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Therapeutics > final exam lecture 5 > Flashcards

final exam lecture 5 Flashcards

1
Q

Increase in intestinal motility leads to_____. Decrease un intestinal motility leads to_____

A

diarrhea, constipation

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2
Q

relationship between segmenting contractions and diarrhea

A

patients with diarrhea often have fewer spontaneous segmenting contractions

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3
Q

classifications of diarrhea

A

Acute, persistent, chronic, chronic idiopathic

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4
Q

difference between acute, persistent, chronic and chronic idiopathic

A

acute diarrhea <14 days (usually caused by infectious process)
persistent >14 days
chronic >30 days
chronic idiopathic >or equal to 4 weeks (persistently loose stool without identifiable cause)

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5
Q

chronic diarrheaaffects what percent of people

A

5%

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6
Q

most common foodborne cause of diarrhea and vomiting

A

Norovirus

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7
Q

What is fecal incontinence

A

Inability to control bowel movements, causing stool to leak unexpectadely

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8
Q

4 ways to classify diarrhea

A

Secretory
osmotic
exudative
altered intestinal transit

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9
Q

Secretory diarrhea mechanism? what does it cause?

A

Change in active ion transport causes water to move into the intestine. Causes large stool volumes (>1L/day). It does not improve with fasting

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10
Q

how is osmotic diarrhea caused? What does it cause?

A

It is caused when poorly absorbed substances are retained in intestinal fluids; resulting in influx of water. Causes lactose intolerance. Improves with fasting.

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11
Q

Exudative diarrhea define

A

Subset of diarrhea. secondary to inflammatory disease of the bowel. We see mucus, protein and blood in gut.

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12
Q

3 infectious organisms commonly associated with causing diarrhea

A

Bacteria (salmonella) most common bacteria in US), viral
viral- norovirus/ rota virus

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13
Q

common medications for drug induced diarrgea

A

Laxatives, metformin etc

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14
Q

complications of diarrhea

A

dehydration
electrolyte imbalance

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15
Q

evaluating a patient for dehydration

A

skin tenting, concentrated urine, dizziness when standing, dry mucous membrane

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16
Q

questions to ask patients regarding their diarrhea

A

When did symptoms begin
Frequency, consistency and color of stool
abdominal pain?
recent travel?

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17
Q

non pharmacologic treatment for diarrhea. What kind of diarrhea is it more important for?

A

BRAT diet (banana, rice, apple sauce, toast)
more important foo osmotic diarrhea

fluid- electrolyte replacement

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18
Q

Treatment if acute diarrhea (<3 days) with no fever or systemic symptoms

A

Symptomatic therapy
1) fluid/electrolyte
2) loperamide, diphenoxylate
3) diet

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19
Q

How to treat acute diarrhea with fever or systemic symptoms

A

Check feces for WBC/RBC/Ova and parasites.
If negative- symptomatic therapy.
If positive- use appropriate antibiotic therapy

20
Q

treatment of chronic diarrhea

A

Always refer to physician
Give hydration and loperamide

21
Q

how to prevent travelers diarrhea

A

drink bottled water
antimicrobial prophylaxis should not be used routinely

22
Q

medicine to prevent travelers diarrhea

A

Bismuth subsalicylate

23
Q

When is the only time we can use antimicrobial prophylaxis to treat travelers diarrhea? What antibiotic is recommended

A

Rifaximin is recommended. Only used for at risk populations.

24
Q

Treatment for mild travelers diarrhea

A

Oral rehydration is used on ALL patients with travelers diarrhea.
Antibiotic use is not recommended
Loperamide or BSS may be considered
BSS dose: 60 ml or 2 tabs QID

25
Q

Moderate travelers diarrhea treatment

A

Antibiotic MAY be used. Loperamide may be considered as monotherapy or adjunctive

26
Q

Travelers diarrhea (severe)

A

Antibiotic treatment SHOULD be used. Single dose therapy preferred. Loperamide may be used as adjunctive therapy

27
Q

How to treat drug induced diarrhea

A

Dx offending agent and use oral rehydration agents.

28
Q

how do antimotility drugs treat diarrhea

A

They activate Mu opioid receptors on smooth muscle of the bowel to reduce peristalsis and increase segmentation

29
Q

What are some concerns with antimotility drugs? name an antimotility drug

A

Should not be used long term and Not to be used with C.diff diarrhea.
Loperamide

30
Q

loperamide doses

A

4 mg initially with 2 mg after each loose stool. Do not exceed 16 mg/day

31
Q

how do anti secretory drugs treat diarrhea

A

act by reducing secretions in gut.

32
Q

name an expample of antisecretory drugs

A

BSS (bismuth sub salicylate) (pepto bismol)

33
Q

dosing of peptobismol? side effects?

A

2 tabs (30 ml) every 30-60 mins prn (upto 8 doses/24 hrs)
may potentiate anticoagulants, cause stools to turn black

34
Q

Name 4 antimotility drugs. Maxdosing? OTC or RX? controlled sybstance?

A

Loperamide- do not exceed 8 pills a day, OTC
diphenoxylate/atropine (lomotil)- do not exceed 20 mg/day (4 pills), C V (RX ONLY)
Difenoxin/Atropine (motofen)- Not to exceed 8 tabs a day (CIV) Rx only1

35
Q

Name an absorbent. DIarrhea or constipation? DOsing?

A

Psyllium (metamucil), 1-2 tsp mixed in 8 oz water 1-3 times a day

36
Q

name some causes of constipation

A

Dietary
(Poor fluid intake, decreased caloric intake)
Disease states that slow down GI motility
(diabetes, Parkinsons, CNS injury)

37
Q

Common drugs that cause constipation

A

Opioids (mu receptor antagonists)
NSAIDs (much less extent than opioids)
Antacids
Iron preparations

38
Q

When to refer patients with constipation?

A

Sx persist longer than 2 Weeks
Fever
black tarry stools
marked abd pain/discomfort
Severe nausea/vomiting
Family history of IBD or colon cancer

39
Q

Measures to help promote regular bowel habits

A

6-8 glasses of water a day
Add fiber to diet slowly (increase over 7-10 days)
Prunes

40
Q

Moa of bulk laxatives

A

Forms emollient gels which retain water, swell and stimulate BM

41
Q

Bulk laxative drugs

A

Psyllium- metamucil
Methylcellulose- citrucel (will not cause gas)
Calcium polycarbophil- fibercon

42
Q

Advantage vs disadvantage of bulk laxatives

A

Advantage- Softens the stools better than docusate
Disadvantage- gas formation, impact on drug absorption

43
Q

MOA of hyperosmotic agents

A

Draws fluid into colon due to hugh cone=centration of sugar.

44
Q

Examples of Hyperosmotic drugs

A

MiraLAX, PEG

45
Q

Adv vs Disadv of hyperosmotic agents

A

EXCELLENT FOR CHRONIC CONSTIPATION

disadv- 1-3 day onset

46
Q

Dose of miralax

A

17 g po daily

Therapeutics (46 decks)

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