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Diarrhea Flashcards

1
Q

What % of adverse drug effects does diarrhea account for?

A

7%

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2
Q

Roughly how many drugs are implicated in drug-induced diarrhea?

A

~700

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3
Q

Which antibiotics are the main culprits of drug-induced diarrhea?

A

fluoroquinolones
penicillins
cephalosporins

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4
Q

How long after starting an antibiotic does the diarrhea tend to appear?

A

2-3 days after starting
resolves once its dc

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5
Q

How is C.difficile-associated diarrhea characterized?

A

received antibiotic within past 3 months
significant loss of fluid, fever, and abdominal pain

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6
Q

What are the three options we have when a patient is experiencing drug-induced diarrhea?

A

withdrawal
continuing (especially antibiotics)
adjustment of dosage

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7
Q

What is the basis of treating drug-induced diarrhea?

A

diet and oral rehydration therapy
+/- anti-diarrheal agent (loperamide) if mild cases
-loperamide should be avoided in patients with severe diarrhea

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8
Q

What are some symptoms that could be suggestive of C.diff diarrhea?

A

watery diarrhea for 10-15 days
pus or blood in the stool
fever
weight loss
dehydration
loss of appetite

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9
Q

What is a pharmacological option we have to treat drug-induced diarrhea?

A

loperamide

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10
Q

True or false: Pepto-Bismol has an indication for drug-induced diarrhea

A

false

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11
Q

What is the verdict on using probiotics when put on an antibiotic to try counteract diarrhea?

A

its complete guess work
we dont know which flora are being lost so how do we know which to replace?
could be worth a try but looks iffy
well tolerated, minor adverse effects (dyspepsia, nausea, etc)
remember probiotics are only a move if the diarrhea is from ANTIBIOTICS, not agents like SSRIs or NSAIDs

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12
Q

Is loperamide or probiotics an option for drug-induced diarrhea in kids?

A

loperamide: off label and use and will be more of a concern
probiotics: an option only if antibiotic-induced

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13
Q

What can be used for diarrhea from disagreeable foods?

A

loperamide or Pepto

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14
Q

True or false: the incidence of true food allergies is very high

A

false
true incidence is less than perceived causes

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15
Q

True or false: food allergy incidence decreases with age

A

true

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16
Q

What are the symptoms of a food allergy?

A

can be a rash, GI symptoms, all the way to anaphylaxis

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17
Q

How severe are most cases of food poisoning?

A

most often, food poisoning is mild and resolves without treatment

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18
Q

What are the symptoms of food poisoning?

A

nausea
vomiting
watery or bloody diarrhea
abdominal pain and cramps
fever

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19
Q

How fast do the symptoms of food poisoning appear after eating contaminated food?

A

may start within hours or they may begin days or even weeks later

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20
Q

How long does sickness caused by food poisoning last?

A

few hours to several days

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21
Q

What are the agents we can use for diarrhea from food poisoning?

A

loperamide
Pepto: maybe? (think more so TD)

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22
Q

When would probiotics be used for food poisoning?

A

after the fact

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23
Q

What is the concern that people have with using loperamide for diarrhea from food poisoning?

A

slowing the gut and holding the pathogens in longer

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24
Q

What is the main ingredient in Pepto-Bismol?

A

bismuth subsalicylate
-works by protecting your stomach and is a mild antacid

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25
Which agents would be better than Pepto for discomfort from large meals or spicy foods?
H2 receptor antagonists -famotidine, ranitidine *they work slower than Pepto*
26
Describe kaopectate.
almost gone from the market API is supposed to have adsorbing potential likelihood of value is low disagreeable foods-might be soothing to gut, could help
27
Are probiotics good for food poisoning?
food poisoning is bacterial, so it could help -the situation will be strain-specific not commonly used for this *NO help for food intolerance*
28
What is the most common cause of diarrhea in pediatrics?
viral gastroenteritis
29
Which group of kids most commonly experiences VGE?
3-24 months old -daycare-itis -often in winter months
30
How is VGE transmitted?
fecal-oral route
31
Which pathogen causes VGE?
up to 50% via rotavirus norovirus too
32
What are the symptoms of VGE?
vomiting watery diarrhea low grade fever *WATCH FOR DEHYDRATION*
33
How long does VGE last?
1-3 days is typical, but need ~1 week for gut to normalize
34
How is the Rotavirus vaccine administered?
given by mouth (liquid drops)
35
When should babies get their Rotavirus vaccine?
first dose: 2 months old second dose: 4 months old
36
Describe mild diarrhea in pediatrics.
up to 5% body weight loss increased thirst slightly dry mucous membranes active, alert pinched skin springs back *mild is the only severity we can deal with*
37
Describe moderate diarrhea in pediatrics.
6-9% body weight loss irritable, alert, thirsty dry mucous membranes pinched skin tents briefly reduced urine outflow *MD CARE*
38
Describe severe diarrhea in pediatrics.
>10% body weight loss lethargic, looks sick parched mucous membranes sunken eyes pinched skin shows prolonged tenting continuation of moderate symptoms and: -no urine output -cold extremities -CNS symptoms *MEDICAL EMERGENCY*
39
What are some signs that a person is dehydrated?
sunken eyes pinched skin has prolonged tenting urine flow is reduced weight loss lethargic fast pulse dry mucous membranes
40
What is the urine colour of someone who is extremely dehydrated?
brown *urine becomes darker as we become more dehydrated*
41
What is an obscure sign of dehydration in babies younger than 18 months?
depressed fontanelle
42
When do we refer for pediatrics and diarrhea?
for any situation beyond mild dehydration <6 months
43
For mild situations, when would we refer the following age groups? 1/2-1 year 1-3 years >3 years
1/2-1 year: 1 days duration 1-3 years: 2 days duration >3 years: 3 days duration *quicker with other symptoms: fever, presence of blood, vomiting >8h*
44
What is the focus on with treating VGE at home?
rehydration
45
What do we do for VGE if its mild diarrhea and no signs of dehydration?
commercial rehydration solution is not required go with regular feedings (breastfeeding or usual diet for older kids)
46
What do we do for VGE if dehydration is more of a concern?
Gastrolyte (powder_ Pedialyte (solution and freezer pops) water is fine
47
What do we do for VGE with concurrent mild vomiting?
administer small amounts of fluid frequently anti-emetics not recommended
48
True or false: Gravol is indicated for VGE
false
49
Is there any issue with the following for mild dehydration? water apple juice Pedialyte Gatorade
no they are all fine
50
What was the old thinking regarding re-introducing foods with VGE in the past?
rest the gut (no food during 1st 24 hours) if an infant is formula fed: -stop x 24 hours -then go lactose-free formula x few weeks (allow lactase to re- generate)
51
What is the new thinking regarding re-introducing foods with VGE?
early feeding with age-appropriate diet actually helps the gut recover if an infant is breastfeeding, continue to do so if formula: -gradual re-introduction of milk-based formula not required -switching to lactose-free formula not required
52
What is the BRAT diet?
bananas, rice, applesauce, and toast was once recommended to treat diarrhea but its really not needed
53
True or false: anti-diarrheal agents are recommended for VGE
false kaopectate: totally safe but ineffective loperamide: safe but CI under 2, effective Pepto: safety is probably fine, likely not effective
54
What can be used for VGE in adults?
fluids and loperamide
55
Which organism most commonly causes travelers diarrhea?
ETEC
56
What do most people who get TD experience?
diarrhea within 3-7 days arrival average of 4-5 BMs per day low grade fever
57
True or false: TD is usually self-limiting
true can last up to 7 days
58
What is Montezuma's Revenge?
~3% have >10 BM per day ~15% also vomit ~10% last >1 week
59
When are the chances of getting TD the highest during your vacation?
during 1st week backpackers>resorts PPI/H2 blocker users have increased risk by 12-fold
60
What are the preventive methods for TD?
get an Rx antibiotic before going (start at destination for 3wks max) Pepto: 2 x 262mg QID for 3 weeks max -label dosing down to 3y but that is for acute diarrhea, not prevention dose -less effective than antibiotics -unknown MOA
61
Why is antibiotic prophylaxis for TD not ideal?
concern for resistance and that treatment is effective and pretty fast if TD does occur
62
What is the dosing of Pepto for TD prevention in the following groups? >14yr 10-14yr 5-9yr 2-4yr <2yr
>14yr: 524mg QID 10-14yr: 262mg QID 5-9yr: 131mg QID 2-4yr: 88mg QID <2yr: consult physician *start 1 day before travel and continue until 2 days after leaving destination*
63
True or false: loperamide is a good option for prevention of TD
false
64
What is the Dukoral vaccine used for?
helps prevent cholera not recommended for routine use in all travellers
65
What are the treatment options for TD?
1-3 days of Rx antibiotic + loperamide -antibiotic used if it reaches moderate severity or loperamide alone or Pepto alone (now active treatment dosing) -2 x 262mg tabs q1/2hr up to 8 doses
66
What are the different severities of TD?
mild: tolerable, not distressing, not interfering with activities moderate: distressing, interferes with activities severe: incapacitating, prevents activities, bloody stools -no loperamide for severe persistent: lasting >2 weeks
67
What is an antibiotic that has been shown to be effective in the treatment of travelers diarrhea?
rifaximin -poorly absorbed (favourable safety profile) -resistance is unlikely
68
Which group of patients are more at risk for TD?
kids -higher gastric pH -less lifelong exposure to pathogens -similar etiology as adults
69
What is the treatment of TD in kids?
focus on fluids antibiotics not a priority unless moderate severity
70
What are the legal ages of use for loperamide?
2-12: MD advice only <2: contraindicated *probably safe*
71
What is the dosing of loperamide for anyone older than 12?
4mg stat then 2mg after each loose BM 16mg max per day
72
What is the verdict on the use of probiotics for TD?
have low expectations
73
What do we do if someone was taking an antibiotic for 3 weeks as TD prevention, but it didnt work?
switch to Pepto (q1/2hr dosing) or loperamide *clinical tip: the diarrhea could be from the antibiotic*
74
What do we do if someone was taking the prevention dosing of Pepto for TD, but it didnt work?
switch to antibiotic (1-3) days +/- loperamide
75
What age does the Pepto dosing go down to?
3yrs
76
True or false: TD from a cruise ship is likely bacterial
false likely viral so no antibiotics
77
What is the treatment of TD from a cruise ship?
fluids adults: loperamide or BSS kids: loperamide (caution) or BSS *if viral, we should question the value of BSS=loperamide makes the most sense in this situation**
78
List off all the different presentations of diarrhea that loperamide has an indication for.
acute non-specific diarrhea acute-drug induced diarrhea (but not commonly done) IBS (helpful for IBS-D) TD (treatment not prophylaxis) VGE (adults, not kids under 2) food poisoning (not if bloody) IBD (if mild and on other meds) food intolerance
79
What is the new concern with loperamide in adults?
poor-mans oxycontin self-treatment of opiate withdrawal symptoms 50-300mg/day-->ventricular arrhythmias
80
Which bacteria are in yogurt?
lactobacillus bulgaricus streptococcus thermophilus they have to add lactobacillus acidophilus
81
What are the many indications that the manufacturers put on the label of Pepto?
indigestion upset stomach nausea heartburn diarrhea *same dosing for each of the above*
82
What is the risk of Reyes syndrome with Pepto?
extremely unlikely

PHAR154 (18 decks)

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