On the Run! Diarrhea / Constipation Flashcards
Antidiarrheal agents may be used safely in patients with mild to moderate acute diarrhea.
True or false.
True
Some antidiarrheal agents can be used to control chronic diarrhea caused by such conditions as ________ or ________.
IBS or IBD.
When should you not use antidiarrheals?
When should they be discontinued if you are using them?
They should not be used in patients with bloody diarrhea, high fever or systemic toxicity.
They should be d/c in patients whose diarrhea is worsening despite therapy.
What 4 classes of antidiarrheals does Sue introduce
Opioid agonists
Colloidal bismuth compounds
Bile salt-binding resins
Octreotide
How do opioid and opioid agonists act on the body in terms of constipating effects?
Opioids inhibit presynaptic cholinergic nerves in the submucosal and myenteric plexuses.
Increases fecal transport time and fecal water absorptions.
Decrease colonic movements and the gastrocolic reflex.
Give 3 examples of opioid agonists that are useful to treat for diarrhea.
Loperamide (Immodium)
Diphenoxylate (Lomotil)
(on slide, not in text)
Can opioid agonists have CNS effects?
Sue’s slides: Yes, potential for addiction. Not widely used for diarrhea.
- I feel like loperamide is very widely used for diarrhea…
Text: (Lehne’s) At the doses used for diarrhea, subjective effects and dependence do not occur. However, excessive doses CAN elicit morphine-like subjective effects.
If you think someone has taken too much opioid agonist and you are seeing CNS depression, what could you administer?
Naloxone.
What medication can cause blackened stools? Is this a concern?
Bismuth. Can also cause black tongue.
No.
This medication undergoes rapid dissociation in the stomach allowing absorption of the salicylate. 99% appears in the stool and can be stored in many tissues. May affect other processes and medications.
Bismuth.
Prolonged use of some bismuth compounds may rarely lead to bismuth toxicity resulting in ______?
Encepholopathy.
Traveller’s diarrhea is often caused by which organism?
E. coli
This condition is usually self-limiting and will run it’s course but severe symptoms may be managed with a fluoroquinolone antibiotic.
Traveller’s diarrhea.
Which class of medications may decrease diarrhea caused by disease of the terminal ileum or surgical bowel resection -> malabsorption of bile salts?
Bile salt-binding resins.
-binds with excess bile salt, reducing diarrheal effects
Name 3 bile salt-binding meds.
Cholestryamine
Colestipol
Colesevelam
How does octreotide help to treat diarrhea?
Reduces intestinal fluid secretion
Slows GI motility
Inhibits gallbladder contraction
What are 3 opioid agonists that are useful for diarrhea?
Loperamide
Diphenoxylate
Eluxadoline
Which medication does Sue say is a great option for people with chronic diarrhea due to IBS and IBD?
Ocreotide
Meds used to treat constipation can be categorized as _______ or ________.
Drugs that stimulate GI motility
Laxatives
Drugs that selectively stimulate GI motility are called prokinetic agents. How do they help treat constipation?
Enhance colonic transit
If cholinomimetic drugs (mimicking cholinergic) are used to treat constipation, what are some other effects that can be experienced?
Excessive salivation, n/v/d, bradycardia.
Sue doesn’t recommend using in primary care.
What are the actions and of dopamine and metoclopramide? When do these uses come in handy?
They block activation of dopamine receptors in the GI tract (which inhibits cholinergic smooth muscle stimulation). Handy for constipation.
Increase esophageal peristaltic amplitude, increase lower esophageal sphincter pressure and enhanced gastric emptying. Handy for GERD, impaired gastric emptying, non-ulcer dyspepsia.
Block dopamine D2 receptor in the chemoreceptor trigger zone of the medulla. Handy in n/v.
Domperidone can promote lactation stimulation.
Metoclopramide and domperidone are effective agents to promote small intestine and colon motility.
T/F?
False. No effect.
According to Sue, which meds are safe choices with least side effects to use in people with IBS-C chronic constipation?
Metoclopramide and domperidone.
Which class of abx stimulate motilin receptors on GI smooth muscle, to help constipation?
Macrolides.
Changes in ion secretion, lumen osmolality intestinal motility, or tissue hydrostatic pressure can cause:
Diarrhea or constipation.
Bismuth subsalicylate is safe for all ages. T/F?
False. It it not recommended for children less than 12.
______________ produces its effect through antisecretory, antibacterialm and anti-inflammatory mechanisms.
Bismuth subsalicylate.
Which probiotic is recommended to treat antibiotic-associated diarrhea?
Lactobacillus acidophilus.
