NUR 600: ADVANCED CLINICAL PHARMACOLOGY: GASTROINTESTINAL
(GI):EXAM 5 STUDY GUIDE QUESTIONS WITH COMPLETE SOLUTIONS
Diarrhea -- Answer ✔✔ Diarrhea: diarrhea is an increase in frequency of loose
watery stools (three or more daily), usually over a period of 24 to 48 hours• The
organisms that cause diarrhea are easily transferred from person to person through
food and water.• Children, the elderly, and those who are immunocompromised are
most susceptible to the complications of diarrhea, and serious dehydration can result
from the disorder.
Medications causing Diarrhea -- Answer ✔✔ Antacids (magnesium containing)
antibiotics
Antidepressants (selective serotonin reuptake inhibitors)• Cholinergic agents
colchicine
Digoxin
Gastrointestinal stimulants (metoclopramide)
Laxatives, prostaglandin analog (misoprostol)
Quinidine
metformin
prostaglandins (dinoprostone)
Infective Organisms associated with diarrhea -- Answer ✔✔ Aeromonas species
,Bacillus cereus
Campylobacter
Chlamydia trachomatis
Clostridium difficile
Cryptosporidium
Escherichia coli
Entamoeba histolytica
Giardia
Mycobacterium avium-intracellulare
Salmonella
Shigella
Staphylococcus aureus
Viral agents
Yersinia
Disorders and Procedures Associated with Diarrhea -- Answer ✔✔ Aids
Bowel Resection
Colon Cancer
Diverticulitis
Enteral Feedings
Gastroenteritis
Hyperthyroidism
IBS
Lactose Intolerance
Malabsorption
Pheocromocytoma
, Dietary and lifestyle changes -- Answer ✔✔ Avoid foods that exacerbate the
symptoms (e.g.,lactose, caffeine, fatty, or spicy foods)
Incorporate routine exercise into daily activities
Explore the life stressors that aggravate the symptoms.
Learn ways to deal with stress, such as meditation, counseling, and biofeedback.
Antidiarrheals -- Answer ✔✔ Antimotility agents Loperamide (Imodium) 4-16 mg/d
in divided doses
Diphenoxylate/atropine: (Lomotil) 2.5-5 mg qid•
Selected antisecretory agents
Bismuth subsalicylate (Pepto-Bismol): start: 2 tablets or 30 mL; range: two tablets or
30 mL every 30 min to 1 h up to 8 doses
Polycarbophil (Fiber-Con) 1-6 g/d
Kaolin and bismuth salicylate (Kaopectate): start: 30-120 mL of liquid or two tablets
after each bowel movement; range: up to 7 doses a day• Semi-synthetic antibiotic
Rifaximin (Xifaxan): TD: 200-mg tablets tid x 3days
Recommended order of treatment for diarrhea -- Answer ✔✔ First line:
Loperamide: easy to use, tablet or liquid; Rifaximin (TD): well tolerated, 3-day
course•
Second line: Adsorbents or antisecretory agent: selection based on drug-drug
interactions or allergies (e.g., aspirin sensitivity and bismuth subsalicylate)•
Third line: Diphenoxylate: side effect profile, especially with atropine added, lowers
the utility of this agent
Rome III criteria for irritable bowel syndrome -- Answer ✔✔ Diagnostic criterion
must be fulfilled for the last 3months with symptom onset at least 6 months prior to
diagnosis
Recurrent abdominal pain or discomfort at least 3days/month in the last 3 months
associated with two of the following: Improvement with defecation Onset associated
(GI):EXAM 5 STUDY GUIDE QUESTIONS WITH COMPLETE SOLUTIONS
Diarrhea -- Answer ✔✔ Diarrhea: diarrhea is an increase in frequency of loose
watery stools (three or more daily), usually over a period of 24 to 48 hours• The
organisms that cause diarrhea are easily transferred from person to person through
food and water.• Children, the elderly, and those who are immunocompromised are
most susceptible to the complications of diarrhea, and serious dehydration can result
from the disorder.
Medications causing Diarrhea -- Answer ✔✔ Antacids (magnesium containing)
antibiotics
Antidepressants (selective serotonin reuptake inhibitors)• Cholinergic agents
colchicine
Digoxin
Gastrointestinal stimulants (metoclopramide)
Laxatives, prostaglandin analog (misoprostol)
Quinidine
metformin
prostaglandins (dinoprostone)
Infective Organisms associated with diarrhea -- Answer ✔✔ Aeromonas species
,Bacillus cereus
Campylobacter
Chlamydia trachomatis
Clostridium difficile
Cryptosporidium
Escherichia coli
Entamoeba histolytica
Giardia
Mycobacterium avium-intracellulare
Salmonella
Shigella
Staphylococcus aureus
Viral agents
Yersinia
Disorders and Procedures Associated with Diarrhea -- Answer ✔✔ Aids
Bowel Resection
Colon Cancer
Diverticulitis
Enteral Feedings
Gastroenteritis
Hyperthyroidism
IBS
Lactose Intolerance
Malabsorption
Pheocromocytoma
, Dietary and lifestyle changes -- Answer ✔✔ Avoid foods that exacerbate the
symptoms (e.g.,lactose, caffeine, fatty, or spicy foods)
Incorporate routine exercise into daily activities
Explore the life stressors that aggravate the symptoms.
Learn ways to deal with stress, such as meditation, counseling, and biofeedback.
Antidiarrheals -- Answer ✔✔ Antimotility agents Loperamide (Imodium) 4-16 mg/d
in divided doses
Diphenoxylate/atropine: (Lomotil) 2.5-5 mg qid•
Selected antisecretory agents
Bismuth subsalicylate (Pepto-Bismol): start: 2 tablets or 30 mL; range: two tablets or
30 mL every 30 min to 1 h up to 8 doses
Polycarbophil (Fiber-Con) 1-6 g/d
Kaolin and bismuth salicylate (Kaopectate): start: 30-120 mL of liquid or two tablets
after each bowel movement; range: up to 7 doses a day• Semi-synthetic antibiotic
Rifaximin (Xifaxan): TD: 200-mg tablets tid x 3days
Recommended order of treatment for diarrhea -- Answer ✔✔ First line:
Loperamide: easy to use, tablet or liquid; Rifaximin (TD): well tolerated, 3-day
course•
Second line: Adsorbents or antisecretory agent: selection based on drug-drug
interactions or allergies (e.g., aspirin sensitivity and bismuth subsalicylate)•
Third line: Diphenoxylate: side effect profile, especially with atropine added, lowers
the utility of this agent
Rome III criteria for irritable bowel syndrome -- Answer ✔✔ Diagnostic criterion
must be fulfilled for the last 3months with symptom onset at least 6 months prior to
diagnosis
Recurrent abdominal pain or discomfort at least 3days/month in the last 3 months
associated with two of the following: Improvement with defecation Onset associated
