IBS Treatment

Question 1

Lubiprostone Trade Name

Answer 1

Amitiza

Question 2

Lubiprostone MOA

Answer 2

• selective chloride channel activator
• increase intestinal fluid secretion
• improve stool consistency
• increase intestinal motility

Question 3

Lubiprostone Indication

Answer 3

chronic idiopathic constipation

Question 4

Lubiprostone AEs

Answer 4

• nausea most common
• D/V
• abd pain/distention, gas
• HA, dizziness
• peripheral edema, dyspnea, arthralgia

Question 5

Lubiprostone CIs

Answer 5

-hx of mechanical GI obstruction

Question 6

Lubiprostone Dose

Answer 6

24 mcg bid with meals ($200 month)

Question 7

Linaclotide Trade Name

Answer 7

Linzess

Question 8

Linaclotide MOA

Answer 8

• increase concentration cGMP which leads to secretion of chloride and bicarbonate into intestinal lumen
• causes an increase in fluid and GI transit

Question 9

Linaclotide Indication

Answer 9

• IBS with constipation

- chronic idiopathic constipation

Question 10

Linaclotide AEs

Answer 10

-diarrhea and abd pain

Question 11

Linaclotide CI

Answer 11

• known or suspected mechanical GI obstruction

- age < 6 years (Avoid 6-17 yo)

Question 12

Linaclotide Dose

Answer 12

290 mcg po qday on empty stomach

-swallow whole >30 mins before 1st meal

Question 13

Special Considerations Linaclotide

Answer 13

• frequently stopped due to AEs

- 3rd or 4th line for IBS-C

Question 14

Tegaserod Trade Name

Answer 14

Zelnorm

Question 15

Tegaserod MOA

Answer 15

• 5HT4 partial agonist for short term treatment of constipation predominant IBS in women
• increase the movement of stools through the bowels

Question 16

Tegaserod Indications

Answer 16

• currently only available in US through investigational limited access program
• women under 55 with diagnosis of IBS-C or idiopathic constipation and no satisfactory response to other available tx

Question 17

Tegaserod AEs

Answer 17

• mild HA
• abd pain and D
• linked to heart attacks, strokes, unstable angina

Question 18

Tegaserod Warnings

Answer 18

• potential for serious consequences of diarrhea

- precaution about ischemic colitis and other forms of intestinal ischemia

Question 19

Tegaserod CIs

Answer 19

• renal or hepatic impairment

- pts with hx of bowel obstruction

Question 20

Tegaserod Dose

Answer 20

6 mg bid ac x4-6 wks

Question 21

Alosetron Trade Name

Answer 21

Lotronex

Question 22

Alosetron MOA

Answer 22

• 5HT3 receptor antagonist

- can delay whole gut transit time, increase colonic transit time and alter colon’s reaction to distention

Question 23

Alosetron Indication

Answer 23

-only for tx of women with severe, diarrhea predominant IBS who have failed to respond to conventional IBS therapy

Question 24

Alosetron AEs

Answer 24

-serious and unpredictable GI adverse events, including some that resulted in death