain, distention, or cramps, N/V, dry mouth, constipation, drowsiness, fatigue, skin rash
  • discontinue if there is abdominal distention and constipation)
  • GI adverse effects occurs in < 5%
  • worsens effects of invasive bacteria
49
Q

What is the dose of loperamide?

A

adults: 4 mg initially, followed by 2 mg after each BM (max of 16 mg/24 hours)
- only use for 2 days maximum

50
Q

What are the contraindication of using loperamide?

A
  • individuals with blood or mucous in the stool, fever
  • infectious diarrhea or infectious TD, acute ulcerative colitis
  • pseudomembranous colitis associated with broad spectrum AB
  • age under 2 y/o
51
Q

What is the onset of action of loperamide?

A

0.5 to 1 hour

52
Q

What are the interactions with other drugs and loperamide?

A
  • saquinavir
  • ritonavir
  • gemifibrozil
  • itraconazole
  • st. john’s wort
  • valerian
  • quinidine
53
Q

At high doses, loperamide can cause what?

A
  • can cause CNS toxicity and cardiac toxicity (euphoria, analgesia, respiratory depression, conduction abnormalities (prolonged QT prolongation) or ventricular arrhythmias
  • shows as sx as dizziness, urinary retention, syncope, SOB, palpitations, dystonia
54
Q

What is the MOA of bismuth subsalicylate?

A
  • bismuth: has antimicrobial effect against diarrhea-causing pathogens
  • salicylates: exerts antisecretory effects that rescues fluid and electrolyte losses in acute diarrhea
  • decreases the frequency of unformed stools
  • increases stool consistency
  • relieve symptoms from abdominal cramping
  • decrease N/V in children and adults
55
Q

What is the indication for bismuth subsalicylate (BSS)?

A
  • symptomatic relief of mild diarrhea
  • travellers diarrhea
  • adjuvant to antibiotic treatment of h. pylori associated with PUD
  • indicated for those under 3 y/o
  • do not use in those under 18 that have febrile viral illnesses
56
Q

What are the drug reactions associated with BSS?

A
  • impaction
  • gray-ish black stools/tongue
  • tinnitus
  • headache and confusion
57
Q

What are the warnings to patients associated with BSS?-

A
  • children and adults who have or are recovering from the flu or chicken pox due to risk of aspirin induced Reye’s syndrome (caution: children under 18 y/o)
  • patient sensitive to aspirin (resulting in asthmatic bronchospasm)
  • in susceptible patients, salicylate induced gout attack may occur
  • salicylate may exert antiplatelt effects. Avoid in patients taking anticoagulants or other salicylate
  • do not give to patient with current or a history of a GI bleed
58
Q

What are the interactions with other medications and BSS?

A
  • should be taken at least 3 hours apart from other medication
  • avoid taking in patients also taking anticoagulants, salicylates, probenedic and methotrexate
59
Q

What is the mechanism of action of adsorbents?

A
  • abdorbs 8x its weight in water
  • generally it is considered to be safe and effective
  • absorption is non-selective, toxins, bacteria, digestive enzymes, other drugs
  • reduce the number of BMs/improve stool consistency
  • relieves cramps associated with diarrhea
60
Q

What is the indication for the use of adsorbents?

A
  • can be used safely in children over 3-6 years of age

- do not use for > 2 days unless under the supervision of a physician

61
Q

What is the onset of action of adsorbents?

A
  • initial response is 12-19.5 hours
62
Q

How does fibre work to treat constipation and diarrhea?

A
  • it is a bulk forming agent
  • it will work to increase the consistency of the stool and pass it more easily
  • metamucil can be used to create bulk and pass the stool more easily
  • it adjusts the consistency of the stool by absorbing water in the intestinal tract
63
Q

What is the dosage for psyllium fibre?

A
  • 40 g/day in 2-4 divided doses
64
Q

What ar the side effects of using psyllium fibre?

A
  • cramping and flatulence
65
Q

What is the onset of action of using a fibre product?

A
  • onset of 12-24 hours and a peak effect of 2-3 days
66
Q

What are the monitoring parameters that need referral in patients?

A
  • if the condition does not resolve in 48 hours, if the diarrhea worsens, if the patient has a high fever or if there is blood/mucous in the stool
67
Q

Improvement of diarrhea can be seen within ______ hours

A

24-48

68
Q

What is the definition of travellers diarrhea?

A

3 or more loose, unformed stools per day along with at least 1 symptom of enteric infection such as fever, abdominal cramps, nausea, fecal urgency or dysentery

Clinical Pharmacy (24 decks)

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