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655: Pharmacotherapy > Diarrhea, Constipation, IBS > Flashcards

Diarrhea, Constipation, IBS Flashcards

1
Q

The 3 presentations of Diarrhea

A
  1. Acute: Less than 14 days, infectious
  2. Persistent: 14-29 days, medical condition
  3. Chronic: 30+ days, medical condition
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2
Q

Describe the nature of Acute diarrhea and how to prevent it

A

common causes: food, water, viruses, bacteria

prevention: food safety, hand washing and hygiene, immunizations, travel precautions

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3
Q

Self care exclusions when treating diarrhea

A 
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
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4
Q

what are self care alarm symptoms for diarrhea?

A 
severe dehydration
fever
persistent blood in stool
unexplained change in bowel habits
unexplained weight loss
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5
Q

Diarrhea drug treatment categories and their agents

A

Anti-motility: diphenoxylate, loperamide, opium tincture

adsorbents: kaolin-pectin, polycarbophil
antisecretory: bismuth subsalicylate, lactase

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6
Q

Oral rehydration solutions

A

powder, solution, popsicles, soda, juice, sports drinks

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7
Q

Antimotility agent dosing & precautions

A

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

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8
Q

Adsorbent agent dosing and precautions

A

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

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9
Q

Antisecretory agent dosing and precautions

A

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

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10
Q

Timeline for activity of anti-diarrheals

A

1-6 hours: Kaolin pectin, polycarbophil, lactase, bismuth subsalicylate
6-12 hours: diphenoxylate, loperamide, opium
24-72 hours: octreotide
beyond 72 hours: cholestyramine

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11
Q

Self care exclusions when treating constipation

A 
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
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12
Q

Self care alarm symptoms for constipation

A 
recurrent N/V
unexplained anemia
hematemesis
wt loss (unintended)
family history of malignancy
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13
Q

daily recommended fiber intake

A

25-35 g/day

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14
Q

Bulk forming agents dosing and precautions

A

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

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15
Q

Emollient/stool softener dosing and precautions

A

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

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16
Q

stimulant laxative dosing and precautions

A

ACTION: irritated nerves stimulate colonic motility, decreased water absorption

bisacodyl: age 2+, oral and supp
senna: age 2+, oral and liquid, abd cramps

17
Q

osmotic laxative dosing and precautions

A

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

18
Q

intestinal secretagogue dosing and precautions $$$

A

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

19
Q

PAMORA (peripherally acting mu opioid receptor antagonists) dosing and precautions $$$

A

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

20
Q

probiotics

A

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

21
Q

Myths related to constipation

A

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

22
Q

IBS definition

A

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

23
Q

Drug therapy for IBS-C $$$

A

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

24
Q

Drug therapy for IBS-D $$$

A

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

25
Q

Antidepressants for IBS-D

A

TCAs - benefit demonstrated
SSRI - conflicting results,
both useful for treating abd pain, avoid TCA with IBS-C

26
Q

Important counseling points

A
  • rectal admin of meds handout
  • body positioning recs
  • most common side effects related to underlying condition
  • can interact/bind with other medications
  • encourage fluids, diet and exercise

655: Pharmacotherapy (9 decks)

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