Opiates and opiate-related agents antidiarrheals (2)
- diphenoxylate with atropine (OTC or Rx)
2. loperamide OTC
Adsorbents antidiarrheals (2)
- bismuth subsalicylate (OTC)
2. cholestyramine (Rx)
Probiotic antidiarrheals (1)
- lactobacillus acidophilus
causes of diarrhea that we need to know for this class (3)
- Drug side effects (antibiotics => loss of normal flora)
- laxative abuse
- c. diff bacterial infection
complications with diarrhea and nursing along with them
- hypovolemia / electrolyte loss
- increase fluid and electrolyte intake (PO or IV)
- monitor chemistry panel (CMP) and report/replace (PO or IV) - metabolic acidosis
- monitor ABG and report - life-threatening for high risk patients
- pediatrics or geriatrics
non-pharm 1st supportive treatments for diarrhea
do this while determining the cause
- Encourage clear liquid diet such as sports drinks
- Oral solutions (Gatorade; Pedialyte or Rehydralyte)
- IV fluid and electrolyte replacement
- Avoid dairy products, caffeine
non-pharm 2nd supportive treatments for diarrhea
determine the underlying cause BEFORE treatment
- prior to administering antidiarrheal: collect a stool sample to rule of C.diff, OB (occult blood), C&S (culture & sensitivity), O&P (Ova and parasite)
contraindications for antidiarrheals !!!
- using antidiarrheals longer than 2 days
- if fever with unknown etiology is present
- if the etiology of diarrhea
diphenoxylate with atropine and loperamide MOA
decrease peristalsis by activating opioid receptors in the GI
diphenoxylate with atropine and loperamide side effects
- CNS depressant
- resp depressant
- physical dependence, short-term use only
diphenoxylate with atropine and loperamide contraindications
- avoid ETOH
- avoid other CNS depressants
diphenoxylate with atropine specifically contraindication
avoid with glaucoma/BPH
- added to discourage abuse since diphenoxylate is a synthetic opioid
- also for its anticholinergic effects on GI
bismuth subsalicylate and cholestyramine MOA
- coat the wall of the GI tract
2. adsorb bacteria/toxins
lactobacillus acidophilus route
PO
lactobacillus acidophilus MOA (2)
- replacing normal flora of the GI tract
2. reduces colonization by pathogenic bacteria
lactobacillus acidophilus indications
- antibiotic use (loss of normal flora)
- administer at least 2hrs apart from Abx - IBS, UC, C.diff infection (prophylactically!)
antidiarrheal nursing
- assessment: BM consistency, frequency, and quantity, listen to bowel sounds
- prior to administering antidiarrheal
- collect a stool sample to rule out C. diff by doing OB, C&S, O&P
- monitor VS trend for hypovolemia and shock
- low BP
- tachycardia
- educate
- only short term drugs (only for 48 hours)
- increase fluid intake (PO/IV)
