Diarrhea, Constipation, IBS Flashcards
The 3 presentations of Diarrhea
- Acute: Less than 14 days, infectious
- Persistent: 14-29 days, medical condition
- Chronic: 30+ days, medical condition
Describe the nature of Acute diarrhea and how to prevent it
common causes: food, water, viruses, bacteria
prevention: food safety, hand washing and hygiene, immunizations, travel precautions
Self care exclusions when treating diarrhea
patient age: under 6 months of age or weighing under 8kg, pregnancy lack of response to oral rehydration persistent fever signs of severe dehydration severe abdominal pain alarm symptoms
what are self care alarm symptoms for diarrhea?
severe dehydration fever persistent blood in stool unexplained change in bowel habits unexplained weight loss
Diarrhea drug treatment categories and their agents
Anti-motility: diphenoxylate, loperamide, opium tincture
adsorbents: kaolin-pectin, polycarbophil
antisecretory: bismuth subsalicylate, lactase
Oral rehydration solutions
powder, solution, popsicles, soda, juice, sports drinks
Antimotility agent dosing & precautions
ACTION: Mu receptor activity to reduce peristalsis, anticholinergic
diphenoxylate/atropine: age 2+, confusion & drowsiness
loperamide: age 2+, euphoria, Torsades, take with a lot of fluids
opium tincture: 1mL = morphine 10mg, drops or mLs
Adsorbent agent dosing and precautions
ACTION: absorbing excess intestinal fluids
kaolin-pectin: 30-120mL after each loose stool
polycarbophil: 2 tabs chewed 4x/day or after loose stool MAX 12tabs/day. Take with glass of water, can absorb 60x its weight in water
ACTION: Binding bile acids limits their cathartic effects
cholestyramine: binds other medications take daily up to 4 times/day. Drink shortly after mixing
Antisecretory agent dosing and precautions
ACTION: salicylate has antisecretory effects
bismuth subsalicylate: increase anion gap, 2 months and up, tongue can darken
lactase: age 4+, use if related to lactose intolerance
ACTION: blocks serotonin release, inhibits secretion and increased absorption
octreotide: subQ, for ppl with chronic diarrhea. injection site pain, can cause gall/biliary stones
Timeline for activity of anti-diarrheals
1-6 hours: Kaolin pectin, polycarbophil, lactase, bismuth subsalicylate
6-12 hours: diphenoxylate, loperamide, opium
24-72 hours: octreotide
beyond 72 hours: cholestyramine
Self care exclusions when treating constipation
age less than 2 symptoms lasting more than 14 days or recurring over 3mo daily self initiated laxative use fever intense abdominal pain significant distention/cramping/flatulence N/V alarm symptoms
Self care alarm symptoms for constipation
recurrent N/V unexplained anemia hematemesis wt loss (unintended) family history of malignancy
daily recommended fiber intake
25-35 g/day
Bulk forming agents dosing and precautions
ACTION: providing bulk in intestines and increased water content
Methylcellulose: age 6+, cap or pow, mix with 8 oz liquid
polycarbophil: age 6+, absorb 60x weight in water, take with 8oz water
psyllium: age 1+, mix with 8 oz liquid
guar gum: powder
Emollient/stool softener dosing and precautions
ACTION: water and liquid enter stool to hydrate and soften
docusate sodium: age 2+, can irritate throat, combo tab with senna, caps/liquid/enema
mineral oil: age 6+, aspiration causing pneumonia, absorption of fat soluble vitamins impaired
stimulant laxative dosing and precautions
ACTION: irritated nerves stimulate colonic motility, decreased water absorption
bisacodyl: age 2+, oral and supp
senna: age 2+, oral and liquid, abd cramps
osmotic laxative dosing and precautions
ACTION: draws water into intestine to hydrate and soften
PEG 3350: age 2+. once daily dose sufficient, mix with glass of water
Mg: age 2+, many interaction related to med timing
lactulose/sorbitol/glycerin: daily dosing or less, ok for peds, mix with juice or water
sodium phosphate: age 2+, caution in CKD, bloating, abd pain
intestinal secretagogue dosing and precautions $$$
ACTION: stimulate fluid secretion via Cl channel or guanylate cyclase receptor in enterocytes
lubiprostone: take w food to reduce N/V, dyspnea, N/V, hypotension
linaclotide: 18+, take b4 1st meal to avoid diarrhea due to fat
plecanatide: 18+
prucalopride: HA, dizziness, fatigue, suicidal ideation
PAMORA (peripherally acting mu opioid receptor antagonists) dosing and precautions $$$
ACTION: block receptors in gut restoring GI motility, no impact on pain relief action
methylnaltrexone: oral/subQ, may cause opioid withdrawal, GI: abd pain, gas, N
naldemidine: GI: abd pain, diarrhea, CYP3A4 intrxns
naloxegol: severe abd pain, GI perforation, CYP3A4 intrxns
alvimopan: avoid opioids 7 days prior to use, risk of MI, hypokalemia, begin day prior to surgery and resume day after, in patient use
probiotics
reasonable evidence they improve GI health
safe for infants, children, adults, older adults
use caution if immune comped/vulnerable
5 billion CFU or more/day
Myths related to constipation
diets lacking fiber cause constipation
increasing fluid intake treats constipation
limited physical activity causes constipation
chronic laxatives cause damage
tolerance develops to laxatives (different from rebound)
people becoming physically dependent on laxatives
IBS definition
A brain-gut disorder. abnormal stress response combined with psychological distress and infection/inflammation
chronic abd pain and altered bowels in absence of organic cause
affects more women than men
Drug therapy for IBS-C $$$
ACTION: 5HT4 stimulates peristaltic reflex and intestinal secretion
tegaserod: 30 min prior to meal, females <65yo, MI/CVA/TIA/angina, suicidality, HA, abd pain
ACTION: sodium/hydrogen exchanger 3 inhibitor to increase water, faster transit
tenapanor: immediately prior to meal, not available
Drug therapy for IBS-D $$$
ACTION: mixed opioid receptor activity to reduce abd pain and diarrhea
eluxadolin: take w food, C4, alcohol increases pancreatitis risk
ACTION: serotonin antagonist reducing visceral pain, colonic transit and secretions
Alosteron: BID, BOX: ischemic colitis, constipation
ACTION: antimicrobial may modify gut biome and gas
rifaximin: use 14 days or less, peripheral edema, dizziness, fatigue
