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Clinical Pharmacology Exam 3 > Diarrhea/IBS > Flashcards

Diarrhea/IBS Flashcards

1
Q

Bismuth subsalicylate MOA/indications

A

MOA: Exhibits both anti-secretory, anti-inflammatory, & antimicrobial action

Indications

  • Symptomatic tx of mild diarrhea
  • Prevention & control of Thao’s Traveler’s diarrhea**
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2
Q

Bismuth subsalicylate ADRs

A
  • Darkening of tongue (brush teeth after) & stool*
  • Constipation**
  • Effects of ASA
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3
Q

Loperamide indications

A

MC: Acute nonspecific noninflammatory diarrhea

-Also used for the tx of IBS-D

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4
Q

Abuse of loperamide is common. What is this linked with?

A

-serious arrhythmia and death

“Poor mans methadone”

-has opioid like effects at high doses

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5
Q

Loperamide Contraindications/ADRs

A

CI
-Acute IBD or inflammatory infectious diarrhea

ADRs

  • Constipation
  • Death if overdose
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6
Q

Diphenoxylate & Atropine MOA

A

MOA: Inhibits excessive GI motility & GI propulsion
-Atropine to discourage abuse

-Same indications, CI, and ADRs as loperamide

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7
Q

What are the 4 classifications of IBS

A
  • IBS w/ constipation (IBS-C)
  • IBS with diarrhea (IBS-D)
  • IBS mixed (IBS-M)
  • IBS unclassified (IBS-U)
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8
Q

What is the goal of the treatment of IBS?

A

-Since the exact cause of IBS is unknown, the goal is to manage the symptoms**

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9
Q

What is “KEY” in the management of IBS

A
  • Stress reduction***

- Exercise including yoga may improve the symptoms as well

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10
Q

What is an acronym for the dietary changes used in IBS?

A

Low FODMAP diet
-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, & Polyols

-Also reasonable to avoid gluten

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11
Q

What dietary supplementation may be helpful?

A

-Soluble fiber may be helpful for IBS-C and IBS-D, limited effect on symptoms such as pain

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12
Q

Stepwise approach to IBS

A
  1. Stress reduction
  2. Exercise
  3. Dietary education (Low FODMAP)
  4. Dietary/supplementary fiber
  5. Laxatives: IBS-C patients who don’t respond to fiber
  6. Antidiarrheal: IBS-D can use them as needed
  7. Antispasmodics
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13
Q

Antispasmodics, MOA

A
  • Hyoscyamine
  • Dicyclomine

MOA: Induce intestinal smooth muscle relaxation through myorelaxant effects or anticholinergic mechanisms

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14
Q

Antispasmodics indications/ADRs

A

-Best used for PRN acute attacks of abdominal pain with postprandial symptoms

ADRs
-High dose may lead to anticholinergic ADRs

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15
Q

IBS “Other Options” that have been approved for IBS-C

A
  • Lubiprostone
  • Linaclotide & plecanatide

**See constipation flashies

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16
Q

Tegaserod MOA

A

-Serotonin plays a major role in regulation of GI motility, secretion, & sensation
MOA: Stimulation of 5-HT causes increased secretions and intestinal transit

17
Q

Tenapanor MOA, indications, CI/ADRs

A

MOA: Inhibits sodium/hydrogen exchange, resulting in increased secretions and accelerations of intestinal transit time

-Indications: IBS-C

  • CI in obstruction pts
  • Diarrhea is a common ADR
18
Q

Eluxadoline MOA

A
  • Mu opioid receptor agonist & delta opioid receptor antagonist
  • Tx of IBS-D

ADRs: Nausea, constipation, abd pain

19
Q

What do patients on Eluxadoline have an increased risk for?

A

-Pancreatitis

20
Q

Alosetron

A
  • Serotonin (5-HT3) antagonist

- Highly restricted, last resort for women with severe IBS-D

21
Q

Rifaximin

A

-Approved for the treatment of IBS-D

MOA: thought to alter the microbiota to reduce inflammation

22
Q

Antidepressants for IBS

A

-Used in moderate-severe IBS pts to releive pain, alter GI transit, and treat psych comorbids

  • TCAs: May cause constipation (helpful in IBS-D)
  • SSRIs: May cause diarrhea (Helpful in IBS-C)
23
Q

Probiotics for IBS

A

-Causes change in intestinal flora and may improve pain, bloating, and flatulence

24
Q

Peppermint oil MOA

A
  • Anti-spasmodic properties due to blockade of calcium channels
  • OTC

-ADR: Heartburn

25
Q

What is a non-pharm tx option of IBS?

A

-Psychotherapy

Clinical Pharmacology Exam 3 (19 decks)

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