Antidiarrheal

Acute (short-term) diarrhea refers to a sudden change of bowel movements such that there is a frequent (three or more times per day) passage 

Absorbents, such as kaolin (a hydrated aluminum silicate clay mineral), pectin (a complex carbohydrate often extracted from fruits), and atta-pulgite (a hydrated magnesium aluminum silicate clay mineral), form a thickening powder that absorbs excess fluid and any bacterial toxins present (action of kaolin and attapulgite) and increases the consistency of the stool by forming a viscous colloidal solution (action of pectin). However, these agents may also absorb essential body enzymes and nutrients. 

Many types of bismuth mineral salts (e.g., bismuth subsalicylate) are generally multipurpose intestinal medicinal agents. As an antisecretory agent, bismuth subsalicylate coats and protects irritated and inflamed intestinal lumen tissue (antiulcer actions), decreases the secretion of fluid into the intestine, absorbs or neutralizes bacterial toxins, inhibits any bacterial activity (antidiarrhea actions), and also increases alkaline secretion to counteract any acid production (antacid action). Thus, this agent controls the frequent voluminous loss of watery stools while relieving intestinal cramping and irritation. 

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Diagnosis and alleviation of the cause, if possible, is of primary importance. Often, however, this is not possible and therapy is used to alleviate the inconvenience and pain of diarrhea. These compounds usually only mask the underlying factors producing the problem. Diarrhea may cause significant dehydration and loss of electrolytes and is a particularly serious problem in infants. Antidiarrheals do not usually prevent the loss of fluids and electrolytes into the large bowel and, although these may prevent frequent defecation, often the serious imbalance of body electrolytes and fluids is not significantly affected. 

Diphenoxylate Hydrochloride. l-(3-Cyano-3,3-diphenylpropyl)-4-phenyl-4-piperidinecarboxyhc acidmonohydrochlorhydrate [3810-80-8] (Lomotil) (13) is a white, odorless, crystalline powder that melts at 220—226°C. It is soluble ia methanol, spariagly soluble ia ethanol and acetone, slightly soluble ia water and isopropyl alcohol, freely soluble ia chloroform, and practically iasoluble ia ether and hexane. The method of preparation for diphenoxylate hydrochloride is available (11). Diphenoxylate hydrochloride [3810-80-8] (13) is an antidiarrheal that acts through an opiate receptor. It has effects both on propulsive motility and intestinal secretion. Commercial forms are mixed with atropiae to discourage abuse. 

Weakly absorbed aminoisoxazole (636) has reported antidiarrheal effects in pigs without any side effects (77MIP41600). Sulfanilamide isoxazoles have been used to control atrophic rhinitis in newborn swine. 

Rolgamidine (14) is a dihydropyrrole derivative which has antidiarrheal activity It can be synthesized by alkylation of trans 2,5-dimethyl-3 pyrroline (12) with methyl bromoacefate to give 13 An amide-ester exchange reaction with guanidine hydrochloride completes the synthesis of rolgamidine (14) [3]... 

Examples small amounts of narcotics (codeine) used as antitussives or antidiarrheals... 

When an opiate is used as an antidiarrheal drug, the nurse records each bowel movement, as well as its appearance, color, and consistency. The nurse should notify the primary health care provider immediately if diarrhea is not relieved or becomes worse if die patient has severe abdominal pain or if blood in die stool is noted. 

These dm may produce withdrawal symptoms in those physically dependent on the narcotics. The patient must not have taken any opiate for the last 7 to 10 days. Naloxone may prevent die action of opioid antidiarrheals, antitussives, and analgesics. This drug is used cautiously during lactation. 

Antidiarrheals decrease intestinal peristalsis, which is usually increased when the patient has diarrhea. Examples of these drug s include difenoxin with atropine (Motofen), diphenoxylate witii atropine (Lomotil), and loperamide (Imodium). 

These drugs are contraindicated in patients whose diarrhea is associated witii organisms that can harm the intestinal mucosa (Escherichia coli, Salmonella, Shigella) and in patients with pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice The antidiarrheal drugs are contraindicated in children younger than 2 years. 

The antidiarrheal drugs are used cautiously in patients with severe hepatic impairment or inflammatory bowel disease Antidiarrheals are classified as Pregnancy Category B drugs and should be used cautiously during pregnancy and lactation. 

The antidiarrheal drugs cause an additive CNS depression when administered with alcohol, antihistamines, narcotics, and sedatives or hypnotics. There are additive cholinergic effects when administered with other drugp having anticholinergic activity, such as antidepressants or antihistamines. Concurrent use of the antidiarrheals witii a monoamine oxidase inhibitor increases the risk of a hypertensive crisis. 

ANTIDIARRHEALS. These drags may be ordered to be given after each loose bowel movement. The nurse inspects each bowel movement before making a decision to administer the drag. 

ANTIDIARRHEALS. The nurse notifies the primary health care provider if an elevation in temperature occurs or if severe abdominal pain or abdominal rigidity or distention occurs because this may indicate a complication of the disorder, such as infection or intestinal perforation. If diarrhea is severe, additional treatment measures, such as IV fluids and electrolyte replacement, may be necessary. 

Antidiarrheal medications that reduce GI motility, such as loperamide, diphenoxylate/atropine, or codeine should be avoided in patients with active IBD due to the risk of precipitating acute colonic dilation (toxic megacolon). 

Educate the patient about (1) the causes of acute and chronic diarrhea (2) the possible complications of diarrhea (3) the goals of treatment for diarrhea (4) the antidiarrheal medication used to manage acute or chronic diarrhea and (5) if appropriate, the circumstances when antibiotics are used to treat diarrhea. 

Bowel symptoms in MS patients can include both fecal incontinence and constipation. Fecal incontinence is difficult to treat. Some patients may have improvement if they use a regular schedule for emptying the bowel with laxative suppositories or enemas. Alternatively, antidiarrheal medications such as loperamide can be used.14... 

HT3 antagonist, prochlorperazine for emesis (avoid corticosteroids), H2 blocker for gastritis, antidiarrheal as needed (loperamide, diphenoxylate/atropine, codeine). 

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