Anti diarrheals

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What is Diarrhea and what are the drugs that can be used for its treatment.

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Anti diarrheals

  1. 1. Anti diarrhealsFawad ALI
  2. 2. Objectives To classify commonly usedantidiarrheals To explain the mechanism of actionand common adverse effects of eachgroup To manage a patient with diarrheaaccordingly
  3. 3. Diarrhea Is it one liquid stool each day? Is it several soft, semi formed stooleach day? Is it frequent, watery stools throughout the day and night? Water 60-90% (>90%) is calleddiarrhea
  4. 4. DiarrheaAbnormalincrease infrequency andliquidity of stool
  5. 5. Causes of Diarrhea Bacterial infections Viral infections Food intolerance Parasites Reaction to medicines Intestinal diseases Functional bowel disorders After surgical procedures unknown
  6. 6. BacteriaSource: contaminated food or waterCommon bacteria: Campylobacter Salmonella Shigella Escherichia coli
  7. 7. VirusesNorwalk virusCytomegalo virusHerpes simplex virusViral hepatitis
  8. 8. Food IntoleranceLactose intolerance
  9. 9. ParasitesGardia lambliaEntamoeba histolyticaCryptosporidium
  10. 10. MedicinesAntibioticsMagnesium containingAntacids
  11. 11. Intestinal diseasesInflammatorybowel diseaseCeliac disease
  12. 12. Travelers diarrheaMost common causative organisms: E.Coli, E.Histolytica, Gardia Lamblia, CholeraCan be prevented by: ________________________________ ________________________________ ________________________________ ________________________________
  13. 13. Cause SymptomsViral (stomachflu)gastroenteritisNausea, vomiting, watery diarrhea, fever, aches.Usually 1-3 days.BacterialinfectionDiarrhea, fever, chills, sometimes blood or mucus inthe stools. Vomiting less common.Foodintolerance/lactoseintoleranceBloating, gas, cramps, loose stools hours after eatingdairy products or other offending foods. No othersigns of illness or infection.EmotionaldistressCramping, loose stools, predictable during times ofstress.
  14. 14. TypesAcute (short term)diarrhea (< 4 week) Bacterial Viral parasiticChronic diarrhea (long term)(> 4 week) Irritable bowel syndrome Inflammatory bowel disease Lactose malabsorption Chronic laxative use
  15. 15. Diagnosis History Examination Stool culture Electrolytes Fasting tests Sigmoidoscopy Colonoscopy
  16. 16. Pathology Rapid transit of stool Osmotic diarrhea Secretory diarrhea Exudative diarrhea
  17. 17. 1. Increased luminal osmolality Non absorbable solute in intestine Promotes retention fluid in intestine Stimulates peristalsis Examples: magnesium antacids, lactasedeficiency
  18. 18. 2. Increased chloride secretionFluid follows sodium chlorideinto the intestineExamples: bacterial toxins,laxative abuse
  19. 19. 3. Increased intestinal motilityDecreased contact time forfluid reabsorptionExample:diabetic neuropathyIrritable bowel syndrome
  20. 20. 4. Exudative diarrheaInflammation of intestinal mucosaDefective fluid reabsorptionExample: ulcerative colitis
  21. 21. Approach to patients with diarrheaMaintenance of fluid andelectrolyte balanceUse of anti infective agentsUse of anti diarrheal agents
  22. 22. Maintenance of fluid and electrolytebalanceGlucoseSodium chloridePotassium chlorideTrisodium citrateORS
  23. 23. Anti infective agentsRarely required
  24. 24. Anti diarrheal agents Anti motility agents Adsorbents Fluid and electrolyte transport modifiers
  25. 25. Anti motility agents Opiates Anti muscarinic agents(Atropine + Diphenoxylate)
  26. 26. OpiatesCodeineDiphenoxylateLoperamide
  27. 27.  Diphenoxylate (Lomotil) Loperamide (Imodium)Synthetic drugsChemically related to narcotic meperidineDecrease intestinal motilityTravelers diarrhea
  28. 28. MOAInhibition of acetylcholinerelease through presynapticopioid receptor in the entericnervous system
  29. 29. Therapeutic Indications Severe or prolonged (>2 to 3 days) diarrhea toprevent severe fluid and electrolyte loss Relatively severe diarrhea in young children andelderly adults. In chronic inflammatory diseases of the bowel(Ulcerative Colitis, Crohns disease) In ileostomies or surgical excision of portions ofthe ileum, HIV/AIDS associated diarrhea When specific causes of diarrhea have beendetermined
  30. 30. Adverse effectsConstipationAbdominal crampsDrowsinessDizzinessPhysical dependence
  31. 31. CONTRA INDICATIONDiarrhea caused bytoxic material,microorganisms,antibiotic associated colitis
  32. 32. Anti cholinergicsDecrease cramping, motility and hyper secretioncombination with opiatesExample:Diphenoxylate + AtropineTwo half lives21/2 h for Diphenoxylate3 to 20 h for atropineOnset of action: 45 to 60 minD.O.A: 3-4 hours
  33. 33. Adsorbents
  34. 34. AdsorbentsKaolinPectinCharcoalMethyl celluloseBismuth salts
  35. 35. MOAAdsorb intestinal toxins
  36. 36. Agents reducing electrolytesecretionα 2 agonist

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