Diarrhea/IBS Flashcards
Bismuth subsalicylate MOA/indications
MOA: Exhibits both anti-secretory, anti-inflammatory, & antimicrobial action
Indications
- Symptomatic tx of mild diarrhea
- Prevention & control of Thao’s Traveler’s diarrhea**
Bismuth subsalicylate ADRs
- Darkening of tongue (brush teeth after) & stool*
- Constipation**
- Effects of ASA
Loperamide indications
MC: Acute nonspecific noninflammatory diarrhea
-Also used for the tx of IBS-D
Abuse of loperamide is common. What is this linked with?
-serious arrhythmia and death
“Poor mans methadone”
-has opioid like effects at high doses
Loperamide Contraindications/ADRs
CI
-Acute IBD or inflammatory infectious diarrhea
ADRs
- Constipation
- Death if overdose
Diphenoxylate & Atropine MOA
MOA: Inhibits excessive GI motility & GI propulsion
-Atropine to discourage abuse
-Same indications, CI, and ADRs as loperamide
What are the 4 classifications of IBS
- IBS w/ constipation (IBS-C)
- IBS with diarrhea (IBS-D)
- IBS mixed (IBS-M)
- IBS unclassified (IBS-U)
What is the goal of the treatment of IBS?
-Since the exact cause of IBS is unknown, the goal is to manage the symptoms**
What is “KEY” in the management of IBS
- Stress reduction***
- Exercise including yoga may improve the symptoms as well
What is an acronym for the dietary changes used in IBS?
Low FODMAP diet
-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, & Polyols
-Also reasonable to avoid gluten
What dietary supplementation may be helpful?
-Soluble fiber may be helpful for IBS-C and IBS-D, limited effect on symptoms such as pain
Stepwise approach to IBS
- Stress reduction
- Exercise
- Dietary education (Low FODMAP)
- Dietary/supplementary fiber
- Laxatives: IBS-C patients who don’t respond to fiber
- Antidiarrheal: IBS-D can use them as needed
- Antispasmodics
Antispasmodics, MOA
- Hyoscyamine
- Dicyclomine
MOA: Induce intestinal smooth muscle relaxation through myorelaxant effects or anticholinergic mechanisms
Antispasmodics indications/ADRs
-Best used for PRN acute attacks of abdominal pain with postprandial symptoms
ADRs
-High dose may lead to anticholinergic ADRs
IBS “Other Options” that have been approved for IBS-C
- Lubiprostone
- Linaclotide & plecanatide
**See constipation flashies
Tegaserod MOA
-Serotonin plays a major role in regulation of GI motility, secretion, & sensation
MOA: Stimulation of 5-HT causes increased secretions and intestinal transit
Tenapanor MOA, indications, CI/ADRs
MOA: Inhibits sodium/hydrogen exchange, resulting in increased secretions and accelerations of intestinal transit time
-Indications: IBS-C
- CI in obstruction pts
- Diarrhea is a common ADR
Eluxadoline MOA
- Mu opioid receptor agonist & delta opioid receptor antagonist
- Tx of IBS-D
ADRs: Nausea, constipation, abd pain
What do patients on Eluxadoline have an increased risk for?
-Pancreatitis
Alosetron
- Serotonin (5-HT3) antagonist
- Highly restricted, last resort for women with severe IBS-D
Rifaximin
-Approved for the treatment of IBS-D
MOA: thought to alter the microbiota to reduce inflammation
Antidepressants for IBS
-Used in moderate-severe IBS pts to releive pain, alter GI transit, and treat psych comorbids
- TCAs: May cause constipation (helpful in IBS-D)
- SSRIs: May cause diarrhea (Helpful in IBS-C)
Probiotics for IBS
-Causes change in intestinal flora and may improve pain, bloating, and flatulence
Peppermint oil MOA
- Anti-spasmodic properties due to blockade of calcium channels
- OTC
-ADR: Heartburn
What is a non-pharm tx option of IBS?
-Psychotherapy
