Test 3 Diarrhea and Constipation

Question 1

acute and chronic diarrhea

Answer 1

• acute: lasts < 14 days

- chronic: last > 30 days

Question 2

What are the common causes of diarrhea?

Answer 2

• viral

- food induced

Question 3

Medications Associated with Diarrhea

Answer 3

• Laxatives
• Magnesium containing antacids
• Antineoplastics
• Antibiotics

Question 4

Exclusions To Self-Treatment for diarrhea

Answer 4

• < 6 months of age 
• SEVERE diarrhea with 
– Associated dehydration 
– Fever ≥ 38.3 degrees Celsius (101oF), low BP, dizziness, severe abdominal pain
– 6-9 stools per day
• Blood, mucus or pus 
• Protracted vomiting 
• Pregnancy
• Chronic > 30 days without treatment
• Duration > 48 hours with treatment

Question 5

What is the recommendation for dietary management?

Answer 5

Rehydration + age-appropriate foods ASAP

Question 6

What is the only medicine approved for prevention measures?

Answer 6

• Bismuth subsalicylate (pepto bismol)

- for traveler’s diarrhea prophylaxis

Question 7

Antimotility agents

Answer 7

• Loperamide (OTC)

- diphenoxylate (Rx only)

Question 8

Loperamide

Answer 8

• stimulates μ receptors
• decrease gut motility
• Do not use if high grade fever, fecal leukocytes (WBC) or bloody stools, liver disease
• Not recommended in children <6 years

Question 9

adverse effects of Loperamide

Answer 9

• dizziness

- constipation

Question 10

Lomotil®

Answer 10

• inhibits excessive GI motility and GI propulsion

Question 11

adverse effects of Lomotil

Answer 11

– CNS

– Anticholinergic effects

Question 12

Antisecretory agents

Answer 12

• Bismuth subsalicylate

- octreotide

Question 13

Bismuth Subsalicylate (BSS)

Answer 13

• antimicrobial and antisecretory effect

- supposed to cut down # of stools by half

Question 14

Exclusions To Self-Treatment of constipation

Answer 14

• Marked abdominal pain, significant distension
• Marked flatulence
• Fever
• Nausea / vomiting
• Paraplegia / quadraplegia
• Daily laxative use

Question 15

What exclusion to self care is indicative for disease or cancer condition?

Answer 15

• Unexplained changes in bowel habits
• Change in stool appearance
• Persistent bowel symptoms
• History of IBD

Question 16

How to treat chronic constipation?

Answer 16

fluids, fiber, exercise, bulk laxatives

Question 17

psyllium

Answer 17

• Bulk-Forming Agents

- Stimulate peristalsis

Question 18

Docusate

Answer 18

• Emollients / StoolIncrease wetting efficiency Softeners

- Often used for opiate-induced constipation with a stimulant (senna/bisacodyl)

Question 19

adverse effects of docusate

Answer 19

– Diarrhea and abdominal cramping
– Overdosage may cause weakness, sweating, muscle cramps, irregular heartbeat
– May increase absorption of other substances such as mineral oil

Question 20

Saline Laxatives

Answer 20

• when acute evacuation of bowel is required
• onset:
  • (oral) ½ to 3 hours
  • (rectal) 2 to 5 minutes
• fastest: MOM

Question 21

Hyperosmotic Laxatives

Answer 21

• Glycerin Suppositories
• Miralax
• any age, no AE -> first line

Question 22

Stimulants

Answer 22

• Senna
• irritate gut to get it moving
• limit use to 1 week; can get off and on again but don’t want to be on for too long because can cause the way the gut functions

Question 23

adverse effects of stimulants

Answer 23

• Electrolyte / fluid deficiencies
• Malabsorption
• can change color of gut
• diarrhea
• Senna may color urine pink to red

Question 24

Enemas

Answer 24

• counsel pt to hold it as long as possible

- can lay on side