IBS

Question 1

Signs and symptoms of IBS

Answer 1

Chronic abdominal pain with altered bowel habits (diarrhea or constipation), bloating

Question 2

Rome IV criteria for IBS

Answer 2

Chronic abdominal pain at least 1 day/week in the last 3 months AND AT LEAST 2 OF THE FOLLOWING:

Associated with defecation
Change in stool frequency
Change in form/appearance of stool

Question 3

Does IBS affect women or men more?

Answer 3

Women <50 years old

Question 4

Etiologies of IBS

Answer 4

Genetics, motility factors, colonic infections (gastroenteritis), bowel flora overgrowth, psychological stress

Question 5

Complications: IBS-C

Answer 5

Bristol Stool Chart: >25% of types 1 and 2, <25% of types 6 and 7

Question 6

Complications: IBS-D

Answer 6

Bristol Stool Chart: >25% of types 6 and 7, <25% of types 1 and 2

Question 7

Complications: IBS-M

Answer 7

Bristol Stool Chart: >25% of types 1, 2, 6, and 7

Question 8

IBS treatment goals

Answer 8

Improve stool frequency and consistency, improve global symptoms

Question 9

Treatment options for IBS-C

Answer 9

Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)
Tegaserod (Zelnorm)

Question 10

Lubiprostone is approved for IBS-C in what patients?

Answer 10

WOMEN ONLY

Question 11

Lubiprostone dosing

Answer 11

8mg BID WITH FOOD

Question 12

Lubiprostone side effects

Answer 12

Diarrhea and nausea

Question 13

Secretagogue medications

Answer 13

Linaclotide (Linzess) and plecanatide (Trulance)

Question 14

Linaclotide dosing

Answer 14

290mcg PO QD

Question 15

Plecanatide dosing

Answer 15

3mg PO QD

Question 16

ADE of linaclotide and plecanatide

Answer 16

Diarrhea (Linzess more than Trulance)

Question 17

5-HT4 agonist drug

Answer 17

Tegaserod (Zelnorm)

Question 18

When to use secretagogues in IBS-C therapy

Answer 18

FIRST! It’s first-line!

Question 19

When to use 5-HT4 agonist/tegaserod in IBS-C therapy

Answer 19

Last-line if patients fail to respond to first-line treatment

Question 20

Tegaserod/Zelnorm dosing

Answer 20

6mg PO BID

Question 21

Tegaserod ADE

Answer 21

Increased risk of cardiac events

Question 22

What patients can you use tegaserod/Zelnorm in? (Patient characteristics)

Answer 22

Use in women <65 years old without cardiac history and no more than one risk factor (HTN, smoking, BMI >30, DM, HLD, age >55)

Question 23

When to stop tegaserod/Zelnorm

Answer 23

No benefit seen in 4-6 weeks

Question 24

Treatments for IBS-D

Answer 24

Rifaximin, eluxadoline (Vibrezi), alosetron

Question 25

Rifaximin dosing

Answer 25

550mg PO TID x14 days, can be repeated up to 2 more times in a year

Question 26

Rifaximin has the greatest effect in what patients?

Answer 26

Patients with SIBO

Question 27

Eluxadoline (Vibrezi) dosing

Answer 27

100mg PO BID (alternative is 75mg PO BID)

Question 28

ADE of eluxadoline (Vibrezi)

Answer 28

Sphincter of Oddi dysfunction

Question 29

Contraindications of eluxadoline

Answer 29

History of pancreatitis, no gallbladder, history or current history of alcoholism, patients who ingest ≥3 alcoholic drinks a day

Question 30

Eluxadoline (Vibrezi) drug class

Answer 30

Mu agonist, delta antagonist, kappa agonist

Question 31

Alosetron drug class

Answer 31

5HT-3 antagonist

Question 32

Alosetron dosing

Answer 32

0.5mg PO BID IN WOMEN ONLY

Question 33

When to use alosetron in IBS-D treatment

Answer 33

Patients who have failed rifaximin and eluxadoline

Question 34

Side effects of alosetron

Answer 34

Severe constipation and severe colitis --> REMS PROGRAM!

Question 35

When to stop alosetron treatment

Answer 35

If there's no effect within 4 weeks

Question 36

Treatments for both IBS-D and IBS-C

Answer 36

Tricyclic antidepressants, soluble fiber products, nonpharm care

Question 37

Tricyclic antidepressants for IBS

Answer 37

Amitriptyline and nortriptyline

Question 38

Amitriptyline dosing

Answer 38

50-100mg PO

Question 39

When should you take amitriptyline?

Answer 39

At bedtime due to anticholinergic side effects

Question 40

Nortriptyline dosing

Answer 40

25-75mg PO

Question 41

Soluble fiber products

Answer 41

Psyllium, oat bran, barley, beans

Question 42

Nonpharm care for IBS

Answer 42

Psychotherapy, counseling, relaxation, stress management techniques, hypnosis, cognitive-behavioral treatment