Diarrhea/Constipation/IBS Flashcards
Constipation definition
Less than or equal to 3 bowel movements per week, but also depends on the patient
Constipation - Causes
Low fiber
Not enough water
Opioid-Induced
Iron
Anti-cholinergic (AH,TCAs)
CCBs
Pregnancy
IBS
Diabetes
Hypothyroid
Constipation - Osmotics
PEG 3350 (Miralax) –> Powder
Lactulose –> Liquid
Chronic Idiopathic Constipation Therapies
Lubiprostone (PO)
Linaclotide (Linzess) (PO)
Plecanatide (Trulance) (PO)
Lubiprostone - ADEs
Diarrhea (may be reduced by taking with food)
Nausea
Linaclotide + Plecanatide - ADEs
Diarrhea
Opioid Induced Constipation Therapies
Methylnaltrexone (SQ)
Naloxegol (PO)
Naldemedine (PO)
Lubiprostone (PO)
Opioid Induced Constipation Therapies - ADEs
Bowel perforation in those with GI malignancy/wall abnormalities
Severe abdominal pain/diarrhea
D/C if any of these occur – May lead to sepsis, which may be fatal
Diarrhea definition
At least 3-4 bowel movements in a 24 hour period
Diarrhea - Causes
Gastroenteritis
IBS-D
Medications (ABX,C. Diff, metformin, chemotherapy, lactose)
Celiac
IBD
When would you want to use probiotics?
Kids receiving antibiotics
Diarrhea Therapies
Loperamide (PO)
Diphenoxylate (+ Atropine to prevent abuse) (PO)
Octreotide (SQ, IM depot Q4W)
Octreotide - Effects
Decreased intestinal mobility
Decreased secretion of gastrin, motilin
Decreases insulin/glucagon
Octreotide - Uses
Intestinal carcinoid tumors
Chemo induced diarrhea
IBS - Definition
Most common in women less than 50 YO
Rome IV Criteria
Abdominal pain at least 1 day per week in the last 3 months associated with defecation, a change in stool consistency, or a change in stool frequency
Diagnosis of exclusion
IBS - Symptoms
Bloating, pain, change in bowel habits (improving these symptoms is considered global improvement)
Gut hypersensitivity
Gastroenteritis
Microbiota - increased bacteria (small intestine bacteria overload)
Psychosocial stress
IBS - C Definition
Hard stool >25% of the time
IBS - D Definition
Sludgy/liquidy stool >25% of the time
IBS - M Definition
Hard stool >25% of the time AND Sludgy/liquidy stool >25% of the time
IBS - C Therapies
Lubiprisone (PO)
Linaclotide (PO)
Plecanatide (PO)
Tegaserod (PO)
Tenapanor (PO)
Lubiprostone (IBS-C) - Indication
Only approved for women with IBS
Tegaserod - ADEs
Increased cardiac events
Increased GI secretion/motility
But, decreased visceral pain
*If no effect in 4 weeks, then D/C
Otherwise, <5% had headache, diarrhea
Tegaserod - Indication
Women <65 YO without a history of CV ischemia
Tenapanor - ADEs
15% experience diarrhea
IBS - D Therapies
Rifaximin (PO)
Eluxadoline (Viberzi) (PO)
Alosetron (Lotronex)(PO)
Rifaximin - ADEs
Generally well tolerated
Little systemic side effects
Rifaximin - Counseling points
Poorly absorbed ABX
14 day course - 550 mg PO TID
Repeat course if needed
Eluxadoline - Contraindications
History of pancreatitis
History of alcoholism
Has more than 3 drinks of alcohol per day
Eluxadoline - ADEs
Constipation, nausea, abdominal pain
Alosetron - ADEs
Severe constipation
Ischemic colitis
REMS - D/C use in 4 weeks if no benefit seen
Alosetron - Indication
Women with severe IBS-D
IBS - Any Type Therapies
Anti-depressants, more specifically tricyclic (amitriptyline, nortriptyline)
Soluble fiber (psyllium, oat bran, barley, beans)
Tricyclic antidepressants - ADEs
And which one is best
Anti-cholinergic (dry, sedation, constipating)
Amitriptyline has more side effects
Nortriptyline has less side effects
Tricyclic antidepressants - Counseling points
Take at night (anti-cholinergic side effects)
Should improve global IBS symptoms
