Things to remember about drugs OTC

Question 1

Loperamide MOA

Answer 1

Synthetic opioid agonist; stimulates micro-opioid receptors located on the intestinal circular muscles to slow intestinal motility and allow absorption of electrolytes and water; anti-secretory effects

Question 2

Loperamide dosage form and dosing

Answer 2

Liquid: 1mg/7.5ml (use OTC labeling for dosing, NOT your text)

Caplets: 2 mg

Adults and children 12 years and over–2 caplets after the first loose stool; 1 caplet after each subsequent loose stool; NMT 4 caplets/24 hours

Children 9-11 years (60-95lbs)–1 caplet after the first loose stool; ½ caplet after each subsequent loose stool; NMT 3 caplets/24 hours

Children 6-8 years (48-59lbs)–1 caplet after the first loose stool; ½ caplet after each subsequent loose stool; NMT 2 caplets/24 hours

Question 3

Loperamide things to remember

Answer 3

Relief of acute, nonspecific diarrhea
–
Traveler’s diarrhea indication (in combo with antibiotics)
–
Do not use with high fever, blood/mucous in stools, or if fecal leukocytes are present –refer
–
Text: < 6 yrs–not recommended

Minimal risk of ADR

Question 4

Loperamide brand name

Answer 4

Immodium

Question 5

Bismuth Subsalicylate

Answer 5

Management of acute diarrhea & traveler’s diarrhea
–
Avoid in children (<12 years)
■
Avoid in children/teensrecovering from chicken pox/flu -Reye’s syndrome
■
Children’s Peptodoes not contain salicylates (only calcium carbonate –not an effective treatment for diarrhea)

Question 6

Bismuth Subsalicylate dosing and dosage form

Answer 6

Dosing
–Age >12: 525 mg Q 30 to 60 minutes; MAX 4200 mg/day (8 doses/day)

Dosage Forms:
–262mg (caplets & tablets)
–262mg/15ml liquid & 525mg/15ml liquid

Question 7

Bismuth Subsalicylate MOA

Answer 7

Exerts direct antimicrobial effect

Exerts anti-secretory effects through salicylate to decrease inflammation and reduce fluid and electrolyte loss

Question 8

Pedialyte for MildDehydration (<3%)

Answer 8

Continue regular diet

Consider adding dextrose-electrolyte solution OR increase intake of usual dietary fluids to replace ongoing stool losses

> 6 months –5 years: 10ml/kg for each loose stool
5 years: ~ 1 to 2 cups per loose stool (ballpark)

Question 9

Pedialyte for Mild-to-Moderate Dehydration (3-9%)

Answer 9

Rehydration:

> 6 months –5 years: 50-100 mL/kg over 3-4 hours
5 years: 2-4 L over 3 hours

Maintenance:
> 6 months –5 years: 10 mL/kg for each loose stool
> 5 years: Replace ongoing losses