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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
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Bismuth or Pepto-Bismol is used to treat?? (3 things)
indigestion, nausea, adjunct tx to H-Pylori in PUD
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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
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Don't treat diarrhea until
you know the cause
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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.
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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
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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.
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Name some chronic causes of diarrhea..
- -lactose intolerance
- -IBS
- -Fecal impaction
- -Ulcerative colitis
- -Crohn's disease
- -malignancy
- -radiation
- -malabsorption(celiac sprue, pancreatic disease)
- -chronic infection (HIV, parasites, c-diff)
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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.
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Name some medications that cause diarrhea.
- antacids
- antibiotics
- antidepressants
- colchicine
- dig
- gi stimulants (reglan)
- laxatives
- metformin
- prostaglandins
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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.
Osmotic diarrhea
*can be increased by poorly absorbed salts, lactose, large amounts of sugar, diet foods, soft drinks
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Which diarrhea occurs when you have colonic absorption of fluid that is 2ndary to active transport of Na ions ??
Secretory diarrhea
??? look back at this in notes
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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.
Exudative diarrhea
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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)
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Why is atropine added to Lomotil?
- to discourage deliberate overdose...
- Lomotil can be habit forming.
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How do absorbents work to treat diarrhea?
These agents absorb H2O and help solidify loose stools.
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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.
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How does polycarbophil(Fibercon) work?
absorbs water in the GI tract and is used as an antidiarrheal as well as bulk forming laxative.
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What is the most common side effect of absorbents?
Constipation
- *may have a feeling of fullness, Gi upset, bloating and gas
- *generally these meds are safe because they are not absorbed systemically
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What class is Bismuth or Pepto Bismol from??
Antisecretory
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How does Pepto Bismol work?
(bismuth subsalicylate)
Provides antisecretory effects as well as some antimicrobial effects.
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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.
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What is the first line treatment for diarrhea?
Loperamide (Imodium)
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What is the second line treatment for diarrhea?
Absorbents or Antisecretory agents
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What is the 3rd line treatment for diarrhea?
Lomotil
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What is the best way to treat diarrhea in the elderly and peds?
Rehydration.
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.
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What is the first line treatment in pregnant women?
absorbents
all other meds should be avoided bc they either have not been tested on humans or at teratogenic in animals.
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When treating pregnant women with absorbents, what may you need to add?
Iron bc of decreased nutrient absorption.
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