ANTIDIARRHEAL MEDICATIONS %* TREAT DIARRHEA ("Slow through") STOOL that CONTAINS FLUID WEIGHT & i > 200 of FLUID/DAY A % T FREQUENCY of BOWEL —|\@9 @ MOVEMENT is COMMON : * TREAT MILD — MODERATE i eB : ) MASK or EXACERBATE. so i UNDERLYING CONDITION OSMOTIC DIARRHEA %* POOR ABSORPTION of CERTAIN MOLECULES + EXCESSIVE AMOUNT of SOLUTES in LUMEN S FLUID RETENTION LACTOSE INTOLERANCE * DEFICIENCY in BRUSH BORDER ENZYME. LACTASE \ BREAKS down LACTOSE. \ EXCESS LACTOSE STAYS in LUMEN \ DIARRHEA : % RESOLVES when PERSON STOPS a J INGESTING CAUSATIVE PRODUCTSECRETORY DIARRHEA % } SECRETION or | ABSORPTION of IONS (chloride, bicarbonate) %* CAUSED by BACTERIAL ENDOTOXINS CHOLERA TOXIN * T SECRETION of CHLORIDE & BICARBONATE * INHIBITS Na" [ON ABSORPTION * IONS CAUSE OSMOTIC EFFECT g * SYMPTOMS REMAIN, EVEN w/ | ORAL INTAKE INFLAMMATORY DIARRHEA * IMMUNE-MEDIATED DAMAGE to the EPITHELIAL LINING G imprins ABSORPTIVE ABILITY for NUTRIENTS & WATER * INFLAMMATORY BOWEL DISEASES '~ CROHN DISEASE. = ULCERATIVE COLITIS * INFECTIONS ~~ ROTAVIRUS = SALMONELLA ~ SHIGELLA ~€.COLDERANGED MOTILITY * e.g. IRRITABLE BOWEL SYNDROME » T ENTERIC NERVOUS SYSTEM ACTIVATION| Gt FREQUENCY of PERISTALSIS. Less TIME for WATER & NUTRIENTS te be ABSORBED DIARRHEA * MOST CASES are SELF-LIMITING & NO TREATMENT is NECESSARY * SEVERE CASES — REPLACE FLUIDS & ELECTROLYTES ~ PREVENT: }-— PHARMACOTHERAPY ANTIDIARRHEAL MEDICATIONS * CAN | FREQUENCY & SEVERITY DO NOT ADDRESS the UNDERLYING CAUSE. %* ADSORBENTS, OPIOIDS, & ANTICHOLINERGICSADSORBENTS BIND te DIARRHEA-CAUSING TOXINS 4 CANNOT ACT on CELLS of GI TRACT » BISMUTH, CHOLESTWRAMINE, KAOLIN, & PECTIN BISMUTH — "FORM: BISMUTH SUBSALICYLATE + ANTACID for DYSPEPSIA * BISMUTH SUBSALICYLATE HETRONDAZOLE TETRACYCLINE + MECHANISM ig POORLY UNDERSTOOD KAOLIN * CLAY PECTIN PLANT POLYSACCHARIDE Goapsore BACTERIAL TOXINS & my M — PANTI-SECRE Gt sroo. eux & viscosity SANT onan ADSORBENTS CHOLESTYRAMINE » STICKY & INSOLUBLE RESIN GIVEN as CHOLESTEROL LOWERING AGENT * USED te TREAT DIARRHEA in INDIVIDUALS with BILE ACID MALABSORPTION @ crorestvaanine CERTAIN BACTERIAL TOXINS INSOLUBLE COMPLEXES ©) sive sacs EXCRETED with FECESADSORBENTS SIDE EFFECTS BISMUTH SUBSALICYLATE. % TONGUE & STOOL TURN BLACK a a * OTOTOXICITY SHEARING LOSS & TINNITUS * CHILDREN RECOVERING From a VIRAL INFECTION \ LIFE-THREATENING ENCEPHALOPATHY called REYE'S SYNDROME A ‘AVOID in PEDIATRIC POPULATION ADSORBENTS SIDE EFFECTS CHOLESTYRAMINE » GI DISTURBANCES ABDOMINAL PAIN, ANOREXIA, NAUSEA, 2 FLATULENCE * DISCOLORATION & EROSION of the TEETH * REDUCES the ABSORPTION of FAT-SOLUBLE VITAMINS D ®@ 220085, | craesremne —e|DSORBENTS 22-3 HRS — iE BIND OTHER MEDICATIONS in GI TRACT & PREVENT THEIR ABSORPTION ADSORBENTS SIDE EFFECTS KAOLIN & PECTIN * CONSTIPATION 3 | 22-3HRS — %* BIND OTHER MEDICATIONS in GI TRACT & PREVENT THEIR ABSORPTIONOPIOIDS 0% ® LOPERAMIDE & DIPHENOXYLATE. Ef) ® LOW RISK of DEVELOPING DEPENDENCE 5} ENTERCNS? GG; » STIMULATE they or 6 OPIOID RECEPTORS ——_ esse EIN {| PERISTALSIS LOPERAMIDE DIPHENOXYLATE * HIGH ANTIDIARRHEAL & » SOME PENETRANCE in CNS ANTISECRETORY EFFECTS 4 HIGHER ADDICTIVE POTENTIAL * LOW PENETRANCE in CNS. * GIVEN as PREPARATIONS that CONTAIN an + | ADDICTIVE POTENTIAL & ANTICHOLINERGIC lise ATROPINE T LkELINOOD of ABUSE *» EFFECTIVE in CHRONIC DIARRHEA * FIRST-LINE TREATMENT f TRAVELER'S DIARRHEA a5] OPIOIDS ® LOPERAMIDE & DIPHENOXYLATE ® LOW RISK of DEVELOPING DEPENDENCE STIMULATE the 11 or 6 OPIOID RECEPTORS — ‘S| PERISTALSIS LOPERAMIDE DIPHENOXYLATE * HIGH ANTIDIARRHEAL & » SOME PENETRANCE in CNS ANTISECRETORY EFFECTS “+ HIGHER ADDICTIVE POTENTIAL LOW PENETRANCE in CNS. * GIVEN as PREPARATIONS that CONTAIN an + | ADDICTIVE POTENTIAL & ANTICHOLINERGIC lise ATROPINE [LIkELINOOD of ABUSE *» EFFECTIVE in CHRONIC DIARRHEA * sibe EFFECTS “DRY MOUTH ~ HYPERTHERMIA * FIRST-LINE TREATMENT f BLURRED VISION ~ URINARY TRAVELER'S DIARRHEA tt = SEDATION RETENTIONOPIOIDS ® LOPERAMIDE & DIPHENOXYLATE ® LOW RISK of DEVELOPING DEPENDENCE ENTERIC NS & \ % STIMULATE the j10r 6 OPIOID RECEPTORS ——__stoots muscLe E/N S| PERISTALSIS — ees LOPERAMIDE DIPHENOKYLATE * HIGH ANTIDIARRHEAL 2 + SOME PENETRANCE in CNS ANTISECRETORY EFFECTS 1 Wien adbirive POTENTIAL + LOW PENETRANCE in CNS * GIVEN as PREPARATIONS led CONTAIN an nL ADDICTIVE POTENTIAL ANTICHOLINERGIC ie ATROPINE * SIDE EFFECTS » EFFECTIVE in CHRONIC DIARRHEA ie » FIRST-LINE TREATMENT f BLURRED VISION ~ URINARY TRAVELER'S DIARRHEA SEDATION RETENTION | + INHIBITS INTESTINAL MOTILITY E'secReTION OPIOIDS SIDE EFFECTS LOPERAMIDE DIPHENOXYLATE * CONSTIPATION * ABDOMINAL CRAMPS * DROWSINESS * DIZZINESS *PARALYTIC ILEUS * TOXIC MEGACOLON G uccerarive courris A OTHER CNS DEPRESSANTS aK meena tse vs penesson aRITURATES = ALCOHOL * TORSADES DE POINTES ® HEPATIC COMA A) & CARDIAC ARREST GWepamic w RENAL eS ) G tt Doses than RECOMMENDED IMPAIRMENT a 1? tenteronesh H@axeago Tee rn AOS 6S ols MyOPIOIDS CONTRAINDICATIONS LOPERAMIDE DIPHENOXYLATE. * CHILDREN < 4 * QT PROLONGATION DsTumbances Glow martes snnons sosrnae APSE EE ams” ADE K cHOLesTANE Sy