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Flashcards in IBS/IBD Deck (107)
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1

what is IBS?

Idiopathic chronic relapsing disorder with abdominal discomfort and change in bowel habits

2

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

3

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)

4

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

5

_______ can improve abdominal pain and global symptoms
They may be considered for patients with moderate to severe symptoms

anti-depressants

6

three main categories of IBS

constipation, diarrhea, abdominal pain/bloating

7

all three kinds of mild IBS are treated with ?

education, stress management, diet and exercise

8

moderate IBS-C txt options

Osmotic Laxative: Polyethylene glycol (Miralax)

9

severe IBS-C txt options (2)

Prescription Laxative:
1. Chloride Channel Activator : lubiprostone
2. Guanylate Cyclase-C Agonist: linaclotide, plecanatide

10

moderate IBS-D txt options (2)

Antidiarrheal Agent:
1. Loperamide
2. Bile Acid Sequestrants

11

severe IBS-D txt options: (2)

Antibiotic : rifaxamin
5-HT3 antagonist : Alosetron

12

moderate IBS- abd pain/bloating txt options (3)

Antispasmodic:
1.Peppermint oil
2.Dycyclomine
3.Hyoscyamine

13

severe IBS-abd pain/bloating txt options (2)

1. TCAs: Amitriptyline
2. SSRIs: -cytalopram and fluoxetine

14

3 groups of drugs we can use for IBS

antidepressants, antispasmotics, probiotics

15

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

16

what two probiotics can we use for IBS?

(lactobacillus & bifidobacterium)

17

what can probiotics do for IBS?

Reduces IBS symptoms
Improve abdominal pain, bloating, flatulence
Help to restore normal GI flora

18

IBS D&C w/ abd pain: txt as a ____ syndrome . first line and second line drugs?

chronic pain
first line: antidepressants (TCAs)
second line: antidepressants (SSRIs)

19

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?

Amitriptyline
-Anticholinergic properties of TCA are helpful at decreasing motility & GI secretions without affecting mental status

20

dosage of TCAs (Amitriptyline) for IBS?

-Low dosage (10-50mg for IBS vs 150mg or more for depression) decreases adverse effects

21

what are the SSRIs we use for second line IBS D&C w/ pain?

Paroxetine (Paxil); Citalopram (Celexa); Fluoxetine (Prozac)

22

the_______ are anticholinergics

antispasmodics

23

what are the 2 antispasmodic drugs we use?

Dicyclomine (Bentyl)
Hyoscyamine (Levsin)

("mine")

24

MOA of anti-spasmodics?

Inhibiting muscarinic input in the enteric plexus & on smooth muscle
Decreases contractility of intestinal smooth muscle

25

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

26

MOA of peppermint oil products (pepogest and IBgard)?

Blocks calcium channels causing relaxation of GI smooth muscle

27

pepogest and IBgard: take ____ a day. when?

3 times a day (before meals)

28

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
Rifaximin (Xifaxan)
Eluxadoline (Viberzi)
Alosetron (Lotronex)

*however, diarrhea often gets better on its own. so question whether these are really needed/helpful

29

MOA of Rifaximin (Xifaxan)

Inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase

30

Abs and excretion of Rifaximin

Minimally absorbed, eliminated unchanged in feces