Flashcards in IBS/IBD Deck (107)
what is IBS?
Idiopathic chronic relapsing disorder with abdominal discomfort and change in bowel habits
What is the goal with txt of IBS?
relieve symptoms (constipation, diarrhea, abd pain/bloating) and improve bowel function
-we don't know what causes it so we just txt symptoms
IBS is a chronic ____ not a chronic _____ condition. what does this mean for us when txting it?
chronic relapsing not chronic progressive
- although we want to give comfort, careful with meds as risks can outweigh benefits (b/c we're not decreasing morbidity/serious complications with our treatment anyways)
IBS what are some examples of food triggers vs natural fiber sources ?
food trigger example: raw veges, caffeine, carbonation, fructose and sorbitol
natural fiber example: Beans (navy, kidney, pinto); broccoli, celery, apples, pears, strawberries
_______ can improve abdominal pain and global symptoms
They may be considered for patients with moderate to severe symptoms
three main categories of IBS
constipation, diarrhea, abdominal pain/bloating
all three kinds of mild IBS are treated with ?
education, stress management, diet and exercise
moderate IBS-C txt options
Osmotic Laxative: Polyethylene glycol (Miralax)
severe IBS-C txt options (2)
1. Chloride Channel Activator : lubiprostone
2. Guanylate Cyclase-C Agonist: linaclotide, plecanatide
moderate IBS-D txt options (2)
2. Bile Acid Sequestrants
severe IBS-D txt options: (2)
Antibiotic : rifaxamin
5-HT3 antagonist : Alosetron
moderate IBS- abd pain/bloating txt options (3)
severe IBS-abd pain/bloating txt options (2)
1. TCAs: Amitriptyline
2. SSRIs: -cytalopram and fluoxetine
3 groups of drugs we can use for IBS
antidepressants, antispasmotics, probiotics
antidepressants can be used for ____
while antispasmotics can be used for _____
both txt abdominal pain but in addition...
antidepressants: global symptoms
antispasmodics: acute attacks of pain or before meals for postprandial symptoms
what two probiotics can we use for IBS?
(lactobacillus & bifidobacterium)
what can probiotics do for IBS?
Reduces IBS symptoms
Improve abdominal pain, bloating, flatulence
Help to restore normal GI flora
IBS D&C w/ abd pain: txt as a ____ syndrome . first line and second line drugs?
first line: antidepressants (TCAs)
second line: antidepressants (SSRIs)
what TCA-antidepressant do we go to for IBS D&C w/pain? what properties of this drug are helpful for this kind of IBS and how?
-Anticholinergic properties of TCA are helpful at decreasing motility & GI secretions without affecting mental status
dosage of TCAs (Amitriptyline) for IBS?
-Low dosage (10-50mg for IBS vs 150mg or more for depression) decreases adverse effects
what are the SSRIs we use for second line IBS D&C w/ pain?
Paroxetine (Paxil); Citalopram (Celexa); Fluoxetine (Prozac)
the_______ are anticholinergics
what are the 2 antispasmodic drugs we use?
MOA of anti-spasmodics?
Inhibiting muscarinic input in the enteric plexus & on smooth muscle
Decreases contractility of intestinal smooth muscle
peppermint oil can be useful for what kind of IBS? what are the 2 products we can use?
IBS D&C w/ abd pain
pepogest and IBgard
MOA of peppermint oil products (pepogest and IBgard)?
Blocks calcium channels causing relaxation of GI smooth muscle
pepogest and IBgard: take ____ a day. when?
3 times a day (before meals)
5 drugs utlized for IBS w/ diarrhea
Loperamide (Imodium) - anticholinergic, opiod binding
Diphenoxylate (Lomotil) -anticholineric and opiod binding- combined with atropine b/c potential for abuse
*however, diarrhea often gets better on its own. so question whether these are really needed/helpful
MOA of Rifaximin (Xifaxan)
Inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase