Diarrhea/Constipation

Question 1

Diarrhea

Answer 1

Loose watery stools, more than or equal to 3-4 in a 24 hour period

Question 2

Causes of diarrhea

Answer 2

gastroenteritis, celiac disease, IBD, IBS, medications (abx, chemo)

Question 3

Therapy for diarrhea

Answer 3

• Opiate derivatives (loperamide) - self care
• Diphenoxylate w/atropine -Rx
• Octreotide (somatostatin analog) - reduced intestinal secretions (used in intestinal carcinoid tumors, chemo induced diarrhea)

Question 4

Constipation

Answer 4

patient produces less than or equal to 3 stools a week

Question 5

Constipation causes

Answer 5

Low fiber diet, comorbidities (IBS, diabetes, hypothyroidism, neurologic, pregnancy), drugs (opioids, antihistamines, TCAs, iron, CCBs)

Question 6

Chronic idiopathic constipation/IBS-C

Answer 6

• Rx lubiprostone (amitiza): 24 mcg bid po
• Rx linaclotide (linzess): 145 mcg daily po, dec to 72 mcg prn
• plecanatide (Trulance): 3 mg po daily

Question 7

Opioid receptor antagonists (constipation)

Answer 7

• Methylnatrexone (relistor)
• Naloxegol (movantik)
• Naldemedine (symproic)