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Gastrointestinal > Drugs for IBS > Flashcards

Drugs for IBS Flashcards

1
Q

drugs approved for IBS

A 
Aloestron
Atropine
Dicyclomine
Linaclotide-linzess
Lubiprostone
Polycarbophil
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2
Q

name the antispasmostics

*anticholinergics

A

Atropine
Dicyclomine
Glycopyrrolate

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3
Q

labeled for tx of constipation

A

Poly Ethylene Glycol

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4
Q

off label drugs for IBS

A 
Glycopyrrolate
Loperamide
Methylcellulose
Psyllium
rifaximin

PEG

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5
Q

first line therapy for intermittent symptoms that do not affect QOL

A

Lifestyle and Diet mods :

  1. education and reassurance
  2. exlusis of FODMAPs
  3. lactos and gluten avoidance possibly
  4. DO NOT ALLERGY TEST
  5. INcreased Physical activity
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6
Q

drugs for IBSC and confidence

A

Strong-Linaclotide-high Quality of evidence
Conditional-lubiprostone-moderate QOE
Condtional- PEG-LOW QOE

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7
Q

drugs for IBSD

all conditional

A

Alostetron-moderate QOE
TCA’s- low QOE
Loperamide-Very low QOE

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8
Q

SSRI’s and IBSC

A

Recommendation AGAINST USE-low QOE

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9
Q

antispasmotics and IBSD

A

atropine, dicyclomide, glycopyrrolate

-low QOE

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10
Q

so strong recommendations fo IBSC

A

linaclotide

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11
Q

strong recommendations for IBSD

A

none-all are weak/conditional

*up for debate and not all physcians agree, majority patient want it, some do not, not necessarily policy

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12
Q

underlying cause of IBS

A

innapropriate increase in acitivity of the ENS, activation of an INFLAMMATORY process-cellular components initiate neuronal activaiton
*thought to be dietary component or intestinal microflora

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13
Q

receptors targetted in IBS treatment

A

acetylcholine acting on muscarinic receptors

> serotonin (5-HT) receptors

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14
Q

serotonin manufatured by

A

enterochromaffin cells

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15
Q

serotonin (5HT) is secreted into _____ and then binds too_______.

A

Interstitial space of the LP

binds to 5HT receptors on nearby nerve fibers

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16
Q

discuss termination of 5HT signalling

A

terminated during recovery phase

  • SERT takes up 5HT into the epithelial cells where it is enzymatically degraded
  • or it enters the blood stream where it is transported into platelets and STORED FOR LATER USE
17
Q

drugs for IBSC that act within the lumen to absorb and retain water-increasing the bulk of stool and alleviating C symptoms

A
  1. PEG- also activates stretch receptors with increased stool bulk-increases cholinergic activity
  2. Psyllium
    methylcellulose
    polycarbophil-increase peristalsis and bowel motility
18
Q

Drugs or IBSC that work by promoting secretion

  • increase volume and hydration of the stool
  • trigger endogenous stretch receptors to improve motility
A

Linaclotide- indirectly promotes motility by increaseing-cGMP-this then enhaces CFTR secretion-Na and H20 follow Cl-
Lubiprostone->PGE1 derivative activates plasma chloride channel2 (ClC2)

19
Q

in general laxatives are contraindicated in

A

patients with known or suspected GI obstruction

20
Q

linaclotide contraindicated in…

A

patients under 6

-juvenile rodent toxicity

21
Q

all the agents for IBSC in one way or another work via

A

stimulation of endogenous stretch receptors in the ENS-increasing Cholinergic activation of SM-increasing peristalsis and alleviating IBSC symptoms

22
Q

slective 5HT3 anatagonist

A

alosetron

23
Q

5HT3 receptor is a ..

A

natural agonist of SM contraction-these receptors are extensive throughout the gut-stimulation moves feces through GI tract-inhibition slows movement

24
Q

drugs that treat OBSD by modulating ENS activity

A

Alosetron
Loperamide
Anti-spasmatic anticholinergics

25
Q

direct action on ciruclar and longitudinal muscles of the intestinal wall to slow motility

A

loperamide

26
Q

copetitive post ganglionic muscarinic receptor antagonists

A

atropine
dicyclomine
glycopyrrolate

27
Q

reduce uptake of NE and serotinin in CNS

-some have strong anticholinergic actions

A

TCAs

28
Q

selective serotonin reuptake blockade

A

SSRIs

29
Q

SSRI’s work in the

A

CNS

30
Q

enhance actions of 5HT in the CNS

A

SSRIs

31
Q

oral rifampin analog-selectively inhibits baterial and mycobacterial DNA dependent RNA polymerase

A

rifamixin

32
Q

BBW for Alosetron

A

pre-exisiting colitis-severe constipation

33
Q

physicians must enroll in the prescribing program for this drug

A

alosetron
_GI OBSTRUCTION, TOXIC MEGACOLON, GI PERF, IMPACTION, ISCHMIC COLITIS, DEATH
S-TACH AND ARYHTMIAS

34
Q

WELL TOELRATED

A

LOPERAMIDE-OTC?

35
Q

ANTICHOLINERGICS CAUSE

A

OPPOSITE OF DUMMBBELSS

36
Q

MORE TOLERABLE AND SAFER MOOD ALTERING DRUGS FOR IBS

A

SSRIS»>TCAS

37
Q

works on gram positive and gram negative anaerobes and aerobes

A

rifaximin

38
Q

virutally no systemic bioavaliability after oral administration

A

rifaximin-thus great for intraluminal infections

39
Q

end result fo rifaximin use

A

increase lactobacillaceae after use

Gastrointestinal (9 decks)

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