30.2 Antidiarrheals

Diarrhea can be a real pain, but antidiarrheal meds are here to help! These drugs work in different ways to slow things down and dry things up. From opioid agonists to probiotics, there's a range of options to tackle the runs.

Knowing how to use these meds safely is key. We'll look at common drugs like loperamide and bismuth subsalicylate, their side effects, and how to take them right. Plus, we'll cover important tips on staying hydrated and when to see a doctor.

Types and Mechanisms of Antidiarrheal Medications

Opioid receptor agonists, adsorbents, probiotics, antisecretory agents

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• Opioid receptor agonists slow intestinal motility and increase water absorption by acting on opioid receptors in the gut (loperamide, diphenoxylate)
• Adsorbents bind to toxins and bacteria in the intestine, reducing inflammation and fluid secretion (bismuth subsalicylate, attapulgite)
• Probiotics restore balance of gut microbiota, compete with pathogenic bacteria, and enhance immune function (Lactobacillus, Saccharomyces boulardii)
• Antisecretory agents inhibit enkephalinase, reducing secretion of water and electrolytes into the intestine (racecadotril)

Indications, Side Effects, and Drug Interactions

Loperamide, bismuth subsalicylate, probiotics, racecadotril

• Loperamide treats acute and chronic diarrhea, travelers' diarrhea; side effects include abdominal pain, constipation, dizziness, drowsiness; increased risk of CNS depression with other CNS depressants
• Bismuth subsalicylate treats travelers' diarrhea, mild diarrhea, upset stomach; side effects include darkening of tongue and stools, constipation, tinnitus; reduced absorption of tetracyclines, increased risk of bleeding with anticoagulants
• Probiotics treat antibiotic-associated diarrhea, prevent travelers' diarrhea; side effects include bloating, gas, rarely systemic infections in immunocompromised patients; minimal drug interactions, may interact with immunosuppressants
• Racecadotril treats acute diarrhea in adults and children; side effects include headache, nausea, constipation; no significant drug interactions reported

Nursing Considerations and Patient Education

Assess severity, monitor hydration, administer meds, evaluate effectiveness, encourage rehydration

• Assess severity and duration of diarrhea, hydration status, and electrolyte balance to guide treatment
• Monitor for signs of dehydration (dry mucous membranes, decreased skin turgor), electrolyte imbalances (muscle cramps, weakness), and bowel obstruction (abdominal distension, vomiting)
• Administer medications as prescribed, considering route (oral, rectal), dose, and frequency to ensure optimal therapeutic effect
• Evaluate medication effectiveness by monitoring stool frequency and consistency, report adverse reactions promptly to healthcare provider
• Encourage oral rehydration therapy with clear liquids (water, broth, sports drinks) and gradual reintroduction of solid foods as tolerated to maintain hydration and nutrition

Hydration, diet, medication use, hygiene, when to seek care

• Emphasize the importance of staying hydrated with clear liquids and oral rehydration solutions (Pedialyte) to replace lost fluids and electrolytes
• Advise patients to avoid dairy products, caffeine, alcohol, and high-fat or sugary foods during diarrhea episodes as they may worsen symptoms
• Instruct patients to take antidiarrheal medications as directed and not to exceed recommended doses to prevent adverse effects (constipation, abdominal pain)
• Educate patients on common side effects (drowsiness, dizziness) and when to seek medical attention (bloody stools, severe abdominal pain, high fever)
• Encourage good hand hygiene (frequent handwashing) and food safety practices (proper cooking temperatures) to prevent the spread of infectious diarrhea
• Advise patients to consult a healthcare provider if diarrhea persists (>3 days), worsens, or is accompanied by severe symptoms (dehydration, bloody stools) for further evaluation and treatment