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Emergency Medicine Clinics of North... Aug 2021In recent years, there has been an emergence of numerous novel drugs. Such toxicity may occur in both adolescents and adults. This article discusses the opioid epidemic... (Review)
Review
In recent years, there has been an emergence of numerous novel drugs. Such toxicity may occur in both adolescents and adults. This article discusses the opioid epidemic and several emerging opioids, including buprenorphine, loperamide, fentanyl, fentanyl derivatives, and others. Kratom, a plant occasionally used for opiate detoxification, along with the sedatives etizolam and phenibut, will be discussed. Lastly, this article discusses the phenethylamines and marijuana.
Topics: Analgesics, Opioid; Buprenorphine; Cannabinoids; Designer Drugs; Drug Overdose; Fentanyl; Humans; Hypnotics and Sedatives; Illicit Drugs; Loperamide; Mitragyna; Naloxone; Narcotic Antagonists; Phenethylamines; Substance-Related Disorders
PubMed: 34215409
DOI: 10.1016/j.emc.2021.04.013 -
ACS Chemical Neuroscience Aug 2021Loperamide, a popular and inexpensive over-the-counter antidiarrheal medicine, is a potent μ-opioid receptor agonist approved by the U.S. Food and Drug Administration... (Review)
Review
Loperamide, a popular and inexpensive over-the-counter antidiarrheal medicine, is a potent μ-opioid receptor agonist approved by the U.S. Food and Drug Administration (FDA). It has been on the market since 1976 and is relatively safe with no central nervous system-related side effects when used for a short period of time at the recommended therapeutic dose (2-8 mg/day). In recent years, loperamide has become notoriously known as the "poor man's methadone" for people with substance dependence due to the increase in loperamide overdoses from self-administered medication to treat opioid withdrawal symptoms. As a result, in 2018, the FDA decided to limit the available packaged dose of loperamide to stop prominent abuse. This review provides the synthesis and chemical properties of loperamide as well as the pharmacology and adverse effects of its use and the social effects of such abuse.
Topics: Analgesics, Opioid; Antidiarrheals; Drug Overdose; Humans; Loperamide; Substance-Related Disorders
PubMed: 34346690
DOI: 10.1021/acschemneuro.1c00382 -
The American Journal of Medicine Mar 2021
Topics: Aged; Humans; Kaolin; Mining; Pneumoconiosis
PubMed: 32858018
DOI: 10.1016/j.amjmed.2020.07.033 -
The American Journal of Medicine Aug 2020Estimates suggest that 43%-79% of international travelers may develop travel-related illnesses. Most such illnesses are considered mild and self-limited; however, some... (Review)
Review
Estimates suggest that 43%-79% of international travelers may develop travel-related illnesses. Most such illnesses are considered mild and self-limited; however, some are life-threatening. The pretravel consultation is aimed at assessing risks for a range of illnesses, communicating these risks, and then providing individualized recommendations and interventions to minimize or manage such risks. The effective consultation is predicated on a well-prepared clinician and motivated traveler, understanding the traveler's perception of, and tolerance for, risk, and providing education applicable to the actual itinerary. Integral to the clinician's preparation is regular review of up-to-date trip-specific recommendations; country-specific information and recommendations are readily available and can now be efficiently accessed. From the infectious diseases perspective, immunizations, malaria chemoprophylaxis, insect repellent use, and travelers' diarrhea and its self-management are cornerstones of the consultation. This review focuses primarily on updating these 4 topics with recently published information relevant to adult travelers.
Topics: Anti-Bacterial Agents; Antidiarrheals; Antimalarials; Bites and Stings; Chemoprevention; Dysentery; Fluid Therapy; Humans; Insect Repellents; Malaria; Patient Education as Topic; Referral and Consultation; Risk Assessment; Self-Management; Travel; Travel Medicine; Travel-Related Illness; Vaccines
PubMed: 32179056
DOI: 10.1016/j.amjmed.2020.02.005 -
Expert Opinion on Pharmacotherapy Apr 2020Short bowel syndrome (SBS) has traditionally been regarded as a rapidly fatal medical catastrophe. The advent of pharmacological options directly targeting disease... (Review)
Review
INTRODUCTION
Short bowel syndrome (SBS) has traditionally been regarded as a rapidly fatal medical catastrophe. The advent of pharmacological options directly targeting disease pathophysiology justified this review.
AREAS COVERED
Since the 1970s, home parenteral nutrition has reduced mortality, converting SBS into a chronic and disabling compensated and occasionally curable illness. Off-label antidiarrheal drugs and related products, though having minimal scientific evidence of efficacy, represent the standard-of-care and are here reviewed. Trophic intestinal hormones, including GLP-2 and its analogs, have great promise for alleviating malabsorption, the most important symptom within a nonsurgical, routine outpatient framework. Current indications involve adults with massive intestinal losses (fecal wet weight >1500 g/day). Surgical options such as intestinal lengthening or transplantation are also addressed although these options are considerably more aggressive and have stricter indications.
EXPERT OPINION
GLP-2 analogs are the first candidates from a pioneering pharmacotherapic family within the SBS framework, namely disease-modifying, absorption-restoring agents. This family of drugs, potentially applicable in all contexts of severe intestinal loss, could become the therapeutic benchmark of the near future.
Topics: Adult; Animals; Antidiarrheals; Glucagon-Like Peptide 2; Humans; Intestines; Off-Label Use; Parenteral Nutrition, Home; Short Bowel Syndrome
PubMed: 32057270
DOI: 10.1080/14656566.2020.1724959 -
The New England Journal of Medicine Aug 2020
Topics: Abdominal Pain; Adult; Anemia, Hypochromic; Anorexia; Diagnosis, Differential; Drug Contamination; Erythrocytes; Fatigue; Hematologic Tests; Humans; Lead; Lead Poisoning; Male; Opium; Opium Dependence; Porphyrias; Seizures
PubMed: 32757528
DOI: 10.1056/NEJMcps1900799 -
Journal of the American College of... Oct 2023
Topics: Humans; Loperamide; Arrhythmias, Cardiac; Drug Overdose
PubMed: 37852700
DOI: 10.1016/j.jacc.2023.06.054 -
Current Opinion in Infectious Diseases Aug 2020The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to... (Review)
Review
PURPOSE OF REVIEW
The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics.
RECENT FINDINGS
Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications or underlying medical conditions, sometimes Clostridioides difficile, and occasionally viruses. Other infections are rare.
SUMMARY
Clinical assessment remains fundamental to the evaluation of HCAD and targeted testing for C. difficile is sufficient in most patients. Multiplex gastrointestinal panels may have a role in immunocompromised patients but more study is needed. Medication-induced diarrhea is common and underappreciated and not limited to antibiotics, laxatives, and enemas.
Topics: Anti-Bacterial Agents; Antidiarrheals; Clostridioides difficile; Clostridium Infections; Cross Infection; Delivery of Health Care; Diarrhea; Escherichia coli; Hospitalization; Humans; Immunocompromised Host; Laxatives; Multiplex Polymerase Chain Reaction; Prevalence; Salmonella
PubMed: 32657969
DOI: 10.1097/QCO.0000000000000653 -
NPJ Biofilms and Microbiomes Jun 2023The diarrheal disease causes high mortality, especially in children and young animals. The gut microbiome is strongly associated with diarrheal disease, and some...
The diarrheal disease causes high mortality, especially in children and young animals. The gut microbiome is strongly associated with diarrheal disease, and some specific strains of bacteria have demonstrated antidiarrheal effects. However, the antidiarrheal mechanisms of probiotic strains have not been elucidated. Here, we used neonatal piglets as a translational model and found that gut microbiota dysbiosis observed in diarrheal piglets was mainly characterized by a deficiency of Lactobacillus, an abundance of Escherichia coli, and enriched lipopolysaccharide biosynthesis. Limosilactobacillus mucosae and Limosilactobacillus reuteri were a signature bacterium that differentiated healthy and diarrheal piglets. Germ-free (GF) mice transplanted with fecal microbiota from diarrheal piglets reproduced diarrheal disease symptoms. Administration of Limosilactobacillus mucosae but not Limosilactobacillus reuteri alleviated diarrheal disease symptoms induced by fecal microbiota of diarrheal piglets and by ETEC K88 challenge. Notably, Limosilactobacillus mucosae-derived extracellular vesicles alleviated diarrheal disease symptoms caused by ETEC K88 by regulating macrophage phenotypes. Macrophage elimination experiments demonstrated that the extracellular vesicles alleviated diarrheal disease symptoms in a macrophage-dependent manner. Our findings provide insights into the pathogenesis of diarrheal disease from the perspective of intestinal microbiota and the development of probiotic-based antidiarrheal therapeutic strategies.
Topics: Animals; Swine; Mice; Antidiarrheals; Diarrhea; Microbiota; Lactobacillus; Bacteria; Escherichia coli; Homeostasis
PubMed: 37280255
DOI: 10.1038/s41522-023-00403-6 -
The New England Journal of Medicine Dec 2022
Topics: Humans; Bismuth; Salicylates; Organometallic Compounds
PubMed: 36449423
DOI: 10.1056/NEJMicm2027922