Drug Therapy for Diarrhea PDF

Chapter 40 Drug Therapy for Diarrhea  An increase in the liquidity of stool or Diarrhea frequency of defecation to more than 3 stools per day A symptom of numerous conditions that oIncrease bowel motility oCause secretion or retention o...

Chapter 40 Drug Therapy for Diarrhea  An increase in the liquidity of stool or Diarrhea frequency of defecation to more than 3 stools per day A symptom of numerous conditions that oIncrease bowel motility oCause secretion or retention of fluids in the intestinal lumen oCause inflammation or irritation of the GI tract Resulting in rapid propulsion of bowel contents toward rectum; limited absorption of fluids and electrolytes Copyright © 2025 Wolters Kluwer. All rights reserved. 2  Laxative abuse, drug therapy Diarrhea Causes Undigested, coarse, or highly spiced food in GI #1 tract Lack of digestive enzymes Intestinal infection by virus, bacteria, and protozoa Improperly prepared meat, poultry consumption Inflammatory bowel disorders Copyright © 2025 Wolters Kluwer. All rights reserved. 3  Irritable bowel syndrome Diarrhea Causes Drugs #2 Intestinal neoplasms Functional disorders Hyperthyroidism Surgical incisions of portions of the intestine (usually small intestine) HIV/AIDS Copyright © 2025 Wolters Kluwer. All rights reserved. 4  Is the following statement True or False? Question #1 Antibiotic-associated colitis is a mild condition caused by oral antibiotic therapy. Copyright © 2025 Wolters Kluwer. All rights reserved. 5  False Answer to Question #1 Rationale: Antibiotic-associated colitis is a serious condition caused by oral antibiotic therapy. By suppressing normal flora in the colon, antibiotics allow proliferation of pathogenic bacteria, especially Clostridium difficile organisms. Copyright © 2025 Wolters Kluwer. All rights reserved. 6  Bacteria Intestinal oEscherichia coli, Salmonella, Shigella, Infections Clostridium difficile Virus oRotavirus, calicivirus Protozoa oGiardia lamblia, Cryptosporidium parvum Copyright © 2025 Wolters Kluwer. All rights reserved. 7  Acute or chronic, mild or severe Characteristics of oFever, vomiting, and bloody stools are Diarrhea associated with acute diarrhea, and the presence of these symptoms may help determine the cause. Most episodes are the body trying to rid itself of irritants, toxins, and infectious agents. Usually self-limiting, subside within 24 to 48 hours. Severe or prolonged episode may lead to serious fluid and electrolyte depletion. oEspecially in young children, older adults Chronic diarrhea  remissions, exacerbations Copyright © 2025 Wolters Kluwer. All rights reserved. 8  Is the following statement True or False? Question #2 Alosetron is a selective 5-HT3 receptor antagonist indicated for treating female with chronic severe diarrhea-predominant IBS that has not responded to conventional therapy. Copyright © 2025 Wolters Kluwer. All rights reserved. 9  True Answer to Question #2 Rationale: Alosetron is a selective 5-HT3 receptor antagonist indicated for treating female with chronic severe diarrhea- predominant IBS that has not responded to conventional therapy. Copyright © 2025 Wolters Kluwer. All rights reserved. 10  The oral opioid diphenoxylate with atropine is Medications #1 the prototype used to treat moderate to severe diarrhea. Diphenoxylate with atropine slows peristalsis by acting on the smooth muscles in the intestine. Adverse effects of diphenoxylate with atropine include tachycardia, dizziness, headache, flushing, nausea and vomiting, dry skin and mucous membranes, and urinary retention. Hypotension and respiratory depression have occurred, particularly with doses greater than ordered. Copyright © 2025 Wolters Kluwer. All rights reserved. 11  Bismuth salts have antibacterial and antiviral Medications #2 activity. Bismuth subsalicylate, a commonly used over-the-counter drug, also has antisecretory and possibly anti-inflammatory effects because of its salicylate component. Octreotide acetate is a synthetic form of somatostatin, a hormone produced in the anterior pituitary gland and in the pancreas. The drug may be effective in diarrhea because it decreases GI secretion and motility. Copyright © 2025 Wolters Kluwer. All rights reserved. 12  Polycarbophil (e.g., FiberCon) and psyllium are Medications #3 most often used as bulk-forming laxatives. They are occasionally used in diarrhea to adsorb toxins and water, decreasing the fluidity of stools. Cholestyramine and colestipol are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn disease or surgical excision of the ileum. Copyright © 2025 Wolters Kluwer. All rights reserved. 13  Alosetron is a selective 5-HT3 receptor Medications #4 antagonist indicated for treating females with chronic severe diarrhea-predominant IBS that has not responded to conventional therapy. Copyright © 2025 Wolters Kluwer. All rights reserved. 14  Try to determine the duration of diarrhea; Assessment number of stools per day; amount, consistency, color, odor, and presence of abnormal components in each stool; precipitating factors; accompanying signs and symptoms; and measures used to relieve diarrhea. Try to determine the cause of the diarrhea. With severe or prolonged diarrhea, especially in young children and older adults, assess for dehydration, hypokalemia, and other fluid and electrolyte disorders. Copyright © 2025 Wolters Kluwer. All rights reserved. 15  Provide instruction about the use of measures Implementation to prevent diarrhea. #1 Prepare and store food properly and avoid improperly stored foods and those prepared under unsanitary conditions. Dairy products, cream pies, and other foods may cause diarrhea (“food poisoning”) if not refrigerated. Wash hands before handling any foods, after handling raw poultry or meat, and always before eating. Copyright © 2025 Wolters Kluwer. All rights reserved. 16  Chew food well. Implementation #2 Do not overuse laxatives (i.e., amount per dose or frequency of use). Many OTC products contain senna or other strong stimulant laxatives. Provide education about drug therapy. Copyright © 2025 Wolters Kluwer. All rights reserved. 17  Provide supportive care, which is necessary Implementation regardless of whether antidiarrheal drugs are #3 used. oReplace fluids and electrolytes (2 to 3 quarts daily). Fluids such as weak tea; water; bouillon; clear soup; noncarbonated, caffeine- free beverages; and gelatin are usually tolerated and helpful. If the patient cannot tolerate adequate amounts of oral liquids or if diarrhea is severe or prolonged, intravenous fluids may be needed. Copyright © 2025 Wolters Kluwer. All rights reserved. 18  Avoid foods and fluids that may further irritate Implementation GI mucosa (e.g., highly spiced foods; #4 “laxative” foods, such as raw fruits and vegetables). Increase frequency and length of rest periods and decrease activity. Exercise and activity stimulate peristalsis. If perianal irritation occurs because of frequent liquid stools, cleanse the area with mild soap and water after each bowel movement and then apply an emollient, such as white petrolatum. Copyright © 2025 Wolters Kluwer. All rights reserved. 19