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Therapeutics > 67: IBS > Flashcards

67: IBS Flashcards

1
Q

Syndrome

A

-number of symptoms occuring together and characterizing a specific disease

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2
Q

IBS

A

-ab pain
-cramping
-changes in bowel function
-most common GI disorder
-chronic

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3
Q

IBS epidemiology

A

-5-15%
-mostly mild
-no inflammation, changes in tissue or inc risk of colorectal cancer
-more women under 50
-low socioeconomic status

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4
Q

IBS patho

A

-ab pain w abnormal bowel movements
-can be constipation predominant or diarrhea predominant OR alternate :)
-though to be due to somatovisceral and motor dysfunction of intestine
-pain independent of motility and psych disturbance
-majority of serotonin receptors in enteric nervous system

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5
Q

IBS non GI symptoms

A

-urinary
-lower back pain
-fatigue
-dyspareunia (painful sex)

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6
Q

common-co morbities of IBS

A

-fibromyalgia
-functional dyspepsia
-chronic fatigue syndrome

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7
Q

IBS diagnosis

A

-no biomarkers of disease know
-celiac indicated
-lactose intolerance suspicion
-colonoscopy no needed if no alarm features

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8
Q

IBS diagnostic critera

A

-recurrent ab pain at lead once a week in previous 3 months
-inc pain related to pooping
-change in freq of stool
-change in appearance of stool

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9
Q

IBS alarming features

A

-rectal bleeding
-weight loss
-iron deficient anemia
-nocturnal symptoms
-fam hx of colorectal cancer, IBD, or celiac
-onset before age 50

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10
Q

Dietary tx of IBS

A

-AVOID foods that make it worse
-low FODMAP diet
-fermentable ssugars
-fiber water exercise

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11
Q

Non pharma tx of IBS

A

-physical activity
-cognitive behavioral therapy
-gut telling brain to contract so working with that

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12
Q

IBS-C onstapation predominant tx

A
  1. inc fiber + fluid
  2. add bulk lax
  3. consider anti-spasmodic/anticholinerfic agent for pain/cramping
  4. consider lubipro$tone or linaclotide $ for constipation and ab pain
  5. psychotherapeutic behvior modification, consider antidepressants
  6. consider serotonin-4 agonist as last line
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13
Q

bulk lax (step 2) for IBS-C

A

-soluble fiber psyllium
-PEG

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14
Q

psyllium

A

-20-30g fiber qd
-1tbsp wf start qd inc to TID
-can worsen IBS symptoms

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15
Q

PEG for IBS-C

A

-osmotic lax
-17g titrate to effect and tolerability

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16
Q

Anti-spasmodic therapy for IBS-C

A

-hyoscyamine
-dicyclomine

-anticholinergic, blocks AcH on PSNS
-improves ab pain
-use caution in elderly
-avoid in glaucoma
-avoid if constipation
-most used

17
Q

Hyoscyamine (levsin)

A

-anti-spasmodic for IBS-C
-0.125-0.25mg q4h prn, max 1.5mg
-dizziness, somnolence, blurred vision

18
Q

Dicyclomine (Bentyl)

A

-20mg QID for 7 days may inc to 40
-evaluate 2 weeks
-dry mouth, dizziness, dec appetite, blurred vision

19
Q

IBS-C antidepressants

A

-SSRIs
-Citalopram 10mg
-Escitalopram 10mg
-Fluoxetine 20mg
-Fluvoxamine 50mg
-Paroxetine 20mg
-Sertraline 25mg

-reduce sensitivity
-N/V, sex probs, sedation, insomnia

20
Q

Pro-secretory agents for IBS-C tx

A

-Lupirostone 8mcg BID
-Linaclotide 290mcg qd

21
Q

Lubiprostone

A

-pro-secretory for IBS-C tx
-chloride channel activator, inc intestinal secretions
-8mcg BID
-N, HA, diarrhea
-AVOID in preg
-AVOID in intestinal block
-take wf and water
-woment over 18
-24mcg for CIO

22
Q

Linaclotide

A

-prosecretory agent for IBS-C
-inc cGMP
-inc secretion of chloride and bicarbonate in intestine
=inc fluid and dec transit time
-290mcg qd
-diarrhea worse w high fat meals
-DO NOT USE IN KIDS UNDER 17 DEHYDRATION RISK
-30 min before first meal
-CIC at 145mcg
-keep in og container she dont like to get wet

23
Q

5-HT4 agonist for IBS-C

A

-Tegaserod

24
Q

Tegaserod

A

-6mg BID before meals for 4-6 week
-can continue if response
-stimulates peristalsis and secretions
-modulates sensitivity
-HA, ab pain, dizziness, diarrhea, CV events
-only available thru FDA under emergency protocol

25
Q

IBS-D tx non pharma

A

-manage stress
-cut out lactose and caffeine
-avoid foods that inc symptoms

26
Q

Tx of IBS-D iarrhea

A
  1. Diet
  2. add loperamide or dicyclomine (anti-spasmodic)
    2a. Replace w eluxadoline if pain persists
    2b. consider rifaximin
  3. add serotonin-3 ANTAgonist
  4. behavior mod, consider antidepressants
27
Q

Loperamide

A

-4mg start, 2mg after each loose stool max 16mg/day
-inhibits peristalsis and GI secretions
-mods sensitivity
-constipation BBB concern
-dependence
-reduces diarrhea but no effect on ab pain

28
Q

Diphenoxylate-atropine

A

-5mg TID-QID PRN
-max 20mg/day
-antidiarrheal

29
Q

Anti-diarrheals

A

-loperamide
-diphenoxylate-atropine

30
Q

Opioid receptor agonist for IBS-D

A

-Eluxadoline

31
Q

Eluxadoline

A

-100mg BID (75 is nogallbladder)
-mu-opioid receptor AGONIST
-reduce ab pain and diarrhea
-dizziness, euphoria, fatigue, constipation, pancreatitis
-AVOID in pt w hx of pancreatitis, alcholism, child class C
-CIV due to abuse potential
-CYP metabolism

32
Q

5-HT3 ANTAgonists for IBS-D

A

-Alosetron 0.5mg BID

33
Q

Alosteron

A

-5HT3 ANTAgonist for IBS-D
-dec sensitivity and motility
-0.5mg BID max 2mg
-constipation, ischemic colitis black box
-REMs
-CYP metabolism
-AVOID in child class C

34
Q

Additional agents to treat IBS-D

A

-Rifaximin
-Peppermint oil
-Probiotics

35
Q

Rifaximin

A

-poorly absorbed non-systemic
-targets gut
-550mg TID 14 days
-may repeat up to two times
-dizziness, fatigue, edema

36
Q

Peppermint oil

A

-for IBS-D
-dec upset tummy, bloating, gas, urgency
-1-2 caps PRN upto TID
-take 30 min AC or PC

37
Q

Probiotics for IBS-D

A

-motility, sensitivity, inflammation, barrier integrity, microflora

38
Q

IBS-D antidepressants

A

-Nortriptyline 10mg
-Amitriptyline 25mg
-Trimipramine 25mg
-Desipramine 25mg

-reduce sensitivity and stress
-constipation, dry mouth, drowsiness, weight gain
-most beneficial in pt w IBS-D
-QT prolongation

Therapeutics (78 decks)

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