Diarrhoea Flashcards
What are the 6 groups of drugs used to treat diarrhoea?
- Opoid agonists
- Colloidal bismuth compounds
- Intestinal adsorbents
- Lacteol fort
- Bile salt-binding resins
- Somatostatin-like peptides
What is first-line for rapid, symptomatic relief of diarrhoea?
Loperamide
Diphenoxylate + atropine
Opoid agonists
Which anti-diarrhoeal drug increases risk of cardiac abnormalities on overdose?
Loperamide
MOA of opoid agonists?
Agonist of mu opioid receptors in the intestine, decreasing activity of the enteric nervous system and increasing intestinal transit time
Which anti-diarrhoeal drug causes harmless blackening of stools & tongue?
Bismuth compounds
MOA of bismuth compounds?
Binds to enterotoxins & weak antimicrobial effect against bacteria that cause diarrhoea
What benefit does the bismuth subsalicylate formulation have?
Subsalicylate is a NSAID
Inhibits intestinal PGE production & Cl- secretion, reducing stool frequency and liquidity
Severe adverse effect of bismuth compounds?
Encephalopathy
What patients should avoid taking bismuth compounds?
Renal insufficiency
Name 2 examples of intestinal adsorbents
Kaolin
Diosmectite
MOA of diosmectite?
Adsorbent of bacteria, toxins & fluid
Decreases stool liquidity and number
MOA of lacteol fort?
Adheres onto surface of intestinal cells & normalises the intestinal flora by competitive exclusion, decolonising the harmful organisms
Lacteol fort is contraindicated in ________ patients
Lacteol fort is contraindicated in lactose intolerant patients
Which groups of patients is colestyramine indicated in?
Patients with diseases of the ileum or surgical resection of the terminal ileum
MOA of colestyramine?
Binds & sequesters bile salts, alleviating osmotic diarrhoea caused by excess fecal bile salts
Why does resection/disease of the ileum cause diarrhoea?
Bile salts are unable to be reabsorbed by the ileum, causing the osmotically active bile salts to remain in the GIT, hence causing osmotic diarrhoea
Name an example of a somatostatin-like peptide
Octreotide
MOA of octreotide?
Mimics somatostatin hormone released in the GIT
Inhibits release of various transmitters & hormones, reduces intestinal & pancreatic secretions and slows GI motility
What is ocreotide indicated in?
Secretory diarrhoea caused by GI and neuroendocrine tumours
Adverse effects of ocreotide?
SGBH
Steatorrhoea due to impaired pancreatic secretion
Gallstones
Bradycardia
Hypothyroidism (in prolonged treatment)
Nausea, abdominal pain, flatulence, diarrhoea
What should be the advice given to patients when taking diosmectite & colestyramine?
Avoid oral drugs within 2 hours
What are the anti-diarrhoeal drugs indicated for traveller’s diarrhoea?
Opoid agonists (first-line)
Diosmectite
Bismuth compounds
Lacteolfort
