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PHARM 345 - Other > Diarrhea > Flashcards

Diarrhea Flashcards

(55 cards)

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1
Q

Acute Diarrhea
- Definition

A

Less than 14 days duration

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2
Q

Persistient Diarrhea
- Definition

A

More than 14 days duration

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3
Q

Chronic Diarrhea
- Definition

A

More than 30 days duration or repeated episodes

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4
Q

Diarrhea
- Definition

A

Loose, watery stools 3 or more times a day

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5
Q

Diarrhea
- Complications

A
  • Dehydration
  • Fluid and Electrolyte Disturbances
  • Hemorrhoids
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6
Q

Diarrhea
- Severe Complications

A
  • Fever
  • Abdominal Pain
  • Flatulence
  • Weight Loss
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7
Q

Diarrhea
- Groups at risk of dehydration

A

Infants, Young Children, Elderly

Patients with chronic conditions
- Renal failure
- Cardiovascular disease

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8
Q

Diarrhea
- Types

A
  • Osmotic
  • Secretory
  • Exudative/Inflammatory
  • Increased Gut Motility
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9
Q

Osmotic Diarrhea
- Cause

A

Poorly absorbed substances draw water into bowels
- Sorbitol, Mannitol
- Lactose Intolerance
- Medications (Magnesium)
- Malabsorption Syndrome
- Celiac Disease

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10
Q

Secretory Diarrhea
- Cause

A

Increase or decrease in absorption of water/electrolytes
- Bacterial infections (Toxins)
- Excessive bile salts
- Hormone producing tumours
- Medications (Chemotherapy)

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11
Q

Exudative/Inflammatory Diarrhea
- Cause

A

Inflammation
- Inflammatory Bowel Disease
- Other types of Colitis
- Infections

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12
Q

Dysmotility Diarrhea

A

Increased Gut Motility
- Irritable Bowel Syndrome
- Hyperparathyroidism
- Medications (Metoclopramide)

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13
Q

Diarrhea
- CDI

A

Clostridium Difficile Infection
- Associated with antibiotics (Fluoroquinolones, Cephalosporins, Clindamycin, Carbapenems)

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14
Q

Diarrhea
- Travelers Diarrhea (Onset and Symptoms)

A

Occurs after traveling from developing counties with poor hygiene standards
- Onset of 1-2days of ingesting contaminated food
- Onset of up to 7 days after returning

Symptoms: Abdominal cramping, fever, vomiting

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15
Q

Diarrhea
- Red flag questions

A
  • Fever?
  • Blood or Mucus in stools?
  • Severe pain?
  • Severe diarrhea (More than 6 loose stools for longer than 48 hours)
  • Diarrhea lasting longer than 7 days
  • Debilitating dehydration
  • Clostridium Difficile Infection
  • Overflow diarrhea from fecal impaction
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16
Q

Diarrhea
- At risk patients

A
  • Children younger than 2
  • Elderly
  • Pregnant
  • Multiple Chronic Conditions (CV,CKD, DM)
  • Immunocompromised (HIV, Cancer)
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17
Q

Drugs Associated with Diarrhea

A

Magnesium Antacids
Antibiotics
NSAIDS
SSRI Antidepressants
Sulfasalazine

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18
Q

Diarrhea
- Nonpharm

A

Oral Rehydration Therapy (Gastrolyte, Pedialyte, Hydralyte)
- Maintain electrolyte balance
- Clear fluids for 24 hours
- Avoid juice and carbonated drinks

Discontinue medications/foods causing diarrhea

Diet
- Stop ingesting poorly absorbed carbohydrates (Sorbitol, Mannitol)

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19
Q

Diarrhea
- Nonpharm (Diet)

A

Avoid BRAT diet
- Bananas, RIce, Applesauce, Toast

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20
Q

Diarrhea
- Pharm

A

First Line: Loperamide (OTC)

Second Line: Diphenoxylate + Atropine (Rx)

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21
Q

Loperamide
- Role and Mechanism

A

Used in Moderate-Severe Diarrhea

Binds to opiate receptor in gut wall
- Inhibits Acetylcholine and Prostaglandins

Peripheral Action:
- Reduced peristalsis –> Increased intestinal transit time
- Increased tone of anal sphincter –> Reduced incontinence and urgency

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22
Q

Loperamide
- Dose and Duration

A

4mg, then 2mg after each bowel movement (max 16mg/day)

Not to be used more than 2 days (Can be used longer in patients with Chronic Diarrhea)

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23
Q

Loperamide
- Considerations

Study These Flashcards
A
  • Do not use in children younger than 2 years old
  • Can be used in pregnancy and breastfeeding
  • Avoid in Clostridium Difficile Infections, Malnourished, Severely dehydrated
24
Q

Loperamide
- Contraindications

Study These Flashcards
A
  • Blood stools
  • Liver failure
  • High fever
25
Loperamide - Adverse Effects
- Abdominal Cramps - Dry mouth - Drowsiness - Constipation
26
Lomotil - Role and Mechanism
Diphenoxylate + Atropine Used in Moderate-Severe Diarrhea Slows digestion/gut motility Atropine added to prevent misuse
27
Lomotil - Considerations
- Less effective than Loperamide - Avoid in Clostridium Difficile infection, malnourished, severely dehydrated - Avoid in pregnancy and breastfeeding
28
Lomotil - Adverse Effects
- Urinary Retention - Dry Mouth - Blurry Vision - Constipation
29
Lomotil - Contraindications
- Blood Stools - High Fever - Liver Failure Caution use in elderly and children (Anticholinergic Effects)
30
Diarrhea - Adsorbent Agent
Attapulgite
31
Adsorbent Agent - Role and Mechanism
Attapulgite can absorb water, nutrients, toxins, bacteria - Used in mild diarrhea
32
Adsorbent Agent - Considerations
Attapulgite is: - Less effective than Loperamide - Generally well tolerated - Avoid in children under 2 years old
33
Diarrhea - Hydrophilic Bulking Agents
Psyllium
34
Hydrophilic Bulking Agents - Role and Mechanism
Psyllium can absorb liquid to create firmer stools - Used in mild diarrhea
35
Hydrophilic Bulking Agents - Considearations
Psyllium should be spaced from other medications - Should be cautious if combined with other laxatives
36
Diarrhea - Antisecretory Agent
Bismuth Subsalicylate
37
Antisecretory Agent - Role and Mechanism
Bismuth Subsalicylate's mechanism is not well understood. - Antimicrobial - Decreased attachment of bacteria to GI - Anti-inflammatory/Antisecretory Role: - Used in mild to moderate diarrhea - Used to prevent/treat travellers diarrhea
38
Antisecretory Agent - Dose
Bismuth Subsalicylate - 524 mg (2 tabs or 30 mL) every 0.5-1 hour prn (Max 4.2 g/day)
39
Antisecretory Agent - Adverse Effects
Bismuth Subsalicylate - Black tongue - Black stools - Tinnitus
40
Antisecretory Agent - Considerations
Interacts with - Oral anticoagulants - Other salicylates - Methotrexate Avoid use in children under 2 years old Caution in pregnancy and breastfeeding
41
Zinc Supplements - Role and Mechanism in Diarrhea
Used to treat childhood diarrhea - Decreases severity and duration of diarrhea
42
Cholestyramine - Role and Mechanism
Rx medication Lipid lowering agent that binds bile acid - Used to treat diarrhea from bile acid malabsorption
43
Cholestyramine - Considerations
Can interact and bind with drugs (ex. digoxin) - Administer other drugs 1 hour before or 4-6 hours after cholestyramine
44
How to treat Clostridium Difficile Infection
Metronidazole or Vancomycin
45
What antibiotics can treat/prevent Traveler's Diarrhea
- Fluoroquinolones - Azithromycin - Rifaximin
46
Somatostatin - Role and Mechanism
Octreotide, Lanreotide Used in: - Diarrhea from neuroendocrine tumours - Chronic diarrhea from short bowel syndrome - Chemotherapy diarrhea
47
Alpha2-Adrenergic Agonist - Role and Mechanism
Clonidine Used in opioid withdrawal, diabetic autonomic neuropathies
48
Acute Diarrhea Treatment - Moderate to Severe
Loperamide - Patients with severe diarrhea or red flags should be referred
49
Acute Diarrhea Treatment - Mild to Moderate
Bismuth
50
Acute Diarrhea Treatment - Mild
Attapulgite or Psyllium - Antidiarrheals not needed
51
Chronic Diarrhea Treatment
Loperamide or Attapulgite + NonPharm Options - Diet - Hydration - Discontinue drugs adding to diarrhea Treat specific cause
52
Diarrheas treated by probiotics
- Antibiotic Associated Diarrhea - Infectious Diarrhea - Traveler's Diarrhea - Diarrhea in Irritable Bowel Syndrome
53
Who can not take Probiotics
Immunocompromised Preterm infants Critically Ill
54
Key Stains in Probiotics
Lactobacillus Sp Saccharomyces Boulardii
55
Probiotics - Dose
For Antibiotic Associated Diarrhea: - Probiotics with duration of antibiotic therapy - 5-7 days after course completion

PHARM 345 - Other (36 decks)

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