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IBS Flashcards

1
Q

What is the hallmark symptom of IBS?

A

abdominal pain relieved by defecation that lasts for a prolonged period of time and also varies over time

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2
Q

What are other symptoms of IBS (not hallmark)?

A
  1. diarrhea/ constipation
  2. fatigue
  3. bloating
  4. dyspepsia
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3
Q

What are the proposed mechanisms of IBS?

A
  1. altered gut motility
  2. hypersensitive gut with enhanced visceral perception and pain
  3. dysregulation of the brain-gut axis
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4
Q

What chemical is the main cause of IBS?

A

serotonin

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5
Q

What is the diagnosis of IBS?

A

Recurrent abdominal pain at least 2 days per week over 3 months
PLUS two of the following:
1. pain related by defecation
2. change in frequency of stool
3. change in form of stool

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6
Q

What are the “alarm” / “red flag” symptoms of IBS?

A
  1. 50 y/o without colon cancer
  2. recent change in bowel habit
  3. evidence of GI bleed
  4. nocturnal pain/ passage of stool
  5. unintentional weight loss
  6. Family hx of colon cancer / IBD
  7. iron deficiency anemia
  8. potential drug-induced
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7
Q

What can cause drug-induced diarrhea?

A
  1. antibiotics
  2. caffeine
  3. colchicine
  4. Sorbitol-containing products
  5. laxatives
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8
Q

What can cause drug-induced constipation?

A
  1. anticholinergic agents
  2. aluminum antacids
  3. opioid analgesics
  4. anti-diarrheal agents
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9
Q

What drugs can cause abdominal discomfort?

A
  1. iron
  2. corticosteroids
  3. antibiotics
  4. bisphosphates
  5. NSAIDs
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10
Q

What is the only specific diet that has shown efficacy in IBS?

A

FODMAP

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11
Q

What are non-pharm treatments for IBS?

A
  1. soluble fiber / psyllium
  2. peppermint oil enteric coated capsule
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12
Q

What are psychological therapies for IBS?

A
  1. relaxation therapy
  2. self-administered CBT
  3. behavioral therapy
  4. mindfulness meditation
  5. exercise
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13
Q

What probiotic strain has been shown to improve bloating and flatulence?

A

bifidobacterium

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14
Q

Do the guidelines recommend probiotics?

A

No

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15
Q

What is the MOA of antispasmodics?

A

relaxation of smooth muscle and attenuation of visceral hypersensitivity and pain sensation

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16
Q

When are antispasmodics recommended?

A

for symptomatic short-term, acute relief of IBS symptoms

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17
Q

What agents does Donnatol contain?

A

Hyoscyamine, atropine, phenobarbital, scopolamine

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18
Q

What agents are used for antispasmodics in IBS?

A

Dicyclomine
Hyoscyamine
Donnatol

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19
Q

What antispasmodic is the DOC in Canada?

A

Scopolamine

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20
Q

What are SEs with antispasmodics?

A

anticholinergic- drowsiness, heat intolerance, constipation

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21
Q

When are TCAs used in IBS?

A

sub-depression doses are effective in relieving visceral pain and improving symptom relief

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22
Q

What TCAs are used in IBS?

A

Amitriptyline
Doxepin
Desipramine

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23
Q

What TCA is best at treating pain?

A

Amitriptyline

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24
Q

What TCA is good for pain and improves incomplete evacuation?

A

Doxepin

25
Q

What antibiotic is recommended for IBS-D?

A

Rifaximin

26
Q

What is the MOA of Rifaximin?

A

inhibition of bacterial RNA synthesis

27
Q

What is the daily dosing of Rifaximin for IBS?

A

TID

28
Q

What are ADEs with Rifaximin?

A
  1. peripheral edema
  2. dizziness
  3. nausea
  4. headache
29
Q

What agent is approved for women with severe IBS-D unresponsive to conventional therapy?

A

Alosetron

30
Q

What is the MOA of Alosetron (LOTRONEX)?

A

5-HT3 antagonist

31
Q

What should Alosetron therapy be held and can be restarted at lower dose?

A

Constipation

32
Q

When should Alosetron therapy be discontinued and NOT restarted?

A

Ischemic colitis

33
Q

What dose of Alosetron requires a REMS program for ischemic colitis?

A

1mg BID

34
Q

What is the MOA of eluxadoline?

A

Mixed opioid receptor modulator
( mu and kappa agonist)
(Delta antagonist)

35
Q

What patient population is eluxadoline approved for?

A

Adults with IBS-D

36
Q

What are contraindications to Eluxadoline?

A
  1. No gallbladder
  2. Alcoholism or history of
  3. History of pancreatitis
  4. Severe hepatic impairment
37
Q

What drugs interact with Eluxadoline?

A

Dose -dependent OAT inhibitors:
Cyclosporine
Genfibrozil
Rifampin

38
Q

When should the dose of Eluxadoline be reduced?

A
  1. Unable to tolerate 100mg
  2. Drug interactions
  3. Mild /moderate hepatic dysfunction
39
Q

What warnings should be considered when taking Eluxadoline?

A

Severe constipation
Development of pancreatitis

40
Q

What is the mechanism of Linaclotide?

A

Agonist of guanylate cyclase C;
Increases secretion of chloride and bicarbonate into the intestinal lumen to make an osmotic gradient

41
Q

What ADRs are associated with linaclotide (LINZESS)?

A

severe diarrhea (within first 2 weeks)
GI bleed

42
Q

What is the MOA of Plecanatide?

A

Structural analog of human uroguanylin;
change in the pH of the intestines leading to increased fluid secretion fluid secretion and decreased pain sensation

43
Q

What are the ADRs with Plecanatide (TRULANCE)?

A
  1. dyspnea
  2. nausea
  3. severe diarrhea
44
Q

How is Plecanatide dispensed because it is unstable in air and to improve compliance?

A

blister pack;
do not dispense in vials

45
Q

What agent is approved for women >/= 18 years with IBS-C?

A

Lubiprostone (AMITIZA)

46
Q

What other indications does Lubiprostone (AMITIZA) have?

A
  1. chronic idiopathic
  2. opioid-induced constipation
47
Q

What are ADRs with Lubiprostone?

A
  1. dyspnea
  2. nausea
  3. severe diarrhea
48
Q

How long does it take for Lubiprostone to start working?

A

2 months

49
Q

What is the MOA of Tegaserod (ZELNORM)?

A

5HT4 agonist

50
Q

What population is Tegaserod approved in for IBS-C?

A

Women >/= 18 y/o and < 65 y/o with IBS-C

51
Q

What are ADRs with Tegaserod (ZELNORM)?

A

Cardiovascular events (MI, TIA)
Severe diarrhea
suicidal ideation and behavior

52
Q

What are the contraindications to Tegaserod?

A

Cardiovascular risk factors:
1. active smoking
2. BMI>30
3. HTN, DM, hyperlipidemia
4. any previous cardiovascular event
5. history of ischemic colitis
6. eGFR< 15
7. childs pugh B or C
8. history of gallbladder disease

53
Q

What patient population is Tenapanor approved in?

A

IBS-C in adults

54
Q

What is the MOA of Tenapanor?

A

sodium/hydrogen exchange isoform 3 (NHE3)

55
Q

What are the contraindications to Tenapanor?

A
  1. obstruction
  2. patients under 6 y/o
56
Q

What are ADRs to Tenapanor?

A

Diarrhea
Flatulence
Dizziness

57
Q

What OTC is used for diarrhea but has insufficient evidence to recommend for IBS-D?

A

Loperamide

58
Q

What OTC agent is used but has no evidence for improvement in symptoms or pain?

A

Polyethylene glycol

59
Q

What are ADRs with Polyethylene glycol?

A
  1. bloating
  2. abdominal discomfort

GI (23 decks)

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