IBS

Question 1

antibiotics in IBS

Answer 1

non-absorbable abx
rifaximin and neomycin
role not understood

Question 2

loperamide (immodium) OR

diphenoxylate + atropine (lomotil)

Answer 2

used to treat diarrhea-predominant IBS

1st line

Question 3

alosetron (lotronex)

Answer 3

5HT3 #- # visceral sesnitivity and decreases colonic trasnit rate
- not approved in men
SE: constipation, ischemic colitis, death
- obvious not 1st line

Question 4

1st line agents for IBS-C

Answer 4

lactulose
sorbitol
PEG

Question 5

Tegaserod (Zelnorm)

Answer 5

used in emergency situations to tx IBS-C
5HT4 #- increases peristalsis and # visceral sesntitivity
-only approved in women
-dont use if hepatic or renal, bowl obsturction, gall bladder disease
SE: diarrhea, cholecystitis

Question 6

Lubiprostone (amitiza)

Answer 6

chloride channel activator- increases secretion of fluids into intestinal lumen
2nd line agent for chronic IBS-C
AE: diarrhea, nausea, ab pain, gas
$$

Question 7

linaclotide

Answer 7

increases cGMP leads to increased intestinal fluid
290 mcg qd- 30 min b4 breakfast
2nd line for chronic IBS-C
don't use in kiddies<6 yrs
AE: diarrhea, \$\$

Question 8

peppermint oil

Answer 8

antispasmodic used in IBS-M

Question 9

dicyclomine (Bentyl)

Answer 9

antimuscarininc antispasmodic used in IBS-M
1st line
dont use if IBD, glaucoma, GERD
SE: NV, dizzy, blurred vision

Question 10

hyoscyamine

Answer 10

anticholinergic antispasmodic
1st line for IBS-M
don’t use if IBD, glaucoma, or severe renal or hepatic dysfxn
SE: constipation, dry mouth, dizzy, drowsy, blurred vision, urinary retention

Question 11

TCA

Answer 11

used with other tx in IBS
amitryptyline, nortriptyline, desipramine
anticholinergics
SE: anti-SLUD, drowsy, dizzy, blurred vision, tachycardia
interactions: drugs that increase QT

Question 12

SSRI

Answer 12

paroxetine, citalopram
used in tx with IBS
interactions: linezolid and MAOIs