GI Motility 3 Flashcards
Definition of what?
- A chronic functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits in the absence of an organic disease
IBS
What are the 5 sxs of IBS?
- Abdominal pain
- Distention
- Bloating
- Indigestion
- defecation sx
What are the 3 “subcategories” of IBS?
- pain associated with diarrhea (IBS-D)
- pain associated with constipation (IBS-C)
- pain and diarrhea alternating with constipation (IBS-M)
Tx of IBC-C
- 1st: soluble fiber: Psyllium/ispaghula
- 2nd: PEG
Which drug?
- Improves constipation, but not abdominal pain
- ADE: bloading and abd discomfort
PEG
Which drug?
- stimulates the type 2 chloride channel (ClC-2) in the small intestine: inc. chloride-rich fluid secretion into the intestine
Lubiprostone (Amitiza)
What type of pt would you use Lubiprostone with?
approved for tx of women >18 yo w/IBS-C
In what types of pts should Lubiprostone be avoided?
women of child-bearing age
Category C for preggos
Which drug?
Stimulates intestinal fluid secretion and transit time
-significant improvement in abdominal pain and discomfort
MC side effect = diarrhea
Linaclotide
Which drug?
•Significant improvement in secondary endpoints of abdominal pain/discomfort, bloating, straining, stool consistency, number of CSBMs (complete & spontaneous bowel movements) per week, compared with placebo
Linaclotide (Linzess)
( Guanylate Cyclase-C Agonist )
What is the box warning on Plecanatide?
risk of serious dehydration in pediatric pts
What does Plecanatide tx?
IBS-C (Chronic idiopathic constipation)
Which drug?
Increased # of CV deaths observed
voluntarily removed from the market except in emergencies
emergency tx of IBS-C in women <55
Tegaserod
What is the initial therapy for IBS-D (diarrhea)
Loperamide
- dec. stool frequency and consistency, but NOT bloating or abdominal discomfort
- Take before a meal
Which drug?
Loperamide (IBS-D)
Which drug?
•A mixed mu-opioid receptor agonist, delta-opioid receptor antagonist and kappa opioid receptor agonist
Eluxadoline
(tx for IBS-D)
Which drug?
•Acts locally to reduce abdominal pain and diarrhea
- NO constipating side effects
- abuse potential
Eluxadoline (IBS-D)
What is 2nd line therapy for IBS-D? (3 drugs)
Bile acid sequestrants
- Cholestyramine
- Colestipol
- Colesevelam
What are the 4 SE of Bile Acid Sequestrants
(2nd line therapy for IBS-D)
Gastrointestinal SEs
- Bloating
- Flatulance
- Abdominal discomfort
- Constipation
Name the 4 5-HT3 Antagonists
- Ondanetron
- Granisetron
- Dolasetron
- Palonosetron
can cause fatal ischemic colitis
restricted to women with IBS-D who haven not responded to conventional therapies
requires FDA approved restricted-use program
Which drug?
Alosetron
Tx of chronic abdominal pain in IBS
- Which treatment is helpful?
Tricyclic antidepressants
(Amitriptyline or Desipramine)
Which drug?
- may alter central processing of visceral afferent information
- (anticholinergic properties)
- alters receptors for enteric neurotransmitters such as serotonin
Tricyclic Antidepressants
(Amitriptyline or Desipramine)
For chronic abdominal pain
What are the 2 commonly used antispasmodics?
- Dicyclomine
- Hyoscymine
Antispasmodics work primarily through which activities?
(For IBS)
Anticholinergic activities
Higher doses of Antispasmodics (dicyclomine & hyoscymaine) have additional effects such as what? (4)
Significant additional anticholinergic effects
- dry mouth
- visual disturbances
- urinary retention
- constipation
