Loperamide for Secretory Diarrhoea — SCE Palliative Medicine MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: B — Loperamide 4 mg initially then 2 mg after each loose stool (maximum 16 mg per day)
Explanation lettering: B = shown as A · D = shown as B · A = shown as D
UK palliative care guidelines designate loperamide as the first‑line antidiarrhoeal for malignant diarrhoea: start with 2 mg after each loose stool (up to 16 mg/day), with escalation to regular dosing if needed, and switch to codeine if loperamide fails ([england.nhs.uk](https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf?utm_source=openai)). St George’s Acute Oncology protocol advises loperamide 4 mg after first loose stool, then 2 mg after each subsequent stool, up to 16 mg/day, reserving codeine phosphate if ineffective ([stgeorges.nhs.uk](https://www.stgeorges.nhs.uk/aos/st-georges-healthcare-professional/guidance/diarrhoea/?utm_source=openai)). Codeine alone (A) is second‑line, not first. The kaolin–morphine mixture (B) is outdated. Bismuth subsalicylate (C) and activated charcoal (E) are not used in this context.
Reference: NHS Palliative Care Pain & Symptom Control Guidelines (NHS Commissioning) and St George’s AOS Diarrhoea Management Guidance (both UK, current), https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf