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What drug is used for a the treatment of travelers diarrhea?
Test last year!!
- Loperamide (Imodium)
- This is first line tx
Bismuth or Pepto-Bismol is used to treat?? (3 things)
indigestion, nausea, adjunct tx to H-Pylori in PUD
What are 3 causes of diarrhea?
- 1. viral - noninflammatory = Norwalk, rotavirus
- inflammatory = cytomegalovirus
- 2. Protozoal- Giardia
- 3. bacterial
could be from recent exposure or abx treatment
Don't treat diarrhea until
you know the cause
Diarrhea is classified by duration not frequency.
What are the classifications of ACUTE DIARRHEA? How do you treat ACUTE DIARRHEA?
- -Lasts 1-14 days
- -Usually mild and self limiting
- -treat with bowel rest and adequate hydration, reassure patient, replace 'lytes, ginger ale or cola may be helpful
- -PERFER NOT TO use antidiarrheals with ACUTE diarrhea because it can prolong the infection.
What classifies persistent acute diarrhea? How do you treat?
- -lasts longer than 14 days but less than 30 days.
- -treat with Gatorade or pedialyte rapidly over 3 to 4 hours
- -in infants..continue to breastfeed... do not dilute formula
When should you not treat a patient with antidiarrheals?
- -in acute cases if it can be avoided
- -bloody diarrhea
- -high fever
- -systemic toxicity
- all these can worsen disease if antidiarrheals are used.
Name some chronic causes of diarrhea..
- -lactose intolerance
- -Fecal impaction
- -Ulcerative colitis
- -Crohn's disease
- -malabsorption(celiac sprue, pancreatic disease)
- -chronic infection (HIV, parasites, c-diff)
When should you treat patients with chronic diarrhea with antidiarrheals?
After you identify and treat the cause. Then use antidiarrheals to control symptoms. Should also treat dehydration at this point.
Name some medications that cause diarrhea.
- gi stimulants (reglan)
Which diarrhea occurs when nonabsorbed solutes are retained in the lumen of the intestinal tract? This results in a hyperosmolar state that pulls water and ions into the intestinal lumen.
*can be increased by poorly absorbed salts, lactose, large amounts of sugar, diet foods, soft drinks
Which diarrhea occurs when you have colonic absorption of fluid that is 2ndary to active transport of Na ions ??
??? look back at this in notes
Which form of diarrhea occurs as a result of inflammatory diseases of the mucosa? Inflammation occurs and may cause increase in mucus, pus, blood and serum proteins that increase fluid and overload the colon.
How do opioids aid in the decrease of diarrhea?
act on smooth muscle of the intestinal tract to slow GI motility and propulsion(causing movement)
Why is atropine added to Lomotil?
- to discourage deliberate overdose...
- Lomotil can be habit forming.
How do absorbents work to treat diarrhea?
These agents absorb H2O and help solidify loose stools.
How are absorbents taken?
- Given after each BM until diarrhea is relieved or max dose is reach.
- Normally 30-120ml or 2 tabs after each BM up to 6-7 doses per day.
How does polycarbophil(Fibercon) work?
absorbs water in the GI tract and is used as an antidiarrheal as well as bulk forming laxative.
What is the most common side effect of absorbents?
- *may have a feeling of fullness, Gi upset, bloating and gas
- *generally these meds are safe because they are not absorbed systemically
What class is Bismuth or Pepto Bismol from??
How does Pepto Bismol work?
Provides antisecretory effects as well as some antimicrobial effects.
Pepto Bismol should not be taken in individuals with...?
- -patients taking meds for asthma, gout, dm, and anticoagulation & a history of gi bleeding
- -med should be avoid if allergy to aspirin.
- avoid in children -- risk for Reyes syndrome.
What is the first line treatment for diarrhea?
What is the second line treatment for diarrhea?
Absorbents or Antisecretory agents
What is the 3rd line treatment for diarrhea?
What is the best way to treat diarrhea in the elderly and peds?
Drugs are too risky. Lomotil is risky bc of sedative effect. Do not use in children <2. Meds can interact with meds already prescribed. Absorbents can decrease the absorption of other medications and nutrients. Loperamine and BSS are not recommended in children.
What is the first line treatment in pregnant women?
all other meds should be avoided bc they either have not been tested on humans or at teratogenic in animals.
When treating pregnant women with absorbents, what may you need to add?
Iron bc of decreased nutrient absorption.