IBS Flashcards

1
Q

mainly affects this age range

A

20-30 yr olds

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2
Q

more common in

A

women

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3
Q

symptoms

A
  • abdominal pain or discomfort
  • disordered defecation (e.g. either diarrhoea, or constipation with straining, urgently and incomplete evacuation)
  • mucus in poo
  • bloating
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4
Q

non drug treatment

A
  • increase physical activity
  • eat regularly without missing meals or leaving long gaps between meals
  • limit fresh fruit consumption to max 3 portions a day
  • review fibre intake - if increase required, recommend soluble fibre e.g. isphagula husk or foods high in soluble fibre e.g. oats
  • insoluble fibre e.g. bran and resistant starch should be discouraged as it may exacerbate symptoms
  • increase fluid intake to at least 8 cups a day
  • reduce caffeine, alcohol, fizzy drinks
  • avoid sorbitol in pt with diarrhoea
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5
Q

probiotics

A

if being used, continue for at least 4 weeks while monitoring effects

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6
Q

if symptoms persist following lifestyle and dietary advice

A

single food avoidance and exclusion diets may be an option under supervision of dietician or medical specialist

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7
Q

name antispasmodics

A

peppermint oil
alverine citrate
mebeverine hydrochloride

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8
Q

which laxative is not recommended in IBS

A

lactulose - can cause bloating which can worsen symptoms

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9
Q

drug treatment

A
  • depends on nature and severity of symptoms
  • antispasmodics can be taken in addition to diet and lifestyle changes
  • laxative can be used for constipation (not lactulose due to bloating)
  • loperamide for anti-diarrhoea relief
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10
Q

when can linaclotide be offered

A
  • if pt has not responded to laxatives from different classes and have has constipation for at least 12 months
  • this is indicated for moderate to severe irritable bowel syndrome with constipation
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11
Q

dose of linaclotide

A

290 micrograms once daily, dose to be taken at least 30 minutes before meals, review treatment if no response after 4 weeks.

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12
Q

Low dose TCA e.g. amitriptyline and SSRI

A

(unlicensed indication)
- Can be used for abdominal pain or discomfort as 2nd line option in pt who have not responded to antispasmodics, anti-motility drugs or laxatives
- SSRI may be considered in those who don’t respond to TCA

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13
Q

Mebeverine OTC

A
  • for symptomatic relief of IBS; max single dose is 135mg and max daily dose If TDS (405mg)
  • for uses other than symptomatic relief of IBS; max single dose 100mg, max daily dose 300mg
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14
Q

dose of mebeverine 200mg MR for IBS

A

200mg BD

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15
Q

mebeverine contraindication

A

paralytic ileus

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16
Q

Mebervine in pregnancy and BF

A

avoid

17
Q

peppermint oil - how to take

A

do not break or chew caps as peppermint oil can irritate mouth or oesophagus

18
Q

Dose for peppermint oil

A

1-2 caps TDS, up to 3 months if necessary
Mintec brand: take before meals

19
Q

peppermint oil caution

A

sensitivity to menthol

20
Q

SE peppermint oil

A
  • Ataxia
  • Bradycardia
  • GI discomfort
  • n/v
  • GORD
  • Headache
  • Paraesthesia
  • Rash erythematous
  • Tremor
21
Q

Alverine dose

A

60-120mg one to three times a day

22
Q

Label alverine

A

can make you dizzy - can affect performance of skilled tasks

23
Q

alverine contraindications

A

intestinal obstruction
paralytic ileus