Diarrhoea

Question 1

Management of acute diarrhoea

Answer 1

 The primary aim for all patients with diarrhoea is to prevent or reverse fluid/electrolyte depletion.
Oral rehydration preparations are used to achieve this primary outcome.

Question 2

Antimotility drugs e.g.

Answer 2

Loperamide

These drugs prolong the duration of intestinal transit by binding to opioid receptors in the GI tract.

Not Recommended for use in children, but recommended for uncomplicated acute diarrhoea in adults.
 Loperamide is recommended as it does not cross the blood-brain-barrier.

Question 3

Antispasmodic drugs e.g

Answer 3

Hyoscine (Buscopan)
• These drugs are given to treat abdominal cramp.
Antispasmodics and Anti-emetics should be avoided in young children with gastro-enteritis as they are rarely effective and have troublesome side effects.
- do not use buscopan in pregnancy

Question 4

Bulk-forming drugs

In diverticular disease

Answer 4

(a condition that causes bulges to form in the colon) ….

- Bulk-forming drugs such as ispaghula husk + methylcellulose are useful in controlling diarrhoea.

Question 5

• Colestyramine is used for diarrhoea following i

Answer 5

Ileal disease or resection. Patients on colestyramine should take other medication an hour before, or 4 to 6 hours after each dose.

Question 6

• Loperamide can be used in children - age limits

Answer 6

can be used in children over 4 but OTC it is only licensed for use in children over 12.

Question 7

Most cases of diarrhoea are due to

Answer 7

viruses and do not need antibiotic treatment

Question 8

Loperamide Max dose daily

Answer 8

16mg

Question 9

Loperamide MHRA alert

Answer 9

REPORTS OF SERIOUS CARDIAC ADVERSE REACTIONS WITH HIGH DOSES OF LOPERAMIDE ASSOCIATED WITH ABUSE OR MISUSE - Serious cardiovascular events (such as QT prolongation, torsades de pointes, and cardiac arrest), including fatalities, have been reported in association with large overdoses of loperamide.
Healthcare professionals are reminded that if symptoms of overdose occur, naloxone can be given as an antidote. The duration of action of loperamide is longer than that of naloxone (1–3 hours), so repeated treatment with naloxone might be indicated; patients should be monitored closely for at least 48 hours to detect possible CNS depression.
Pharmacists should remind patients not to take more than the recommended dose on the label.

Question 10

OTC loperamide

Answer 10

• Loperamide can be sold to the public, for use in adults and children over 12 years, provided it is licensed and labelled for the treatment of acute diarrhoea.
• Loperamide can be sold to the public, provided it is licensed and labelled for the treatment of acute diarrhoea associated with irritable bowel syndrome (after initial diagnosis by a doctor) in adults over 18 years of age.