On the Run! Diarrhea / Constipation

Question 1

Antidiarrheal agents may be used safely in patients with mild to moderate acute diarrhea.

True or false.

Answer 1

True

Question 2

Some antidiarrheal agents can be used to control chronic diarrhea caused by such conditions as ________ or ________.

Answer 2

IBS or IBD.

Question 3

When should you not use antidiarrheals?

When should they be discontinued if you are using them?

Answer 3

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.

Question 4

What 4 classes of antidiarrheals does Sue introduce

Answer 4

Opioid agonists

Colloidal bismuth compounds

Bile salt-binding resins

Octreotide

Question 5

How do opioid and opioid agonists act on the body in terms of constipating effects?

Answer 5

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.

Question 6

Give 3 examples of opioid agonists that are useful to treat for diarrhea.

Answer 6

Loperamide (Immodium)

Diphenoxylate (Lomotil)

(on slide, not in text)

Question 7

Can opioid agonists have CNS effects?

Answer 7

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.

Question 8

If you think someone has taken too much opioid agonist and you are seeing CNS depression, what could you administer?

Answer 8

Naloxone.

Question 9

What medication can cause blackened stools? Is this a concern?

Answer 9

Bismuth. Can also cause black tongue.

No.

Question 10

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.

Answer 10

Bismuth.

Question 11

Prolonged use of some bismuth compounds may rarely lead to bismuth toxicity resulting in ______?

Answer 11

Encepholopathy.

Question 12

Traveller’s diarrhea is often caused by which organism?

Answer 12

E. coli

Question 13

This condition is usually self-limiting and will run it’s course but severe symptoms may be managed with a fluoroquinolone antibiotic.

Answer 13

Traveller’s diarrhea.

Question 14

Which class of medications may decrease diarrhea caused by disease of the terminal ileum or surgical bowel resection -> malabsorption of bile salts?

Answer 14

Bile salt-binding resins.

-binds with excess bile salt, reducing diarrheal effects

Question 15

Name 3 bile salt-binding meds.

Answer 15

Cholestryamine
Colestipol
Colesevelam

Question 16

How does octreotide help to treat diarrhea?

Answer 16

Reduces intestinal fluid secretion
Slows GI motility
Inhibits gallbladder contraction

Question 17

What are 3 opioid agonists that are useful for diarrhea?

Answer 17

Loperamide
Diphenoxylate
Eluxadoline

Question 18

Which medication does Sue say is a great option for people with chronic diarrhea due to IBS and IBD?

Answer 18

Ocreotide

Question 19

Meds used to treat constipation can be categorized as _______ or ________.

Answer 19

Drugs that stimulate GI motility

Laxatives

Question 20

Drugs that selectively stimulate GI motility are called prokinetic agents. How do they help treat constipation?

Answer 20

Enhance colonic transit

Question 21

If cholinomimetic drugs (mimicking cholinergic) are used to treat constipation, what are some other effects that can be experienced?

Answer 21

Excessive salivation, n/v/d, bradycardia.

Sue doesn’t recommend using in primary care.

Question 22

What are the actions and of dopamine and metoclopramide? When do these uses come in handy?

Answer 22

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.

Question 23

Metoclopramide and domperidone are effective agents to promote small intestine and colon motility.

T/F?

Answer 23

False. No effect.

Question 24

According to Sue, which meds are safe choices with least side effects to use in people with IBS-C chronic constipation?

Answer 24

Metoclopramide and domperidone.

Question 25

Which class of abx stimulate motilin receptors on GI smooth muscle, to help constipation?

Answer 25

Macrolides.

Question 26

Changes in ion secretion, lumen osmolality intestinal motility, or tissue hydrostatic pressure can cause:

Answer 26

Diarrhea or constipation.

Question 27

Bismuth subsalicylate is safe for all ages. T/F?

Answer 27

False. It it not recommended for children less than 12.

Question 28

______________ produces its effect through antisecretory, antibacterialm and anti-inflammatory mechanisms.

Answer 28

Bismuth subsalicylate.

Question 29

Which probiotic is recommended to treat antibiotic-associated diarrhea?

Answer 29

Lactobacillus acidophilus.