Exam 4 - GI IBS

Question 1

Two main types of IBS?

Answer 1

IBS Diarrhea

IBS Constipation

Question 2

Cause of IBD? Workup?

Answer 2

Idiopathic

Manning Criteria for 6+ months or Rome III Criteria for 3+ months

Question 3

Treatment for Mild IBS-C

Answer 3

Decrease insoluable fiber, Increase soluable fiber, increase fluid

Question 4

Tx for Moderate IBS-C?

Answer 4

Bulk-forming laxatives. Consider adding or discontinuing antispasmodics

Question 5

Tx for Severe IBS-C?

Answer 5

Chloride-channel Activator (Amitiza/Lubiprostone), Guanylate Agonist (Linzess/Linaclotide)

Question 6

Tx for Mild IBS-D?

Answer 6

Dietary restrictions (no caffeine, no lactose, no sorbitol). Avoid meds which cause diarrhea.

Question 7

Tx for Moderate IBS-D?

Answer 7

Loperamide or other antispasmodic

Question 8

Tx for Severe IBS-D?

Answer 8

5HT3-antagonist (Lotronex/Alosetron)

Question 9

Dietary advice for IBS?

Answer 9

Eat regularly; decrease coffee, tea, EtOH, insoluable fiber; limit fruit to less than 240g/day

Question 10

Antidiarrheal classes? (hint: acronym)

Answer 10

A.S.L.A.
Anticholinergics
Serotonin 5HT3 Antagonists
Loperamide
Antibiotics

Question 11

Anticonstipation classes? (hint: acronym)

Answer 11

B.C.G.O.

Bulk-forming laxatives
Chloride-channel activator
Guanylate-agonist
Osmotic laxatives

Question 12

Antispasmodic MOA and use?

Answer 12

Anticholinergic properties inhibit muscarinic receptors in smooth muscle to decrease spasms in GI tract. Anti-SLUD effect at higher doses.

IBS-D.

Question 13

Antispasmodics treat which IBS? Name?

Answer 13

IBS-D.

“-mine”

Question 14

Antidepressant MOA and use?

Answer 14

TCA trigger anticholinergic properties causing anti-SLUD.

IBS-D.

Question 15

Loperamide MOA and use?

Answer 15

Opioid-agonist=decreased motility

IBS-D

Question 16

Viberzi/Eluxaduline MOA and use?

Answer 16

Mu-opioid receptor agonist. Decrease abd pain, decrease diarrhea.

IBS-D

Question 17

Viberzi/Eluxaduline CIs and SEs?

Answer 17

CI=Pancreatitis, liver dz, EtOH abuse

SE=N/V, constipation, increased LFTs

Question 18

Lotronex/Alosetron MOA and use?

Answer 18

5HT3 receptor antagonist in GI tract=decreased bloating, pain, nausea

IBS-D. WOMEN ONLY!

Question 19

Lotronex/Alosetron only used in what population? SE?

Answer 19

WOMEN ONLY!

SE: Constipation. Stop after few days. Can cause death from super constipation.

Question 20

Bulk-forming Laxative MOA and use?

Answer 20

Forms gel that distends colon and increases peristalsis to empty colon.

IBS-C

Question 21

Osmotic Laxative MOA and use?

Answer 21

Non-absorbable stuff causing increased stool liquidity.

IBS-C

Question 22

Amitiza/Lubiprostone MOA and use?

Answer 22

Type-2 Cl channel activator increases intestinal fluid secretions and motility.

IBS-C

Question 23

Amitiza/Lubiprostone only in which population? Preggers category?

Answer 23

WOMEN ONLY!

Preggers Cat C

Question 24

Amitiza/Lubiprostone SEs and CIs?

Answer 24

SE=Dyspnea at first but goes away with additional doses

CI=Mechanical bowel obstruction

Question 25

Linzess/Linaclotide MOA and use?

Answer 25

Binds to Guanylate on GI tract causing increased Cl and bicarb and decreases transit time.

IBS-C and Chronic Idiopathic Constipation.

Question 26

Linzess/Linaclotide SEs and CIs?

Answer 26

SE=Diarrhea, farts, GI upset

CI=Mechanical bowel obstruction

Question 27

Probiotic MOA and use?

Answer 27

Colonize guy with friendly bacteria.

For bloating and flatulance in IBS. Try for more than 4 weeks.