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PHARM 345 GI/NUTRITION > Lecture 3 Managment Of Diarrhea. > Flashcards

Lecture 3 Managment Of Diarrhea. Flashcards

1
Q

Definition of diarrhea

A

Frequent passage of loose, watery stool (>3 per day)
Normal stools 100-300gm/daily

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2
Q

Classification of diarrhea

A

Acute <14days
Persistent >14 days
Chronic > 30 days duration or repeated episodes

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3
Q

Complications of diarrhea

A

Fluid and electrolyte disturbances

Dehydration

May also see: fever, abdominal pain, flatulence, weight loss/anorexia if severe

Hemorrhoids

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4
Q

What are the types of diarrhea

A

Osmotic : poorly absorbed substances draw water into the bowel lumen

Secretory : derangement of fluid and electrolyte transport across the enterocolonic mucosa, stimulating substance increases secretion or decreases absorption of water/electrolytes

Excudative/inflammatory: inflammation

Increased gut motility: reduced contact time in small intestine, premature emptying of colon, bacterial overgrowth

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5
Q

Common causes of acute diarrhea

A

Infectious - one of the most common causes of

  • bacterial
  • viral
  • food toxins
  • in developing countries could lead to chronic diarrhea
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6
Q

Drugs most commonly associated with diarrhea

A

Laxatives
Antacids
Antibiotics
Cholinergic drugs
Promotility agents
SSRI antidepressants
Sulfasalazine
NSAID

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7
Q

Clostridium difficult infections (CDI)

A

Anaerobic bacteria - clostridium difficult

Associated with antibiotics: fluroquinolones, cephalosporins, clindamycin

Range of symptoms includes severe symptoms with watery diarrhea, abdominal pain/distension, fever

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8
Q

Travellers diarrhea

A

Onset usually 1-2 days of ingesting contaminated food and up to 7-10 days after returning home

May be accompanied by abdominal cramping, fever or vomiting

Most cases are self-limiting

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9
Q

Red flags of diarrhea that should be referred

A

Fever >38.5
Blood or abdominal mucus in stools
Sever pain
Sever diarrhea >6 stools per day
Diarrhea >7 days
Signs of debilitating dehydration
Clostridium difficult infection

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10
Q

Therapeutic approach: non pharmacologic for diarrhea

A

Discontinue medication/foods that could be causing diarrhea

Adequate rehydration

Maintain electrolyte balance

Clear fluids for 24 hours

Oral rehydration
Avoid fruit juice and carbonated drinks

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11
Q

Oral rehydration therapy

A

Contains appropriate proportions of Na+, K+, glucose/dextrose and others

Products available : gastrolyte, pedialyte, WHO-ORS, hydralyte

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12
Q

Treatment approaches : Non pharmaologic diarrhea

A

Stop ingestion of poorly absorbed carbs ( sorbitol, mannitol)

Complex carbohydrate diet - BRAT ( not usually recommended)

Regular diet in 1-3 days

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13
Q

Peripheral action of loperamide (Imodium) - OTC

A

Binds to opiate receptor in gut wall
Inhibits release of acetylcholine + prostaglandins
Reduced peristalsis, increases intestinal transit time
Increased tone of anal sphincter- reducing in continence and urgency

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14
Q

Central + peripheral action: diphenpxylate + atropine (lomotil)- RX

A

Slows digestion
Atropine added to prevent misuse

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15
Q

Loperamide (Adult dose, duration, role and children)

A

Adult dose: 4mg, then 2mg after each bowel movement (max 16mg/day)

Duration: recommended not to be sued for more than 2 days ( however, can be used longer in some patients with chronic diarrhea)

Role: moderate to severe diarrhea

Avoid using in children under 2

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16
Q

Adverse effects of loperamide and use in pregnancy and contraindications

A

Abdominal cramps, dry mouth, drowsiness, constipation

Safe in pregnancy

Contraindications: patients with bloody stools and high fever,liver failure

17
Q

Diphenoxylate + atropine ( dose, role, effectiveness)

A

Dose 2.5-5mg, 3-4 times a day ( max 20mg/d)
Role : moderate to severe diarrhea
Less effective than loperamide

18
Q

Diphenoxylate + atropine adverse effects, contraindications and use in pregnancy

A

Side effects: dry outs, blurry vision, urinary retention, constipation

Avoid in clostridium difficult infection or malnourished or severly dehydrated

Contraindications: caution with use in elder, children ( anticholinergic effects)

Avoid in pregnancy

19
Q

Absorbent agents (attapulgite)

A

Absorbs water, nutrients, toxins, bacteria (8x weight)

Role : Mild diarrhea
May not be effective as loperamide
Well tolerated
Dose 1200-1500mg after each liquid bowel movement

Avoid in children under 2

20
Q

Hydrophilic bulking agents (psyllium) role, dose, mechanism

A

Mechanism in diarrhea includes absorbing liquid to create firmer stools

Role: mild diarrhea

Dose 1tsp (5-6m) twice a day

21
Q

Antisecretory agents ( bismuth subsalicylate ) role, dose, mechanism

A

Role : mild to moderate diarrhea, prevention or treatment of travellers diarrhea

Dose 524mg ( 2 tabs or 30mls) ever 0.5-1hr prn ( max 4.2g/day)

Mechanism: Antimicrobial, lower attachment of bacteria to GI apithelium

22
Q

Bismuth subsalicylate adverse effects, drug interaction, use in pregnancy

A

Adverse effects: black tongue, black stools, tinnitus

Drug interactions: oral anticoagulants, other salicylates, methotrexate

Avoid in children under 2

Caution in pregnancy, breastfeeding

23
Q

Zinc supplements for diarrhea

A

Used in developing countries

Lower severity and duration of diarrhea

20mg daily for 10-14days

24
Q

Prescription drugs to treat diarrhea (cholestyramine), role, dose, cautions

A

Cholestyramine

Dose : 4 mg daily or bid for bile acid induced diarrhea

Role: treat diarrhea from bile acid malabsorption

Caution: drug interactions as it may bind drugs. Administer other drugs 1 hour before or 4-6 after

25
Q

Prescription drugs to treat diarrhea (antibiotics)

A

CDI, ex. Metronidazole, vancomycin

Prevent/treat travelers diarrhe* fluroquinolones, azithromycin, Rifaximin

26
Q

Prescription drugs to treat diarrhea (octerotide,lanreotide) role

A

Diarrhea from neuroendocrine tumours

27
Q

Choosing among the OTC antidarrheals

A

Moderate to severe - loperamide

Mild to moderate- bismuth

Mild - attapulgite or psyllium

28
Q

Treatment of chronic diarrhea

A

Treat specific cause
Discontinue drug that may be adding to diarrhea if possible
Non pharmacological
Maintain hydration
Loperamide or adsorbents are options
Prescription drugs to treat diarrhea from specific causes

29
Q

Pregnancy/breastfeeding antidarrheals

Notes

A

Adsorbents
Loperamide
Avoid diphenoxylate/atropine,avoid bismuth subsalicylate

30
Q

Probiotics for treatment of diarrhea (dose)

A

General safe for health individuals

Population at risk: immunocompromised, severe illness

Dose : Depends on strain used

31
Q

Functional food with added probiotics

A

Fermented dairy products like yogurt

32
Q

Choosing a probiotics

A

Determine type of probiotic strain needed

PHARM 345 GI/NUTRITION (7 decks)

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