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Summer pharm 4 > IBS > Flashcards

IBS Flashcards

1
Q

What is IBS

A

a chronic GI disorder with abdominal pain and altered bowel habits

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2
Q

What causes IBS

A 
Visceral hypersensitivity 
altered bowel motility 
neurotransmitter imbalance 
infection 
psychosocial factors
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3
Q

Symptoms of IBS are

A 
abdominal pain 
distention 
bloating 
indigestion
various Sx of defecation
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4
Q

What are the 3 subcategories of IBS

A

Pain with diarrhea
Pain with constipation
Pain with diarrhea and constipation

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5
Q

Patients with IBS can self administer meds to alleviate these Sx

A 
headache 
sleep disturbance
MSK chest pain 
nausea
heartburn
back pain
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6
Q

Foundation for treating IBS is

A

diet and lifestyle modification
Low FODMAP diet (fermentable oligo-, di-, and monosaccharides and polyols)
Exclude foods that increase flatulence, alcohol, and caffeine
Exercise

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7
Q

What foods are in FODMAP

A

O: wheat, barley, rye, onion, cashew, pistacchio, legumes, chickpeas
D: lactose
M: apple, pear, mango, cherries, asparagus
P: apricots, nectarines, mushrooms
(there are a ton more i didn’t write)

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8
Q

Pharm therapy principle for treating IBS is

A

Tx directed at relieving abdominal pain and improving bowel function

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9
Q

For diarrhea predominant IBS, initial Tx is

A

antidiarrheal agent- Loperamide

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10
Q

For constipation predominant IBS, initial Tx is

A

Fiber to soften stool and reduce straining (but be careful bc increased gas production can exacerbate bloating)
1. Psyllium/ispaghula
if this fails, try Polyethylene glycol
Alternate: Lubiprostone, Linaclotide

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11
Q

What serotonin receptors are in the gut

A 
Type 3 (5-HT3) 
Type 4 (5-HT4) 
They are responsible for secretion, sensitization, and motility
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12
Q

What is polyethylene glycol

A

Osmotic laxative
Improves constipation but NOT abdominal pain
Start w/ 17g powder in 8oz water, titrate up or down. Max 34g

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13
Q

ADE of PEG are

A

Bloating

Abdominal discomfort

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14
Q

What is Lubiprostone

A

Prostanoic acid derivative
Stimulates T2 chloride channels in small intestine= increase chloride secretion into sm. int= stimulate intestinal motility and shorten transit time
Good for women 18+ w/ IBS-C, efficacy for men unproven

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15
Q

ADE for Lubiprostone are

A

Nausea 2/2 delayed gastric emptying
Pregnancy category C, increased fetal loss in guinea pigs
Dose must be reduced if w/ severe hepatic impairment

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16
Q

What is Guanlyate Cyclase-C Agonist Linaclotide (Linzess)

A

Stimulates intestinal fluid secretion and transit time
Good for those with persistent constipation where PEG didn’t work- improves abdominal pain, bloating, straining, stool consistency, and spontaneous BM x week
290 mcg daily

17
Q

MC side effect of Linzess is

A

Diarrhea

18
Q

What is Tegaserod

A

5-HT4 agonist that stimulates the release of NT and increases colonic motility
Used only for emergent Tx of IBS with constipation in women <55 y/o

19
Q

Do we like Tegaserod

A

No, it was voluntarily removed from the market (except for emergency) 2/2 increased # of CV death

20
Q

What does Loperamide do

A 
Inhibit peristalsis 
Prolong transit time 
Reduce fecal volume 
Decrease stool frequency and consistency, but does NOT relieve bloating, abd pain, or global IBS Sx 
Take 2mg 45 min before meal 
Good for alternating IBS!
21
Q

What is Eluxadoline (Viberzi)

A

Mixed mu&kappa-opioid receptor agonist, and delta antagonist
Reduces abdominal pain and diarrhea w/o constipating effects
BUT has abuse potential!

22
Q

Contraindications to Eluxadoline are

A

biliary d/o
pancreatitis (esp. severe in those w/o a gallbladder)
severe liver impairment (adjust dose)
heavy alcohol use

23
Q

MC ADE of Eluxadoline are

A

nausea, constipation, abdominal pain
pancreatitis in those w/ biliary d/o or alcoholics
CNS depression

24
Q

What is second line for IBS-D

A

Bile acid sequestrants (Cholestyramine, colestipol, colesevelam)

25
Q

GI ADE of Bile Acid Sequestrants are

A

bloating
flatulence
abdominal discomfort
constipation

26
Q

What are 5-HT3 antagonists

A

Ondansetron, Granisteron, Dolasteron, Palonosteron
Inhibiting this receptor stops the activation of afferent pain sensation from gut to spinal cord/CNS
= Less visceral pain, nausea, and bloating

27
Q

Ondansetron and the other %-HT3 antagonists can also be used to Tx

A

Nausea and vomiting (zofran!)

28
Q

5-HT3 receptor block on terminals of enteric cholinergic neurons inhibits

A

colonic motility, esp. in left colon= increased total transit time

29
Q

Alsoteron is good for

A

women with severe IBS-D who did not respond to conventional therapies, and have been educated on risks
efficacy in men not established- not used for them

30
Q

What are the PK of Alosteron

A

Very potent 5-HT3 antagonist
rapidly absorbed from GI tract (duration longer than 1/2 life makes it seem)
Extensive hepatic CYP450 metabolism
Renal excretion
Dissociates slower than other 5-HT3 antag. b/c it binds with higher affinity receptors

31
Q

What is the efficacy of Alosteron

A

Reduce IBS related lower abdominal pain, cramps, urgency, and diarrhea
Leads to reduction in mean # of BM per day, and stool consistency

32
Q

ADE of Alosteron are

A 
rare but serious GI toxicity 
Constipation 
Hospitalization or surgery 
Episodes of ischemic colitis 
-Requires FDA approved restricted program
33
Q

Alosteron interacts with

A

Nothing significant! Even though it is a CYP450 enzyme

34
Q

Chronic abdominal pain in IBS can be treated with

A

Low dose TCA (Amitryptaline, Desipramine)- they’re anticholinergics!
They alter central processing of visceral afferent information; Reduce stool frequency and liquidity; Alter NT receptors (serotonin) affectung visceral sensation

35
Q

What anti-spasmodics are used in IBS

A

Dicyclomine and Hyoscyamine
They inhibit muscarinic cholinergic receptors in enteric plexus and smooth muscle
Use low dose to avoid autonomic effects
not usually used 2/2 efficacy not convincingly proven

36
Q

ADE of high dose anti-spasmodics are

A 
dry mouth 
visual disturbance 
urinary retention 
constipation 
(anticholinergics)

Summer pharm 4 (14 decks)

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