Symptom Based Treatment - DIARRHEA

Question 1

Slows intestinal motility through OPIOID receptor
Direct effects on circular and longitudinal muscle
Reduces rectal volume and increases viscosity

Answer 1

Loperamide
4 mg then 2 mg after each loose stool

*CI - hypersensitivity, blood diarrhea,high fever, infectious diarrhea,pseudomembranous colitis

Question 2

Increases availability of enkephalins (endogenous opiods) which induces selective increase in chloride absorption

Answer 2

Racecadotril

100 mg PO q8 (max duration 7 days)

*may continue treatment until 2 normal stools are noted

Question 3

Acts on smooth muscle of intestinal tractz (-) GI motility and excessive GI propulsion

Answer 3

Diphenoxylate

• Atropine - added to discourage deliberate overdose of diphenoxylate
• CI - hypersensitivity, obstructive jaundice, and diarrhea from pseudomembranous colitis or infectious enterotoxin producing bacteria

Question 4

MOA of Bismuth Salicylate

Answer 4

Bismuth - Antimicrobial, anti inflammatory action

Salicylate - antisecretory effect

Question 5

5 HT3 receptor antagonist

modulates enteric nervous system

Answer 5

Alosetron 0.5 mg PO q12

*only for women with severe diarrhea-predominant IBS who have chronic IBS symptoms non responsive to conventional therapy