Irritable Bowel Syndrome
Diagnosis
Persistent abdominal pain has been present for at least three days each month for the past three months (Wu & Juurlink, 2022).
The abdominal pain should be accompanied by at least two of the following:
Relief after defecation
Onset related to changed stool frequency
Onset related to changes in the consistency and appearance of stool (Wu & Juurlink, 2022)
First line treatment
Loperamide is the first-line treatment for inflammatory bowel syndrome (IBS) associated with diarrhea (Black & Ford, 2021).
Dosage and frequency: 4 mg STAT, then 2 mg after every loose stool (Black & Ford, 2021).
The daily dosage should not exceed 16 mg (Black & Ford, 2021).
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Classification of the drug
Antidiarrheal
Mechanism of Action
It acts on circular and longitudinal intestinal muscles to inhibit peristalsis and slow intestinal motility. This prolongs bowel transit time, increases the viscosity of fluids, and improves the consistency and frequency of stool (Wu & Juurlink, 2022).
Three to five more common side effects of the drug
Dizziness
Fatigue
Constipation
Nausea
Angioedema (Wu & Juurlink, 2022).
Three to five most serious side effects
QTc interval prolongation (Wu & Juurlink, 2022)
Torsades de Pointes (Wu & Juurlink, 2022)
Cardiac arrest
Syncope
Contraindications for the drug
Known hypersensitivity
Acute dysentery
Pseudomembranous colitis (White, 2019)
Patients aged below 2 years (White, 2019)
High fever
Labs/tests needed and frequency of the tests
Patients who present with the classic symptoms of IBS do not require laboratory testing (Adams et al., 2020).
Lab tests are recommended for IBS patients with alarm features such as weight loss and iron deficiency anemia (Black & Ford, 2021).
Lab tests recommended for patients with alarm features include a complete blood count and stool examination (Black & Ford, 2021).
List three to five patient teaching essentials.
Patients with IBS should keep a diary that indicates foods that worsen the disease. Examples of these foods include wheat products and beans (Adams et al., 2020). This will enable them to avoid these food products.
Patients should be informed that IBS is a functional disease and that the absence of organic disease is associated with a normal life expectancy (Adams et al., 2020).
Patients should avoid foods rich in fermentable polyols, disaccharides, and oligosaccharides (Black & Ford, 2021).
The patient should discontinue loperamide and seek medical advice if they develop constipation.
The patient should not exceed the recommended dose to avert the risk of cardiac adverse effects such as Torsades de Pointes (Black & Ford, 2021).
Is this medication on the BEERS Criteria list and if so, what is the recommendation?
The medication is not on the BEERS criteria list.
Does your state Medicaid pay for this drug?
Loperamide is covered by Medicaid.
Identify the cost of this drug in Good Rx.
The cost of 12 capsules of loperamide ranges from $6.02 to $12.05 in GoodRx (GoodRx., n.d.).
Does Good Rx have a discount for this drug?
Good Rx offers a discount if buyers use GoodRx Gold to purchase the medication. For instance, individuals will pay $3.94 instead of $6.02 when they use GoodRx Gold (GoodRx., n.d.).
Does the manufacturer of the drug have an indigent plan for this drug?
The manufacturer of loperamide does not have an indigent plan, such as patient assistance programs or copays for the drug.
References
Adams, M., Holland, N., & Urban, C. (2020). Pharmacology for Nurses A Pathophysiologic Approach (6th ed.). Pearson Education, Inc.
Black, C. J., & Ford, A. C. (2021). Best management of irritable bowel syndrome. Frontline Gastroenterology, 12(4), 303–315. https://doi.org/10.1136/flgastro-2019-101298
GoodRx. (n.d.). Loperamide. https://www.goodrx.com/loperamide?form=capsule&dosage=2mg&quantity=12&label_override=loperamide
White, C. M. (2019). Loperamide: A Readily Available but Dangerous Opioid Substitute. Journal of Clinical Pharmacology, 59(9), 1165–1169. https://doi.org/10.1002/jcph.1449
Wu, P. E., & Juurlink, D. N. (2022). Loperamide Cardiac Toxicity–Pathophysiology, Presentation and Management. Canadian Journal of Cardiology. https://doi.org/10.1016/*******You should use your textbook and experts related to your topic such as American Heart Association*****.