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Therapeutics - Exam 6 > Lecture 65 > Flashcards

Lecture 65 Flashcards

diarrhea (scott)

1
Q

acute

A

under 14 days
usually caused by an infectious process

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2
Q

persistent

A

over 14 days

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3
Q

chronic

A

over 30 days

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4
Q

chronic idiopathic

A

greater than or equal to 4 weeks
persistently loose stools without identifiable cause

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5
Q

classification of diarrhea

A

based on increased frequency and decreased consistency of fecal discharge compared to an individual’s normal bowel patterns

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6
Q

secretory diarrhea

A

a change in active ion transport by either a decrease in sodium absorption or an increase in chloride secretion into the lumen (water follows)
caused by - pancreatic tumors, unabsorbed fat, laxatives, bacterial toxins
large stool volume (>1 L per day)
normal ionic stool content
not altered by fasting

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7
Q

osmotic diarrhea

A

caused when poorly absorbed substances are retained in interstitial fluids, resulting in influx of water and electrolytes into the lumen
caused by malabsorption syndrome, lactose intolerance, administration of divalent ions, and consumption of poorly soluble CHOs
improves with fasting state

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8
Q

exudative diarrhea

A

subset of secretory (Secondary to inflammatory disease of the bowel)
caused by IBD discharging mucus, proteins, and blood into the gut
characterized by large stool volumes

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9
Q

causes of diarrhea

A

bacterial
viral
drug induced

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10
Q

bacterial causes of diarrhea

A

shigella
salmonella
campylobacter
staphylococcus
E coli

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11
Q

viral causes of diarrhea

A

norwalk (norovirus)
rotavirus

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12
Q

drug induced causes of diarrhea

A

laxatives
antimicrobials
metformin
among others…

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13
Q

salmonella

A

most bacteria in the US due to increased industrialization of farms and shared food sources

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14
Q

norwalk

A

number one cause of diarrhea in the US due to outbreaks being on cruise ships and spreading to other parts of the world

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15
Q

acute diarrhea

A

presentation - lasting less than 3 days
treatment based on if fever or systemic symptoms are present

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16
Q

acute diarrhea with a fever or systemic symptoms

A

check feces for WBC/RBC/ova and parasites
if negative, symptomatic therapy
if positive, use appropriate antibiotic and symptomatic therapy

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17
Q

acute diarrhea without fever or systemic symptoms

A

fluid electrolyte replacement
loperamide, diphenoxylate, or absorbent
diet change

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18
Q

chronic diarrhea

A

presentation - lasting more than 14 days
etiology - intestinal infection, IBD, malabsorption, secretory hormonal tumor, drug induced, motility disturbance
treatment should always be refered

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19
Q

treatment of chronic diarrhea

A

determine possible cause by history and physical exam
determine possible cause by diagnostic studies (stool culture, sigmoidoscopy, intestinal biopsy)
if leads to no diagnosis, replete hydration, d/c potential drug inducer, adjust diet, and loperamide or absorbent
if leads to diagnosis, treat specific cause

20
Q

traveler’s diarrhea

A

presentation - acute watery diarrhea, last 2-3 days with no treatment (sometimes not desirable due to lack of treatment)
etiology - most cases infective, primarily caused bacteria
can be prevented and treated

21
Q

prevention of traveler’s diarrhea

A

drink bottled water and drinks
be sure fresh fruit/vegetables are properly washed and prepared
antimicrobial prophylaxis should not be used routinely (due to antibiotic resistance) but can be considered for complications like Rifaximin
BSS may be considered
Fluorquinolones are not recommended, insufficient evidence to recommend prebiotics or probiotics

22
Q

treatment of travelers diarrhea

A

based on mild, moderate, and severe cases
Oral rehydration solution (ORS) should be use aggressively regardless of severity

23
Q

Mild travelers diarrhea treatment

A

loperamide or BSS may be considered
antibiotics are not recommended

24
Q

moderate travelers diarrhea treatment

A

antibiotic treatment may be used
loperamide may be considered as monotherapy or adjunctive therapy

25
Q

severe traveler’s diarrhea treatment

A

antibiotic treatment should be used
single dose therapy preferred
loperamide may be considered as adjunctive therapy

26
Q

drug-induced diarrhea

A

presentation - may range from mild inconvenience to life threatening antibiotic association, duration varies based on causative agent
etiology - decrease transit time leading to irregular absorption and secretion; alteration of bowel flora

27
Q

treatment of drug induced diarrhea

A

discontinue offending agents when possible
ORS and anti-motility agents may be needed

28
Q

questions to ask pt experiencing diarrhea

A

when did the symptoms begin?
frequency, consistency, and color of stool
have you have similar bouts int eh past?
presence of fever, NV, malaise?
presence of abdominal pain and/or cramping?
others with similar symptoms?
recent travel outside of the US?

29
Q

non pharm treatment of diarrhea

A

diet management
fluid-electrolyte replacement

30
Q

diet management

A

more important with osmotic diarrhea (need to eliminate the causative agent) do not stop feedings in children with bacterial diarrhea
mild, digestible, low-residue diet for 24 hours (bananas, rice, apple juice, toast)

31
Q

fluid-electrolyte replacement

A

rehydrate and prevent electrolyte disturbance and dehydration in severe cases (principle risk in infants, children, frail elderly)
external administration is preferred but parenteral can be indicated in cases of shock, severe dehydration, failed oral rehydration, or repeated bouts of vomiting

32
Q

anti-motility mechanism/indications

A

mechanism - activate the mu opioid receptor to reduce peristalsis and increase segmentation; delaying transit of intraluminal contents
indications - acute, chronic, travelers, drug-induced

33
Q

cons of anti-motility agents

A

cannot be used long term (especially opioid derivatives)
not to be used with C. diff diarrhea
could cause constipation

34
Q

loperamide (imodium) dosing, pros, cons

A

dosing - 4mg initally then 2mg after each loose stool; otc max of 8mg; rx max of 16mg
PROS - OTC, works peripherally
CONS - most cases observed in patients misusing or abusing loperamide

35
Q

loperamide SE and key counseling

A

SE - concern about potential heart arrhythmias, QTc prolongation, torsades de pointes, syncope, cardiac arrest
Counseling - higher than recommended dose can lead to serious heart problems that can lead to death

36
Q

diphenoxylate/atropine (lomotil) dosing, pros, cons

A

dosing - 5mg QID; max of 20mg
PROS - mixed with atropine to prevent abuse
CONS - rx only; c5

37
Q

diphenoxylate/atropine (lomotil) SE

A

not recommended in children under 2 yo
high sensitivity can lead to toxic megacolon
atropine causes dry mouth and blurred vision

38
Q

difenoxin/atropine (motofen) dosing, cons, SE

A

dosing - 2mg initially then 1 tab with each loose stool; max of 8 tabs
CONS - rx only, c4
SE - not recommended in children under 2 yo, high sensitivity can lead to toxic megacolon

39
Q

codeine dosing and cons

A

dosing - 15 to 30mg q6h prn
cons - RX only, c2

40
Q

anti-motility drugs

A

loperamide
lomotil
motofen
codeine

41
Q

absorbents mechanism/indication

A

absorbs nutrients, toxins, drugs, and digestive uses
indications - symptomatic relief of chronic diarrhea in patients who cant form solid stool

42
Q

absorbents pros/cons

A

pros - all are OTC, can be used in diarrhea or constipation
cons - effectiveness not based on clinical trials so still unproven

43
Q

absorbent drugs

A

psyllium
polycarbophil
attapulgite (kaopectate, rarely used)
kaolin-pecin mixture

44
Q

polycarbophil pros

A

can absorb 60times its weight

45
Q

antisecretory

A

act by reducing secretion in the gut
example - BSS (pepto-bismol)

46
Q

BSS cons and SE

A

cons - avoid in patients who should not take salicylates
SE - may potentiate anticoagulants, can cause stools and tongue to turn black

Therapeutics - Exam 6 (11 decks)

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