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PHM 604- GI Therapeutics > IBS > Flashcards

IBS Flashcards

1
Q

Signs and symptoms of IBS

A

Chronic abdominal pain with altered bowel habits (diarrhea or constipation), bloating

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2
Q

Rome IV criteria for IBS

A

Chronic abdominal pain at least 1 day/week in the last 3 months AND AT LEAST 2 OF THE FOLLOWING:

Associated with defecation
Change in stool frequency
Change in form/appearance of stool

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3
Q

Does IBS affect women or men more?

A

Women <50 years old

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4
Q

Etiologies of IBS

A

Genetics, motility factors, colonic infections (gastroenteritis), bowel flora overgrowth, psychological stress

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5
Q

Complications: IBS-C

A

Bristol Stool Chart: >25% of types 1 and 2, <25% of types 6 and 7

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6
Q

Complications: IBS-D

A

Bristol Stool Chart: >25% of types 6 and 7, <25% of types 1 and 2

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7
Q

Complications: IBS-M

A

Bristol Stool Chart: >25% of types 1, 2, 6, and 7

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8
Q

IBS treatment goals

A

Improve stool frequency and consistency, improve global symptoms

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9
Q

Treatment options for IBS-C

A

Lubiprostone (Amitiza)
Linaclotide (Linzess)
Plecanatide (Trulance)
Tegaserod (Zelnorm)

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10
Q

Lubiprostone is approved for IBS-C in what patients?

A

WOMEN ONLY

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11
Q

Lubiprostone dosing

A

8mg BID WITH FOOD

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12
Q

Lubiprostone side effects

A

Diarrhea and nausea

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13
Q

Secretagogue medications

A

Linaclotide (Linzess) and plecanatide (Trulance)

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14
Q

Linaclotide dosing

A

290mcg PO QD

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15
Q

Plecanatide dosing

A

3mg PO QD

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16
Q

ADE of linaclotide and plecanatide

A

Diarrhea (Linzess more than Trulance)

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17
Q

5-HT4 agonist drug

A

Tegaserod (Zelnorm)

18
Q

When to use secretagogues in IBS-C therapy

A

FIRST! It’s first-line!

19
Q

When to use 5-HT4 agonist/tegaserod in IBS-C therapy

A

Last-line if patients fail to respond to first-line treatment

20
Q

Tegaserod/Zelnorm dosing

A

6mg PO BID

21
Q

Tegaserod ADE

A

Increased risk of cardiac events

22
Q

What patients can you use tegaserod/Zelnorm in? (Patient characteristics)

A

Use in women <65 years old without cardiac history and no more than one risk factor (HTN, smoking, BMI >30, DM, HLD, age >55)

23
Q

When to stop tegaserod/Zelnorm

A

No benefit seen in 4-6 weeks

24
Q

Treatments for IBS-D

A

Rifaximin, eluxadoline (Vibrezi), alosetron

25
Q

Rifaximin dosing

A

550mg PO TID x14 days, can be repeated up to 2 more times in a year

26
Q

Rifaximin has the greatest effect in what patients?

A

Patients with SIBO

27
Q

Eluxadoline (Vibrezi) dosing

A

100mg PO BID (alternative is 75mg PO BID)

28
Q

ADE of eluxadoline (Vibrezi)

A

Sphincter of Oddi dysfunction

29
Q

Contraindications of eluxadoline

A

History of pancreatitis, no gallbladder, history or current history of alcoholism, patients who ingest ≥3 alcoholic drinks a day

30
Q

Eluxadoline (Vibrezi) drug class

A

Mu agonist, delta antagonist, kappa agonist

31
Q

Alosetron drug class

A

5HT-3 antagonist

32
Q

Alosetron dosing

A

0.5mg PO BID IN WOMEN ONLY

33
Q

When to use alosetron in IBS-D treatment

A

Patients who have failed rifaximin and eluxadoline

34
Q

Side effects of alosetron

A

Severe constipation and severe colitis –> REMS PROGRAM!

35
Q

When to stop alosetron treatment

A

If there’s no effect within 4 weeks

36
Q

Treatments for both IBS-D and IBS-C

A

Tricyclic antidepressants, soluble fiber products, nonpharm care

37
Q

Tricyclic antidepressants for IBS

A

Amitriptyline and nortriptyline

38
Q

Amitriptyline dosing

A

50-100mg PO

39
Q

When should you take amitriptyline?

A

At bedtime due to anticholinergic side effects

40
Q

Nortriptyline dosing

A

25-75mg PO

41
Q

Soluble fiber products

A

Psyllium, oat bran, barley, beans

42
Q

Nonpharm care for IBS

A

Psychotherapy, counseling, relaxation, stress management techniques, hypnosis, cognitive-behavioral treatment

PHM 604- GI Therapeutics (10 decks)

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