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

1. Anti diarrheals
Fawad ALI

2. 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

3. 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

4. Diarrhea
Abnormal
increase in
frequency and
liquidity of stool

5. Causes of Diarrhea
 Bacterial infections
 Viral infections
 Food intolerance
 Parasites
 Reaction to medicines
 Intestinal diseases
 Functional bowel disorders
 After surgical procedures
 unknown

6. Bacteria
Source: contaminated food or water
Common bacteria:
 Campylobacter
 Salmonella
 Shigella
 Escherichia coli

7. Viruses
Norwalk virus
Cytomegalo virus
Herpes simplex virus
Viral hepatitis

8. Food Intolerance
Lactose intolerance

9. Parasites
Gardia lamblia
Entamoeba histolytica
Cryptosporidium

10. Medicines
Antibiotics
Magnesium containing
Antacids

11. Intestinal diseases
Inflammatory
bowel disease
Celiac disease

12. Travelers diarrhea
Most common causative organisms:
 E.Coli, E.Histolytica, Gardia Lamblia, Cholera
Can be prevented by:
 ________________________________
 ________________________________
 ________________________________
 ________________________________

14. 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.

15. 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

16. Diagnosis
 History
 Examination
 Stool culture
 Electrolytes
 Fasting tests
 Sigmoidoscopy
 Colonoscopy

17. Pathology
 Rapid transit of stool
 Osmotic diarrhea
 Secretory diarrhea
 Exudative diarrhea

18. 1. Increased luminal osmolality
 Non absorbable solute in intestine
 Promotes retention fluid in intestine
 Stimulates peristalsis
 Examples: magnesium antacids, lactase
deficiency

19. 2. Increased chloride secretion
Fluid follows sodium chloride
into the intestine
Examples: bacterial toxins,
laxative abuse

20. 3. Increased intestinal motility
Decreased contact time for
fluid reabsorption
Example:
diabetic neuropathy
Irritable bowel syndrome

21. 4. Exudative diarrhea
Inflammation of intestinal mucosa
Defective fluid reabsorption
Example: ulcerative colitis

22. Approach to patients with diarrhea
Maintenance of fluid and
electrolyte balance
Use of anti infective agents
Use of anti diarrheal agents

23. Maintenance of fluid and electrolyte
balance
Glucose
Sodium chloride
Potassium chloride
Trisodium citrate
ORS

24. Anti infective agents
Rarely required

25. Anti diarrheal agents
 Anti motility agents
 Adsorbents
 Fluid and electrolyte transport modifiers

26. Anti motility agents
 Opiates
 Anti muscarinic agents
(Atropine + Diphenoxylate)

27. Opiates
Codeine
Diphenoxylate
Loperamide

28.  Diphenoxylate (Lomotil)
 Loperamide (Imodium)
Synthetic drugs
Chemically related to narcotic meperidine
Decrease intestinal motility
Travelers diarrhea

29. MOA
Inhibition of acetylcholine
release through presynaptic
opioid receptor in the enteric
nervous system

30. 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

31. Adverse effects
Constipation
Abdominal cramps
Drowsiness
Dizziness
Physical dependence

32. CONTRA INDICATION
Diarrhea caused by
toxic material,
microorganisms,
antibiotic associated colitis

33. 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

34. Adsorbents

35. Adsorbents
Kaolin
Pectin
Charcoal
Methyl cellulose
Bismuth salts

36. MOA
Adsorb intestinal toxins

37. Agents reducing electrolyte
secretion
α 2 agonist