IBS Questions Flashcards
IBS is most frequently observed in ______ younger than ______.
IBS is most frequently observed in (women) less than (50 years old).
What are the common symptoms of IBS
Bloating
Abdominal Pain
Change in Bowel Habits
What is the cause of IBS?
Not fully elucidated. However it is suspected that it has to do with gut hypersensitivity where there is a mismatch of pain signals relative to functional changes in the gut.
What are potential contributing factors to IBS?
- Genetics
- Colonic Infections
- Mechanical Irritation
- Microbiota Alterations
- Psychological Stress
- Inflammation
What are the three subtypes of IBS? What bristol stool type is most commonly associated with each one?
- IBS C (Type I and II)
- IBD-D (Type 6 and 7)
- IBS-M (mixed)
What are the goals of therapy when treating patients with IBS?
- Imrpove stool consistency
- Improve stool frequency
- Improve global symptoms
What are our treatment options for patients with IBS-C (constipation)?
- Amitiza [Lubiprostone]
- Secretagogues [Linzess or Trulance]
- Tenapranor [Ibserela]
- Tegaserod [Zelnorm]
Amitiza Generic Name
Lubiprostone
Take with food
What are the secretagogues?
- Linzess [Linaclotide]
- Trulance [Plecanatide]
Which secretagogue has the highest guideline recommendation for IBS-C?
Linzess [Linaclotide]
What drug class is synonymous with secretagogues?
Guanylate Cyclase Agonists
What is the generic name of Ibserela? What does this drug treat? How does it work? What are the most common ADEs?
- Tenapanor
- IBS-C
- It decreases Na/PO4 absorption which increases H2O in the stool.
*Also has some effect on the GI pain receptors. - 15% of patients develop diarrhea.
What is the generic name of Zelnorm? What is this drug used to treat? How does it work? Why does it have a REMS program?
- Tegaserod
- IBS-C
- 5-HT-4 Agonist (increase GI secretions + improves visceral pain.)
- REMs program due to an increase in observed cardiac events in patients on Tegaserod. Patients may only use if they no CVD Hx or RF for CVD.
Which IBS-C treatment has a REMS program and why?
REMs program due to an increase in observed cardiac events in patients on Tegaserod. Patients may only use if they no CVD Hx or RF for CVD.
What agents are typically used in the management of IBS-D?
- Xifaxan [Rifaximin]
- Viberzi [Eluxadoline]
- Lotrenex [Alosetron]
What is the generic name of Xifaxan? What is this drug used to treat? How does it work? What is the duration of treatment?
- Rifaximin
- IBS-D
- Poorly absorbed antibiotic, which is used if the likely cause is SIBO (small intestinal bacterial overgrowth), determined by a positive methane breath test.
- 14 day course of treatment (may be repeated twice as necessary)
What is the methane breath test used to diagnose?
IBS-D is caused by small intestinal overgrowth. These patients should be treated with Xifaxan.
What is the generic name of Viberzi? What is the mechanism of action of this agent? What is this drug used to treat?
- Eluxadoline
- Mechanism = u-agonist-delta-antagonist- kappa-agonist. (inhibits bowel contractions, leading to a decrease in GI transit time, and ultimately less diarrhea.
- IBS-D
What is the generic name for Lotrenex? What is the mechanism of action of this drug? What is it used to treat? Why does it have a REMS program?
- Alosetron
- 5-HT-3 Agonist (decreases transit time, increase H2O absorption, and decrease the liquidity of the stool.)
- IBS-D
- REMS program due to risk of severe constipation and ischemic cholitis. All patients must discontinue this medication if it is not discontinued within 4 weeks.
Which IBS-D treatment has a REMS program due to the risk of severe constipation and ischemic colitis.
Alosetron [Lotrenex]–> must be discontinued within 4 weeks if no benefit is observed.
Which drug should be discontinued within 4 weeks if no benefit is observed? Please state both the brand and generic name.
Lotrenex [Alosetron]
What medications are used for any subtype of IBS?
- Antidepressants (TCAs preferred)
- Soluble Fiber (Oak bran, Barley, Psyllium, Beans)
- Peppermint Oil = Evidence Based Antispasmodic.
- Anti-spasmodics (Dicyclomine, Hycosamine) = Poor Evidence.
