diarrhea

most common cause of diarrhea

viral

most common bacterial cause

e coli

non drug treatment

fluid and electrolyte replacement

diarrheal drugs

acetylcholinesterase inhibitors (donepezil), mag, antibiotics, antidiabetics, antineoplastics, colchicine, constipation treatment, misoprostol, mycophenolate, prokinetic drugs, protease inhibtiros, quinidine, roflumilast

Non-infectious treatment

short term bismuth subsalicylate or loperamide

eluxadoline generic

viberzi

viberzi use

IBS-D

bsimuth dosing

524mg (30ml/ 2 tabs) every 30-60 mintues prn OR 1050mg (60ml/ 4 tabs) every 60 ming PRN

Max 4.2g/d up to 2 days

warning with bismuth

children/teenagers recovering from viral infection should avoid due to risk of reyes syndrome

bismuth se

black tongue/stool, salicylate toxicity, n, abomdinal pain

loperamide dosing

4 mg po after the first loose stool then 2 mg after each loose stool after.

max 8mg/d (self care) or 16 mg (rx)

loperamide bw

tdp, cardaic arrest/sudden death, <2 yrs avoid use

loperamide ci

acute dysentry, c diff, acute uc

loperamide se

CONSTIPATION, abodmina crmpaing, nause, qT prolongation

loperamide counseling

self treatment limitied to 48 hrs; can cause mild opioid like high in large doses

diphenoxylate/atropine dosing

5 mg (2 tabs) up to 4 times daily; max 20mg

diphenoxylate/atropine control class

cv

lomotil ci

risk of respiratory/cns depression in children (do not use in children <2 yrs of <6 yrs for tabs); Cdiff, abstructive jaundice

lomotil se

mild euphoria, possiple anticholinergic

lomotil counseling

improvment seen within 48 hrs; d/c after 10 days if no benefit; liquid formulation is recommended for <13 yrs, anticholinergic effects due to atropine to discourage abuse

dicyclomine generic

bentyl

discyclomine moa

anit-spasmodic

dicyclomine dose

20 mg qid; max 80mg/d for < 2 weeks

bentyl ci

gi obstruction, severe UC, reflux esophagistis, acute hemorrahge, obstructive uropahty, narrow angle glaucoma, myasthenia gravis, breastfeeding, infants < 6 monts

bentyl warnings

BEERs and toxic megacolol or paralytic ilues in mild/mod UC

Bentyl se

dizziness, dry mouth, n, blurred vision, somnolence, weakness, nervousness

viberzi moa

peripherally acting mix mu opioin receptor AGONIST

viberzi dosing

100 mg po bid with FOOD

vebrizi control class

civ

verbrizi ci

patients without gullbladder, bilary duct obstruction, pancreatic disease, alcoholism, severe hepatic impariment

vebrizi side effects

constipation, n, abodminal pain

vebrizi montiroing

s/sx of pncreatitis or sphincter of Oddi Spasm, LFTS

Viberzi indication

IBS-D

rifaximin use

IBS without constipation

olosetron/lotrenex use

IBS=D; women only; bw for ishcemic colitis