Diarrhea Flashcards
Is diarrhea a common drug related side effect?
Yes, about 7% of side effects reported by patients on new drugs is diarrhea
It is higher in antibiotics (20%)
When does drug-related diarrhea occur after starting a new medication?
2-3 days
What antibiotics are known to cause C. difficile-associated diarrhea?
clindamycin, ampicillin, and cephalosporins
What are some symptoms of C. diff associated diarrhea?
Watery diarrhea 10-15 times a day
Swollen abdomen
Nausea
Loss of appetite
Pus or blood in the stool
Fever
Weight loss
Kidney failure
What is some symptomatic treatment for diarrhea in drug-related diarrhea?
Consists of changes to diet and oral rehydration therapy
Do pharmacists deal with severe diarrhea?
No, this patient needs to see an MD and take care of massive water loss
In antibiotic-associated diarrhea, what drug decisions are made?
- d/c the causative drug
- Change its dose (very unlikely)
- Keep things the same (add loperamide to counteract s/e is not usually done but it is an option)
Can imodium (loperamide) be used to treat drug-related diarrhea?
Yes, but it is not used commonlly
Can Pepto-Bismol be used to treat drug-related diarrhea?
Not very effective, other agents are better for GI related conditions
Are probiotics useful in antibiotic-associated diarrhea?
Can be given, but efficacy is low for prevention
Can children use imodium (loperamide)?
No dose for kids under 12
What are some foods that are more likely to cause diarrhea?
It is culturally specific
It is due to irritants ir natural laxatives, not bacteria
Can allergies cause diarrhea?
Yes, allergy related diarrhea can occur. It can also be accompanied by a rash
What causes food poisoning?
It is an illness caused by eating food contaminated with bacteria, viruses, parasites, and the toxins they produce can all cause food poisoning
Can the symptoms of food poisoning have onset after multiple days following contact?
Yes, when the symptoms emerge weeks after eating contaminated food, it can be hard for HCPs to determine the link between diarrhea and food poisoning
What is Kaopectate?
It is clay-like and it is meant to adsorp toxins from the gut.
Low efficacy
What is a pharmacists mentality towards recomending imodium (loperamide)?
Children:
Initial mindset is to not reccomend loperamide to kids (not recomended under 12, and CI in kids under 2)
Adults:
Not worrying too much about downsides. Highest confidence in no adverse effects
Older adult:
A little weary
What is the common cause of diarrhea in children?
Viral gastroenteritis (VGE)
Most common in infants 3-24 months
Up to 50% caused by rotaviruses
What is the biggest concern for diarhhea in kids?
Dehydration, especially if diarrhea is coupled with vomiting
How can dehydration be quanitifed?
Mild: up to 5% of body weight loss (pharmacists can help here)
Moderate: 6-9% weight loss (MD care)
Severe: Over 10% of body weight loss (MD care)
Are pharmacists responsible for assessing hydration status?
No, more for nursing and MD
What does the skin turgour test assess?
Hydration status (the longer the skin takes to return to normal, greater dehydration)
What is a unique marker for dehydration in infants (up to 18 mo)?
The fontanelle is the “soft bone” in an infant’s skull.
If infant is dehydrated, the fontanelle will be depressed
When should pharmacists refer diarrhea in children?
If under 6 months: Refer
1/2 to 1 year: 1 day
1-3: 2 days
Over 3 years: 3 days
Be quicker to refer if the following apply:
Fever
Presence of blood
Vomiting for more than 8 h
