Drugs for diarrhea

Question 1

opiate-related agents (anti-motility agents)

Answer 1

↓ GI motility
Allows more time for absorption of fluid and electrolytes
Most effective for symptomatic relief

Loperamide (Imodium) - OTC
Diphenoxylate (Lomotil and atropine) - Controlled substance class 5 (low pot for abuse)
   - OD of Lomotil - change in mental status, CNS depression, sedation == antidote is narcan

SE: abdominal cramping, N/V, sleepy

Question 2

bismuth salts (Pepto-Bismal)

Answer 2

• for travelers’ diarrhea

- antibiotic property

Question 3

NI for diarrhea

Answer 3

• stay hydrated (watch for FVD - skin turgor)
• no caffeine
• no spicy food

Question 4

Irritable Bowel Syndrome (IBS)

Answer 4

• spasmatic bowel
• causes - not clear; many theories
• triggered by stress and other factors

S/Sx - recurrent crampy abdominal pain; relieved by BM

• alternate between constipation and diarrhea
• flatulence, bloating

Tx - difficult

Question 5

IBS treatment

Answer 5

1. antispasmodics - anticholinergic: belladonna (Donnatal)
2. bulk forming agents
3. laxatives
4. antidiarrheal agents (Lomotil, Imodium)
5. tricyclic antidepressants (TCAs)
6. ALOSETRON (LOTRONEX)
   - - 5-HT3 antagonist
   - - strict risk management program required
   - - new drug w/many side effects

Question 6

Inflammatory Bowel Disease (IBD)

Answer 6

includes: ulcerative colitis and Crohn’s disease
- autoimmune disorder
- chronic, recurrent diseases (remissions and exacerbations)

S/Sx - anemia, weight loss, abdominal pain, diarrhea

Question 7

IBD Tx: sulfasalazine (Azulfidine)

Answer 7

5-aminosalicylates (5-ASA)

• for mild cases
• suppresses inflammation
• ↓ prostaglandin synthesis
• treats mild/moderate IBD
• maintains remission after Sxs have subsided

SE: fever, rash, arthralgia

• bone marrow suppression
• monitor CBC for ↓ WBC, Hgb, platelet count

Question 8

IBD Tx: Azathioprine (Imuran)

Answer 8

“Sledge hammer” drug
Cytotoxic drug - suppresses cell-mediated & humoral immune responses by killing B and T cells

Indications: IBD, used in organ transplant patients

SE: bone marrow suppression (neutropenia, anemia, thrompocytopenia)

• nephrotoxicity
• neurotoxicity
• hepatotoxicity
• immunotoxicity

NI and Pt Ed: low grade fever (99.5) - CALL DOCTOR
- wash hands

Question 9

IBD Tx: Cyclosporine

Answer 9

"sledge hammer" drug
immunosuppressant 
- also used for transplant pts
- risk of infection, lymphoma cancer
- nephrotoxicity
- hepatotoxicity

NI and pt ed: wash hands

Question 10

IBD Tx: monoclonal antibodies (IgG)

Answer 10

Targetted agents
- fewer side effects
- “immunododulating agents”
= immunoSTIMULANT –> cancer treatment
= immunoSUPPRESSANT –> autoimmune disorders
TNF blockers
Must screen pt for TB before tx

Question 11

IBD Tx: infliximab (Remicade)

Answer 11

• immunosuppressant - TNF (tissue necrosis factor) blocker (binds and inactivates TNF antibody)
• IV q6-8 wks

SE: immunosupporessant

• infusion rxn: fever, chills, rash
• lymphoma if on long term

Question 12

cytokines: what are they

Answer 12

protein mediating bodies

released by any immune system cell

Question 13

types of cytokines

Answer 13

1. interleukins (1-12) - reg lymphocytes
   2, interferons (a, beta, y) - has antiviral activity
2. TNF - promotes inflammation
3. colony stimulating factors (CSF) - stim production of WBC, RBC, platelets