GI deck 2 Flashcards
Bismuth subsalicylate effects
antisecretory and antimicrobial effects
Atropine causes
causes decreased bowel secretions and slows peristalsis
Loperamide binds to
opioid receptors and slows gastric motility
5-HT3 receptor antagonist example
Lotronex
Diphenoxylate is an
opioid
Lotronex is used in
long term. IBS
Treatment for diarrhea
1 to 7 days fluids and culture
after 7 days treatment with medication IF the culture comes back negative
Kaolin and pectin are not
absorbed and are eliminated in feces.
Bismuth subsalicylate dissociates into
salicylate that is absorbed (similar to aspirin), metabolized in the liver, and excreted in urine with the bismuth that is not absorbed.
The opioid agents are all absorbed and distributed
systemically, metabolized in the liver, and eliminated in urine and/or feces.
Opioids decrease intestinal motility and may cause
toxic megacolon.
Bismuth subsalicylate is contraindicated
in children with viral or flu-like illness.
Antidiarrheals use cautiously in
older adults
Antidiarrheals are contraindicated in the treatment
of diarrhea in most children.
Monitor patients taking eluxadoline for
pancreatitits
Alosteron has a boxed warning and is contraindicated in
patients with constipation
Bismuth: causes
black tongue and gray-black stools
Diphenoxylate and difenoxin with atropine
have ADR anticholinergic effects
Opioid ADR
have central nervous system (CNS) effects
Dizziness, drowsiness, sedation, headache
Acute diarrhea clinical use
Treat source of diarrhea
Absorbents (kaolin-pectin or bismuth subsalicylate) used after each loose stool
Maintain hydration
Electrolyte solution in infants and young children
Flat soda or water in adults
Opioids dosed 3 or 4 times/day or after each stool
bismuth is in
peptobsimol
Antidiarrheals bowel disease clinical use
Loperamide QID: may be used as adjunct therapy
antdiarrheal chronic infantil diarrhea treatment
Bismuth subsalicylate
traveler’s diarrhea treatment
Bismuth subsalicylate with each meal and at bedtime to prevent traveler’s diarrhea
Irritable bowel syndrome
treatment
Eluxadoline or loperamide
Alosetron in women with severe irritable bowel syndrome (IBS) not responsive to other treatments
Patients taking HIV antiretroviral drugs dirrhea treatment
Crofelemer
Any antidiarrheal can be used for
acute diarrhea in adults
Bismuth subsalicylate and loperamide are used for
traveler’s diarrhea.
Cost of antidiarrheal
OTC drugs are inexpensive.
Eluxadoline and alosetron are very expensive.
Antidiarrheal patient education
Rebound constipation Bismuth turning tongue and stool black Products with atropine may cause dry mouth and anticholinergic effects Opioids may cause CNS effects Fluxadoline may cause pancreatitis
NSAIDs: cause
gastric mucosal damage and ulcer formation
Cucralfate (Carafate): selectively binds
to ulcer tissue, acting as a barrier
Mosprostol (Cytotec): inhibits
gastric secretion, has mucosal protective qualities
cytroprotecitve agent is a
cell protective agent
Precautions and contraindications
Cytoprotective agents
Misoprostol pregnancy category X (abortifacient)
Cytoprotecitve agent ADR
Sucralfate: constipation
Misoprostol: diarrhea, menstrual problems
Cytoprotective Agents Drug interactions
Sucralfate: decreases absorption of other drugs
Misoprostol: diarrhea with magnesium-containing antacids
Cytoprotective Agents Ulcers associated with NSAID use
First choice is to stop NSAIDs.
Use misoprostol if patient requires NSAID therapy.
Dose four times per day.
Women of childbearing age need pregnancy test.
Misoprostal is
pregnancy category X and will cause abortion
Cytoprotective Agents Duodenal ulcers from other causes
Sucralfate for up to 8 weeks to heal ulcer
Given four times per day, 1 hour before meals
Misoprostol taken
with food
sucralfate taken on
empty stomach
Sucralfate ADR
constipation prevention
ADR
diarrhea; contact provider if lasts more than 1 week
Misoprostol: pregnancy category X
