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PDAT2 > 28 - IBS > Flashcards

28 - IBS Flashcards

1
Q

Normal Bowel Function

A

3x / Day

to

1x every 2-3 days

Frequencies Vary based on:
Age / Diet / Activity level / Medications

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2
Q

IBS Definition

A

Alterations in MOTILITY
w-o-w
Ab Pain = visceral hypersitivity /// Bloating

Linked to gut microbiota
may have SIBO = small intestinal bacterial overgrowth

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3
Q

IBS - D

A

TYPE 6 or 7
on bristol stool chart

Increase in
BM Frequency
Daily Stool Weight + Amount
Fluidity

S/Sx
weight loss / nausea / anorexia

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4
Q

IBS-C

A

TYPE 1 or 2
Stool on Bristol chart

Decrease in
BM Frequency = <2/week
Daily stool weight / amount
Fluidity

S/Sx

  • *Straining / Incomplete** evacuation
  • *Hard / Lumpy Stools**
  • *Sensation of anorectal Blockade/Obstruction**
  • *Manual Disimpaciton**
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5
Q

IBS Stool Chart

3-5 is ideal

Type 1&2 closer to
Constipation

Types 6&7 closer to
diarrhea

A
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6
Q

SEE MD
for IBS

A

Symptoms
Fevers / Weight loss
Nocturnal Diarrhea // MELANA-ANEMIA

Pt. Characteristics
H/O GI disorders / IBD / Celiac
F/H of Colon Cancer
Pregnant / Elderly / Infants

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7
Q

Diagnosis of IBS

A
  • *Rule out other diseases / causes**
  • *IBD** / Malignancy / Infection / Laxative use
  • *Food Induced** = Lactose / Celiac
  • *Medication-Induced**
  • *NO SINGLE LAB TEST**
  • grey area*

Various procedures:
Proctoscopy / Colonoscopy / Sigmoidscopy / Endoscopy
ET / Barium Enema

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8
Q

ROME 4

A

Criteria / Diagnosis of IBS
Recurrent AB PAIN for at least >1 day/week
in the last >3 Months
associated with 2 or more of the following:

Change in the frequency of stool
Change in the form / appearance of stool

After fulfilled for last 3 months:
Symptoms onset for
AT LEAST 6 MONTHS PRIOR TO DIAGNOSIS

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9
Q

Psychological Component

of IBS

A
  • *PSYCH CARE** should be given
  • *IN ADDITION** to IBS treatment

Can have coexisting:
Anxiety / Depression / Sleep distrubances
Or h/o Sexual/Physical Abuse

Some people express
Emotional Conflict = GI Issue

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10
Q

Non-Pharmacological Treatment

of IBS

A

EDUCATION
Dietary modifications = FODMAP DIET
Proper Fiber + Fluid

Moderage Exercise

  • *Stress**
  • *Management / Reduction / Meditation**

Counseling / psychotherapy

HYPNOSIS

CBT = Cognitive behavioral Therapy

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11
Q

FODMAP DIET

A

Fermentable Oligo-/Di-/Mono- (And)/Polyols
short chain carbs that are:
Osmotically Active –> cause diarrhea
&
Easily Fermentable –> yield gas / Bloating

REMOVAL / DECREASE of FODMAP FOODS
can reduce functional GI symptoms
mainly for CONSTIPATION = IBS-C

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12
Q

Fructose
Fruits / HFCS
Apples / Pears / Watermelon / Honey / Dried fruits

Polyols
Sugar / Alcohols (-tols) / Stone Fruits / Avocado
Mushrooms / Cauliflower

Lactose
MILK / Yogurt / Soft Cheese

Fructans / Galactans

  • *LEGUMES / LENTILS /** Wheat / Rye
  • *Garlic / Onions** / Soy
  • *Cabbage / Brocolli / Artichokes / Asparagus**
A

FOODS TO AVOID

HIGH FODMAP Food Sources

will contribute to
Diarrhea / Bloating / Flatulance

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13
Q

Fructose
Citrus // Berries // Bananas
Grapes / honeydew / cantaloupe / Kiwi

Polyols
Artificial sweeteners NOT ending in “-OL”
sweeteners / sugar / glucose / aspartame

Lactose
Rice Milk // Hard Cheeses

Fructans / Galactans

  • *Starches** = Rice / potato / corn / quinoa
  • *Veggies : squash /lettuce /s pinach / cucubers**
  • *TOMATO / Green Beans / BELL Pepper / Eggplant**
A

ALTERNATE FODMAP FOODS

BETTER 4 U

Diarrhea / Bloating / Flatulance

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14
Q

Dietary Fiber + Bulking Agents
Non-Pharmacological IBS Treatment

A
  • *INCREASE FLUID INTAKE**
  • *Fruits / Veggies / Whole Grains / Bran / beans**

Goal fiber intake = 20-35g /day

3-5 days Onset –> <1 month for peak benefit

MOA
INCREASED Stool Mass –> Colonic Activity –> expulsion
INCREASED Water Content – Soften stool

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15
Q

BLOATING = IBS -B

Pharmacotherapy Options for IBS

A

RIFAXIMIN
non-absorbable antibiotic
further discused in IBS-D

  • *Probiotic = Bifidobacterium**
  • *Activia / Align**

Simethicone
pops the bubbles

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16
Q

IBS-Constipation

Pharmacotherapy Options for IBS

A
  • do NOT use STIMULANT Laxatives*
  • due to RELIANCE*

Osmotic Laxatives = PEG

Chloride Channel Activator = Lubiprostone

GC-C = Linaclotide (linzess)

SSRI

  • *5-HT4 Agonist**
  • *Tegaserod = EMERGENCY ONLY**
17
Q

Lubiprostone
Pharmacotherapy Options for IBS

24 Hour Onset

Ab Pain / Nausea / Diarrhea
HA / Flatuelence / Dizziness

6/12 month studies = safety

A

IBS-Constipation
8mcg BID WF
Includes patients >65 y/o
also for = CIC = Chronic Idiopathic Constipation

Amitiza
Chloride Channel Activator@GI Lumen
Sodium + Fluid secretion
without electrolyte disturbances

18
Q

Linaclotide
Pharmacotherapy Options for IBS

Diarrhea / Ab pain + distention / Flatuelence

Risk of Toxicity in children:
DNU if <6y/o /// AVOID in 6-17 y/o

DNU in Gi obstruction

A
  • *IBS-Constipation**
  • *290mcg 30min b4 first meal**
  • no adjustment for RENAL / HEPATIC impairment*
  • also for CIC, diff dose*

Linzess
GC-C Agonist –> Luminal Surface of Intestinal epithelium
INCREASE in IC/EC levels of cGMP
–> secrete chloride + bicarb –> ^^ intestinal fluid / fast transit time

19
Q

Tegaserod
Pharmacotherapy Options for IBS

onset ~24 hours

Potential INCREASE in CV events
HA / D / N / Flatuelence

DNU/Denial if:
H/O = MI / CVA / UA / DM / HTN / HL / >55y/o

A
  • *ONLY FOR EMERGENCY USE**
  • *6mg BID 30 min prior to meal**

MOA:
5-HT4 Receptor Partial Agonist
INCREASES : Motility + Intestinal Secretion
decreases:visceral sentitivity

20
Q

IBS - Diarrhea
Pharmacotherapy Options for IBS

for non-pharmacotherapy

  • *low FODMAPs DIET**
  • lactose restriction* + PROBIOTICS
A
  • *Anticholinergies / Antispasmotics**
  • *hyoscamine / dicyclomine**
  • *5-HT3 Antagonist**
  • *Alosetron = Lotronex** = females only
  • *RIFAXIMIN**
  • non-absorbable antibiotic*

Eluxadoline = Viberzi

TCAs
amitriptyline / nortriptyline / imipramine

  • *Antidiarrheals**
  • *Immodium / Loperimide** - take PRIOR to meals
21
Q

Which Antidepressants for IBS?

A

IBS-Constipation
use SSRI’s –> Shit Right

IBS-Diarrhea
use TCA’s –> Tricyclic to not poop

IBS-Pain
Use TCA / SSRI / other CNS Agents
mirtazapine / clonidine / buspirone / quetiapine

22
Q

Rifaximin
Pharmacotherapy Options for IBS

ADR:
Flatuelence / HA / Abpain / Dizziness / NVC
Tenesmus / Defecaition urgency
generally more tolerable

Less systemic exposure vs other ABx ( cipro/metro )

A
  • *IBS- Bloating & Diarrhea**
  • *550mg TID x 14 days**
  • may repeat up to 2 times*
  • also used for HEPATIC ENCEPHALAPATHY*

Semisynthetic / Non-absorbable ANTIBIOTIC
inhibits bacterial RNA synth by
binding to the B-subunit of bac. DNA-dependent RNA polymerase

23
Q

Alosetron = Lotronex
Pharmacotherapy Options for IBS

Pain Relief in 2-4 weeks
effects stops 1 week after DC // bowel fxn improves in 1 week

ADR:
Ischemic Colitis
Constipation –> perforation / TOXIC MEGACOLON
Need to be enrolled in the Prometheus Prescribing Program

A

IBS-Diarrhea** in **Adult FEMALES
Treats Ab pain + discomfort, for non-responders of initial treatment
0.5 BID –> 1mg BID
increase if ineffective @ 4 WEEKS
D/C if 1mg for 4 weeks if no relief

5-HT3** **ANTAGONIST
Competes with systemic serotonin receptor sites
–> delays colonic transit

24
Q

Toxic Megacolon

A

Severe ADR of ALOSETRON
for IBS-D for adult females

LIFE-THREATENING –> dialated colon
Pseudomembranous colitus
Can result in Septic Shock
S/Sx:
SEVERE Ab pain // Bloating
tenderness / fever / tachycardia / dehydration
shock / loss of bowel sounds

25
Q

ELUXADOLINE = Viberzi
Pharmacologic Treatment for IBS

DNU if >3+ Alcohol Drinks daily

Substrate of OATP1BI

D/C if severe constipation X 4 days
Risk of severe pancreatitis –> patients w/o gallbladder
ADR:
N/V/C / dizziness / ab pain
respiratory infection // ^^ALT/AST^^ // rash
Pancreatitis // Sphincter of ODDI Spasm

A
  • *IBS-Diarrhea**
  • *100mg BID**
  • 75mg BID*
  • if hepatic impairment or w/ OATP1BA Inhibitor*

Locally-Acting –> MU OPIOID Receptor Agonist
Delta Opioid Receptor ANTAGONIST

26
Q

IBS-PAIN
​Pharmacologic Treatment for IBS

A

AUGMENTATION
low dose combos of meds + psych meds

  • *Antidepressants**
  • *TCA // SSRI**

Other CNS Agents
Mirtazapine / clonidine / Buspirone / Quetiapine

27
Q

AntiDepressant Augmentation

if resistance
address barriers / false beliefs
explain rationale for AD’s
Central analgesics / neuromodulators
lower dose vs for depression
NON-Addictive
motivaitional interviewing

A

Treat:

  • *Refractory Functional GI Disorder_ & _IBS-PAIN**
  • *Non-Pharm Therapy + Low-Dose Antidepressants**
  • appear to improve response for longer periods of time*

Ex.
Psych Treatment + TCA
Hypnosis/CBT + SSRI
SSR + TCA
Quetiapine to TCA or SSRI

PDAT2 (22 decks)

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