Pharmacologic Profile

General Use

For the control and symptomatic relief of acute and chronic nonspecific diarrhea.

General Action and Information

Diphenoxylate/atropine, difenoxin/atropine, and loperamide slow intestinal motility and propulsion. Bismuth subsalicylate affects fluid content of the stool. Bismuth subsalicylate is also used as part of the management of peptic ulcer disease due to Helicobacter pylori. Polycarbophil acts as an antidiarrheal by taking on water within the bowel lumen to create a formed stool. Polycarbophil may also be used to treat constipation. Octreotide is used specifically for diarrhea associated with GI endocrine tumors.

Contraindications

Previous hypersensitivity. Severe abdominal pain of unknown cause, especially when associated with fever.

Precautions

Use cautiously in patients with severe liver disease or inflammatory bowel disease. Safety in pregnancy and lactation not established (diphenoxylate/atropine and loperamide). Octreotide may aggravate gallbladder disease.

Interactions

Polycarbophil ↓ the absorption of tetracycline. Octreotide may alter the response to insulin or oral hypoglycemic agents.

Nursing Implications

Assessment

• Assess the frequency and consistency of stools and bowel sounds before and throughout therapy.
• Assess patient's fluid and electrolyte status and skin turgor for dehydration.

Potential Nursing Diagnoses

• Diarrhea (Indications)
• Constipation (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Shake liquid preparations before administration.

Patient/Family Teaching

• Instruct patient to notify health care professional if diarrhea persists; or if fever, abdominal pain, or palpitations occur.

Evaluation/Desired Outcomes

• Decrease in diarrhea.

Antidiarrheals included in Davis's Drug Guide for Nurses

• bismuth subsalicylate
• difenoxin/atropine
• diphenoxylate/atropine
• loperamide
• octreotide
• polycarbophil