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Identify common medication causes of diarrhea and constipation
What is chronic diarrhea?
Lasts >14 days
What are possible causes of chronic diarrhea?
Infection
IBD
Malabsorption
Tumor
Drug
Factitious
Motility disturbance
How do you treat chronci diarrhea with a diagnosis vs without a diagnosis?
With a diagnosis- Treat the cause
No Diagnosis- Hydration, dicontinue implicated drug, adjust diet, loperamide
What are the prescription anti-diarrhea medications
Diphenoxylate/atropine (Lomotil)
Difenoxin/Atropine (Motofen)
Paregoric (camphorated tincture of opium)
Octreotide (Sandostatin)
What is the atropine for in Lomotil and Motofen
Atropine discourages abuse
What is the issue with Paregoric
Not used much due to abuse potential
What is Octreotide used for
Diarrhea associated with tumors and carcinoid syndrome
What is the treatment algorithm for constipation?
Bulk forming medications for constipation and what ages can they be used for
Methylcellulose (6&up)
Polycarbophil (6&up)
Psyllium (1&up)
Guar gum
When can we expect releif when on bulk forming meds
3 days
Emollients/stool softners
Docusate sodium (throat irritation)
Docusate calcium
Docusate postassium (can be used rectally)
Should we use mineral oil to treat constipation?
NO! Can cause aspiration
Emollient/stool softerns are mainly for….
Prevention of constipation
Osmotic laxatives for constipation
PEG 3350 (2&up)
Magnesium (2&up)- many med timing interactions
Lactulose/sorbitol/glyceirn- Ok for peds
Sodium phosphate - (2&up)
Stimulant laxatives
Bisacodyl- oral, suppository
Senna- oral, liquid
*ages 2 & up for both
Stimulant laxatives side effect
Abdominal cramps
Intestinal Secretagogue
Lubriprostone- take with food to lessen nausea
Linaclotide- adults only, take before first meal of day
Plecanatide - adults only
Opioid antagonsits/PAMORA for constipation
only work for pts on opiods
Methylnaltrexone
Naldemidine
Naloxegol
Alvimopam (hospital only)
IBS-C vs IBS-D Treatment algorithm
How much dietary fiber for IBS-C?
gradually to goal of 25-35 gm
How much bulk fiber for IBS-C
1 tbsp with one meal per day gradually increases- best evidence favors psyllium
Serotonin 4 agonist for IBC
Tegaserod- REMS, heart issues, only for FEMALES
Dietary modifications for IBS-D
Avoid caffeine, alcohol, artificial sweetners
consider lactose intolerance
herbal products may contain senna
Should we use loperamide for IBS-D
It helps with diarrhea but does not address abdominal pain
Rifaximin & Eluxadoline side effects
Rifaximin- Decreases abd pain, improves stool consistency & bloating
Eluxadoline- alcohol increases pancreatitis risk
5HT3 anatagonist for IBS-D
Alosteron- for females with IBS-D for 6 motnh or longer
Antidepressants
TCAs- only for IBSD bc they slow GI transit time
Duloxetine with anxiety and MDD
TCA or SSRI for IBS abdominal pain