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604 GI Therapeutics > Diarrhea/Constipation/IBS > Flashcards

Diarrhea/Constipation/IBS Flashcards

1
Q

Constipation definition

A

Less than or equal to 3 bowel movements per week, but also depends on the patient

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2
Q

Constipation - Causes

A

Low fiber
Not enough water
Opioid-Induced
Iron
Anti-cholinergic (AH,TCAs)
CCBs
Pregnancy
IBS
Diabetes
Hypothyroid

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3
Q

Constipation - Osmotics

A

PEG 3350 (Miralax) –> Powder
Lactulose –> Liquid

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4
Q

Chronic Idiopathic Constipation Therapies

A

Lubiprostone (PO)
Linaclotide (Linzess) (PO)
Plecanatide (Trulance) (PO)

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5
Q

Lubiprostone - ADEs

A

Diarrhea (may be reduced by taking with food)
Nausea

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6
Q

Linaclotide + Plecanatide - ADEs

A

Diarrhea

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7
Q

Opioid Induced Constipation Therapies

A

Methylnaltrexone (SQ)
Naloxegol (PO)
Naldemedine (PO)
Lubiprostone (PO)

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8
Q

Opioid Induced Constipation Therapies - ADEs

A

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

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9
Q

Diarrhea definition

A

At least 3-4 bowel movements in a 24 hour period

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10
Q

Diarrhea - Causes

A

Gastroenteritis
IBS-D
Medications (ABX,C. Diff, metformin, chemotherapy, lactose)
Celiac
IBD

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11
Q

When would you want to use probiotics?

A

Kids receiving antibiotics

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12
Q

Diarrhea Therapies

A

Loperamide (PO)
Diphenoxylate (+ Atropine to prevent abuse) (PO)
Octreotide (SQ, IM depot Q4W)

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13
Q

Octreotide - Effects

A

Decreased intestinal mobility
Decreased secretion of gastrin, motilin
Decreases insulin/glucagon

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14
Q

Octreotide - Uses

A

Intestinal carcinoid tumors
Chemo induced diarrhea

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15
Q

IBS - Definition

A

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

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16
Q

IBS - Symptoms

A

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

17
Q

IBS - C Definition

A

Hard stool >25% of the time

18
Q

IBS - D Definition

A

Sludgy/liquidy stool >25% of the time

19
Q

IBS - M Definition

A

Hard stool >25% of the time AND Sludgy/liquidy stool >25% of the time

20
Q

IBS - C Therapies

A

Lubiprisone (PO)
Linaclotide (PO)
Plecanatide (PO)
Tegaserod (PO)
Tenapanor (PO)

21
Q

Lubiprostone (IBS-C) - Indication

A

Only approved for women with IBS

22
Q

Tegaserod - ADEs

A

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

23
Q

Tegaserod - Indication

A

Women <65 YO without a history of CV ischemia

24
Q

Tenapanor - ADEs

A

15% experience diarrhea

25
Q

IBS - D Therapies

A

Rifaximin (PO)
Eluxadoline (Viberzi) (PO)
Alosetron (Lotronex)(PO)

26
Q

Rifaximin - ADEs

A

Generally well tolerated
Little systemic side effects

27
Q

Rifaximin - Counseling points

A

Poorly absorbed ABX
14 day course - 550 mg PO TID
Repeat course if needed

28
Q

Eluxadoline - Contraindications

A

History of pancreatitis
History of alcoholism
Has more than 3 drinks of alcohol per day

29
Q

Eluxadoline - ADEs

A

Constipation, nausea, abdominal pain

30
Q

Alosetron - ADEs

A

Severe constipation
Ischemic colitis
REMS - D/C use in 4 weeks if no benefit seen

31
Q

Alosetron - Indication

A

Women with severe IBS-D

32
Q

IBS - Any Type Therapies

A

Anti-depressants, more specifically tricyclic (amitriptyline, nortriptyline)
Soluble fiber (psyllium, oat bran, barley, beans)

33
Q

Tricyclic antidepressants - ADEs
And which one is best

A

Anti-cholinergic (dry, sedation, constipating)
Amitriptyline has more side effects
Nortriptyline has less side effects

34
Q

Tricyclic antidepressants - Counseling points

A

Take at night (anti-cholinergic side effects)
Should improve global IBS symptoms

604 GI Therapeutics (5 decks)

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