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GI Exam 2 > IBS Medication Management > Flashcards

IBS Medication Management Flashcards

1
Q

What are 3 modifying agents of the gut bacteria?

A
  1. Probiotics
  2. Antibiotics
  3. Rifaximin
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2
Q

What agent in probiotics has the most benefit?

A

Bifidobacterium

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3
Q

What has the most significant improvement in bloating and flatulence?

A

Probiotics

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4
Q

What is the MOA for antispasmodics?

A

Relax smooth muscle and attenuation of visceral hypersensitivity and pain sensation

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5
Q

What are antispasmodics recommended for?

A

Symptomatic short term relief of IBS symptoms

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6
Q

True or false: Antispasmodics can be used for long term therapy

A

False

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7
Q

What 4 agents are antispasmodics?

A
  1. Hyosycamine
  2. Scopolamine
  3. Dicyclomine
  4. Donnatol
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8
Q

How long should a patient be on bentyl?

A

7 days

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9
Q

What is the most common side effect for antispasmodics?

A

Heat intolerance

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10
Q

What are the most common ADEs for scopolamine, hyoscyamine, and dicyclomine? 3

A
  1. Drowsiness
  2. Heat intolerance
  3. Constipation
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11
Q

What 2 things are frequent co-morbidities with IBS?

A
  1. Depression
  2. Anxiety
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12
Q

What antidepressant class is utilized in IBS?

A

TCAs

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13
Q

What doses for antidepressants are utilized in IBS?

A

Sub-depression doses

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14
Q

What type of IBS are TCAs used for?

A

All types

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15
Q

What are the 3 TCAs used for IBS?

A
  1. Amitriptyline
  2. Doxepin
  3. Desipramine
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16
Q

What 3 drugs are mainly used in IBS-D?

A
  1. Rifaximin
  2. Alosetron
  3. Eluxadoline
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17
Q

What does Rifaximin inhibit?

A

Bacterial RNA synthesis

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18
Q

How is Rifaximin dosed?

A

TID

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19
Q

What are 4 ADRs of Rifaximin?

A
  1. Peripheral edema
  2. Dizziness
  3. Nausea
  4. Headache
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20
Q

True or False: alosetron is only utilized in women

A

True

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21
Q

When can alosetron be used?

A

In patients who have IBS-D that are unresponsive to conventional therapy

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22
Q

True or false: Alosetron is in the REMS program

A

True

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23
Q

What do you do if a patient experiences constipation when using Alosetron?

A

Hold therapy until it resolves

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24
Q

If a patient experiences _____ with Alosetron, you should discontinue therapy and DO NOT restart

A

Ischemic colitis

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25
Q

What mu-opioid receptor agonist can be used for IBS?

A

Eluxadoline

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26
Q

When does Eluxadoline have low systemic absorption?

A

When there’s normal hepatic function

27
Q

Eluxadoline

28
Q

What are 4 contraindications of Eluxadoline?

A
  1. Pts without a gallbladder
  2. Alcoholism
  3. Pancreatitis history
  4. Severe hepatic impairment
29
Q

When should you reduce Eluxadoline to 75 mg BID? 3

A
  1. Unable to tolerate 100 mg
  2. Drug interactions
  3. Mild or moderate hepatic dysfunction
30
Q

What is linaclotide an agonist of?

A

Guanylate cyclase-C

31
Q

What does linaclotide increase the secretion of?

A

Chloride and bicarbonate

32
Q

When should linclotide be taken?

A

30 minutes before a meal

33
Q

Linaclotide

34
Q

What type of IBS is linzess used for?

35
Q

What are 2 ADRs of linaclotide?

A
  1. Severe diarrhea
  2. GI bleed
36
Q

Plecanatide

37
Q

What is plecanatide a structural analog of?

A

Human uroguanylin

38
Q

What is the MOA of trulance?

A

Changes pH of the intestines leading to increased fluid secretion and decreased pain sensation

39
Q

What type of IBS is plecanatide used for?

40
Q

What are 3 ADRs of Plecanatide?

A
  1. Dyspnea
  2. Nausea
  3. Severe Diarrhea
41
Q

How is plecanatide dispensed?

A

In a blister pack

42
Q

When is trulance not stable?

A

When exposed to air

43
Q

Lubiprostone

44
Q

What is the MOA of lubiprostone?

A

A chloride channel activator

45
Q

What does lubiprostone promote?

A

Fluid secretion into the GI tract

46
Q

True or false: Amitiza is approved in both men and women

A

False (women only)

47
Q

What patient population can lubiprostone be used in?

A

Women >/= 18 years old

48
Q

What are the 3 indications for amitiza?

A
  1. IBS-C
  2. Chronic idiopathic constipation
  3. Opioid induced constipation
49
Q

What are 3 ADRs for amitiza?

A
  1. Dyspnea
  2. Nausea
  3. Severe Diarrhea
50
Q

When does lubiprostone show improvement in abdominal pain?

A

At 2 months

51
Q

Tegaserod

52
Q

True or false: Tegaserod brings water into the GI tract

53
Q

What is the MOA of Tegaserod?

A

5-HT4 agonist

54
Q

What patient population is zelnorm FDA approved for?

A

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

55
Q

What are 3 ADRs of Zelnorm?

A
  1. Cardiovascular events
  2. Severe diarrhea
  3. Suicidal ideation and behavior
56
Q

What are the 4 contraindications of cardiovascular risk factors for Zelnorm?

A
  1. Active smoking
  2. BMI >30
  3. HTN, DM, Hyperlipidemia
  4. Any previous cardiovascular event
57
Q

What are the (second) 4 contraindications for Tegaserod?

A
  1. History of ischemic colitis
  2. eGFR < 15 mL/min/1.73 m2
  3. Childs Pugh B or C
  4. History of gallbladder disease
58
Q

Tenapanor

59
Q

What is the MOA of Tenapanor?

A

Sodium/hydrogen exchanger isoform 3

60
Q

What type of IBS is Tenapanor used for?

61
Q

What are 2 CI for Ibsrella?

A
  1. Obstruction
  2. Patients under the age of 6
62
Q

What are 3 ADRs of Ibsrella?

A
  1. Diarrhea
  2. Flatulence
  3. Dizziness
63
Q

What is loperamide used for?

A

Symptomatic relief

64
Q

What are the primary ADEs for polyethylene glycol?

A
  1. Bloating
  2. Abdominal discomfort

GI Exam 2 (11 decks)

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