Objectives
To classify commonly used
antidiarrheals
To explain the mechanism of action
and common adverse effects of each
group
To manage a patient with diarrhea
accordingly
Diarrhea
Is it one liquid stool each day?
Is it several soft, semi formed stool each day?
Is it frequent, watery stools through out the day and night?
Water 60-90% (>90%) is called diarrhea
Causes of Diarrhea
Bacterial infections
Viral infections
Food intolerance
Parasites
Reaction to medicines
Intestinal diseases
Functional bowel disorders
After surgical procedures
unknown
Bacteria
Source: contaminated food or water
Common bacteria:
Campylobacter
Salmonella
Shigella
Escherichia coli
Travelers diarrhea
Most common causative organisms:
E.Coli, E.Histolytica, Gardia Lamblia, Cholera
Can be prevented by:
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Cause Symptoms
Viral (stomach
flu)
gastroenteritis
Nausea, vomiting, watery diarrhea, fever, aches.
Usually 1-3 days.
Bacterial
infection
Diarrhea, fever, chills, sometimes blood or mucus in
the stools. Vomiting less common.
Food
intolerance/lac
tose
intolerance
Bloating, gas, cramps, loose stools hours after eating
dairy products or other offending foods. No other
signs of illness or infection.
Emotional
distress
Cramping, loose stools, predictable during times of
stress.
Types
Acute (short term)diarrhea (< 4 week)
Bacterial
Viral
parasitic
Chronic diarrhea (long term)(> 4 week)
Irritable bowel syndrome
Inflammatory bowel disease
Lactose malabsorption
Chronic laxative use
1. Increased luminal osmolality
Non absorbable solute in intestine
Promotes retention fluid in intestine
Stimulates peristalsis
Examples: magnesium antacids, lactase
deficiency
2. Increased chloride secretion
Fluid follows sodium chloride
into the intestine
Examples: bacterial toxins,
laxative abuse
3. Increased intestinal motility
Decreased contact time for
fluid reabsorption
Example:
diabetic neuropathy
Irritable bowel syndrome
4. Exudative diarrhea
Inflammation of intestinal mucosa
Defective fluid reabsorption
Example: ulcerative colitis
Approach to patients with diarrhea
Maintenance of fluid and
electrolyte balance
Use of anti infective agents
Use of anti diarrheal agents
Maintenance of fluid and electrolyte balance
Glucose
Sodium chloride
Potassium chloride
Trisodium citrate
ORS
Diphenoxylate (Lomotil)
Loperamide (Imodium)
Synthetic drugs
Chemically related to narcotic meperidine
Decrease intestinal motility
Travelers diarrhea
MOA
Inhibition of acetylcholine
release through presynaptic
opioid receptor in the enteric
nervous system
Therapeutic Indications
Severe or prolonged (>2 to 3 days) diarrhea to prevent severe fluid and electrolyte loss
Relatively severe diarrhea in young children and elderly adults.
In chronic inflammatory diseases of the bowel (Ulcerative Colitis, Crohns disease)
In ileostomies or surgical excision of portions of the ileum,
HIV/AIDS associated diarrhea
When specific causes of diarrhea have been determined
Anti cholinergics
Decrease cramping, motility and hyper secretion
combination with opiates
Example:
Diphenoxylate + Atropine
Two half lives
21/2 h for Diphenoxylate
3 to 20 h for atropine
Onset of action: 45 to 60 min
D.O.A: 3-4 hours
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