Antipropulsives / Antidiarrhoeals - Loperamide

Question 1

There are 4 basic layers of the GIT. Organise them with the closest layer to the lumen 1st:

1 - mucosa
2 - serosa
3 - muscularis externa also known as muscularis propria
4 - submucoas

Answer 1

1 - mucosa
4 - submucoas
3 - muscularis externa also known as muscularis propria
2 - serosa

Question 2

In the 3rd layer of the GIT is the muscularis externa, contains smooth muscle. There are 2 layers of smooth muscle, an inner circular layer and an outer longitudinal layer. Together these perform peristalsis. Which of these layers is responsible for stopping food move backwards, and which is responsible for moving food forward?

Answer 2

• stopping food moving backwards = INNER CIRCULAR LAYER
• moving food forward = OUTER LONGITUDINAL LAYER

Question 3

The 3rd layer of the GIT is the muscularis externa, containing an inner circular and an outer longitudinal layer os smooth muscle. This is separated by what?

1 - submucosal nerve plexus
2 - lamina propria
3 - myenteric nerve plexus
4 - muscularis mucosa

Answer 3

3 - myenteric nerve plexus

Question 4

Which of the following is NOT contained within the dense submucosal layer?

1 - arteries
2 - veins
3 - submucosal nerve plexus
4 - lamina propria

Answer 4

4 - lamina propria

Question 5

Which 2 of the following are the functions of the submucosa plexus contained within the submucosal layer of the GIT?

1 - peristalsis of the GIT
2 - control of blood vessels
3 - secretion of mucus
4 - GIT secretions

Answer 5

2 - control of blood vessels
4 - GIT secretions

Question 6

The mucosa contains 3 separate layers. Which of the following is NOT a layer of the mucosa?

1 - muscularis mucosa
2 - submucosal nerve plexus
3 - lamina propria
4 - epithelial layers

Answer 6

2 - submucosal nerve plexus

• muscularis mucosa = break up food
• lamina propria = blood and lymph vessels
• epithelial layers = absorbs and secretes mucus and GIT secretions

Question 7

According to NICE, diarrhoea is the abnormal passage of loose or liquid stools. Which 2 of the following are needed in a patient to be diagnosed with acute diarrhoea?

1 - >3 times/day daily and/or a volume of stool >200g/day
2 - >10 times/day and/or stool volume >500g/day
3 - <14 days in duration
4 - >14 days in duration

Answer 7

1 - >3 times/day daily and/or a volume of stool >200g/day

3 - <14 days in duration

• chronic diarrhoea is >4 weeks

Question 8

Which of the following are included in the definition of constipation?

1 - <3 bowel movements/wk
2 - excessive straining
3 - abdominal pain or bloating
4 - all of the above

Answer 8

4 - all of the above

Question 9

Which of the following are included in the definition of chronic constipation?

1 - <3 bowel movements/wk
2 - excessive straining
3 - abdominal pain or bloating
4 - symptoms present in 12 weeks of the last 6 months
5 - all of the above

Answer 9

5 - all of the above

Question 9

Which of the following are included in the definition of chronic constipation?

1 - <3 bowel movements/wk
2 - excessive straining
3 - abdominal pain or bloating
4 - symptoms present in 12 weeks of the last 6 months
5 - all of the above

Answer 9

5 - all of the above

Question 10

Which of the following is the core anti-diarrhoea that we need to be aware of?

1 - Loperamide
2 - Senna
3 - Ispaghula husk
4 - Macrogol

Answer 10

1 - Loperamide

Question 11

Which drug class does Loperamide belong to?

1 - ACE-I
2 - opioids
3 - benzodiazepines
4 - NSAIDs

Answer 11

2 - opioids

Question 12

Which of the following is Loperamide indicated to be used in?

1 - acute diarrhoea
2 - chronic diarrhoea
3 - faecal incontinence
4 - pain in palliative pair
5 - all of the above

Answer 12

5 - all of the above

Question 13

Loperamide is a class of opioid. What is the mechanism of action of loperamide?

1 - inhibit mu receptors
2 - stimulate mu receptors
3 - inhibit kappa receptors
4 - stimulate kappa receptors

Answer 13

2 - stimulate mu receptors

• these are located in the enteric nervous system, most likely the myenteric nerve plexus

Question 14

Loperamide is a class of opioid. Does this medication have a high risk of dependence?

Answer 14

• no
• low penetration in CNS

Question 15

Which of the following are loperamide contra-indicated in the use of?

1 - active ulcerative colitis (can cause mega toxic colon)
2 - antibiotic-associated colitis
3 - bacterial enterocolitis
4 - abdominal distension
5 - children <5 y/o
6 - all of the above

Answer 15

5 - all of the above

Question 16

Which of the following are adverse events caused by loperamide?

1 - constipation
2 - abdominal pain/cramps
3 - headaches/dizziness
4 - nausea
5 - all of the above

Answer 16

5 - all of the above