T2-Diarrhea

Question 1

What are two types of GI receptors?

Answer 1

1. Cholinergic (parasympathetic innervates the GI tract. When these neurons fire, they increase motility [push food], these neurons release Ach)
2. Opioid (mu) receptors (when these neurons fire, they slow down GI motility–why when you take a lot of morphine [opioid] you get constipated)

Question 2

So cholinergic increase motility and pushes food out. What happens when we give an anti-cholinergic?

Answer 2

We can slow down bowel motility and halt diarrhea

Question 3

What is it called when you add something to the body?

Answer 3

Exogenous

Question 4

Exogenous opioids slow down [decrease] the GI motility, which is what we would want in patients with _____.

Answer 4

Diarrhea

Question 5

What are the three drugs that slow down motility?

Answer 5

Dicyclomine
Loperamide
Diphenoxylate/atropine

Question 6

Which diarrhea drug isn’t given for your typical diarrhea. What is it given for instead?

Answer 6

Dicyclomine; it is given for a disorder that can CAUSE diarrhea

Question 7

What disease is dicyclomine given for?

Answer 7

Irritable Bowel Syndrome (IBS)

Question 8

How many Americans are affected by IBS?

Answer 8

20%

Question 9

More than ___ visits to a GI doctor are about IBS.

Answer 9

1/4

Question 10

What is IBS?

Answer 10

Involves having pain that is relieved by defecation

Question 11

Is dicyclomine an anticholinergic or an exogenous opioid?

Answer 11

Anti-cholinergic

Question 12

Does dicyclomine slow down bowel motility?

Answer 12

Yes

Question 13

What is Loperamide given for?

Answer 13

Diarrhea

Question 14

What receptor does Loperamide work on?

Answer 14

Mu

Question 15

Loperamide and meperidine (another opioid) are very structurally similar to one another. What is the key difference between them?

Answer 15

Loperamide will not cross the BBB

Question 16

Loperamide is an opioid. Do we see pain relief, euphoria, or addiction with this drug?

Answer 16

NO! It doesn’t cross the BBB so, you don’t have those effects even though it is an opioid

Question 17

What is the combination drug used for diarrhea?

Answer 17

Diphenoxylate/atropine

Question 18

What is diphenoxylate (an anti-cholinergic or an opioid)?

Answer 18

An opioid

Question 19

Can diphenoxylate dissolve in water?

Answer 19

No

Question 20

What happens if you take too high a dose of diphenoxylate?

Answer 20

You can get a “buzz”

Question 21

What drug did they add to dipphenoxylate so you can’t get a buzz with the opioid if you take too high a dose?

Answer 21

Atropine

Question 22

What kind of drug is atropine?

Answer 22

Anti-cholinergic

Question 23

What situations is atropine used in a lot?

Answer 23

Code situations

Question 24

At a low dose, atropine _____.

Answer 24

Doesn’t do much

Question 25

At a high dose, atropine ______

Answer 25

Has anticholinergic side effects

Question 26

Can you get diphenoxylate/atropine OTC?

Answer 26

No; prescription only

Question 27

What CSA schedule is diphenoxylate/atropine?

Answer 27

5

Question 28

What are the adverse effects to dicyclomine?

Answer 28

Dry eyes/blurry vision (can't see) Urinary retention (can't pee) Dry mouth (can't spit) Fatigue

Question 29

Dicyclomine is on ____.

Answer 29

Beer's criteria list (avoid in geriatrics unless for acute comfort care)

Question 30

What are the adverse effects of loperamide?

Answer 30

Nothing stands out, Very well tolerated

Question 31

What are the adverse effects of diphenoxylate/atropins?

Answer 31

Nothing stands out, very well tolerated (unless you abuse them, then the anti-cholinergic effects)

Question 32

What is the important purpose of diarrhea?

Answer 32

It helps expel infectious agents or irritants from the body

Question 33

In the hospital, do we give a lot of anti-diarrhea?

Answer 33

No--instead go after the cause!! If there is an infection, we fight the infection

Question 34

What is another reason for diarrhea?

Answer 34

Food intolerance (lactose intolerance)

Question 35

T/F: Drugs that trigger opioid receptors in the gut don't necessarily treat the underlying cause.

Answer 35

True

Question 36

If someone has an acute infection diarrhea, what drugs do we NOT want to give and why?

Answer 36

Drugs that trigger opioid receptors because they don't treat the underlying cause