- food allergies or sensitivities - Stress - Antibiotic use - Chronic alcohol use - Bile acid malabsorption - Abnormally low levels of serotonin

- May be caused by a combination of genetic factors and/or environmental conditions that trigger the autoimmune response - During the autoimmune response Tumor Necrosis Factor (TNF) and other antiinflammatory substances are released to fight the "infection" and cause inflammation, ulceration and pain

- Chron's disease may cause chronic inflammation and ulceration of the entire GI tract - Inflammation and ulcers are DEEP within the intestinal wall - Most common in ages 15-45

IBS, UC, Chron's Disease - Chapter 22 Flashcards by Tayler Trainer

Irritable Bowel Syndrome (IBS)

A condition that causes:

Abdominal distress or erratic movement of large bowel leading to decreased quality of life
IBS with diarrhea predominance (IBS-D)
IBS with constipation predominance (IBS-C)
IBS with alternating diarrhea/constipation (IBS-A)
symptoms before 35
NOT inflammatory
Movement of waste through colon too slow or too rapid

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What causes IBS

food allergies or sensitivities
Stress
Antibiotic use
Chronic alcohol use
Bile acid malabsorption
Abnormally low levels of serotonin

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Inflammatory Bowl Disease (IBD)

A chronic and serious autoimmune inflammatory condition of the GI tract causing severe diarrhea, abdominal cramps, rectal bleeding, fever, joint pain, loss of appetite, fatique, bowel obstruction, etc.
Includes ulcerative colitis, Chron’s disease, ulcerative proctitis, and indeterminate colitis

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Causes of IBD

May be caused by a combination of genetic factors and/or environmental conditions that trigger the autoimmune response
During the autoimmune response Tumor Necrosis Factor (TNF) and other antiinflammatory substances are released to fight the “infection” and cause inflammation, ulceration and pain

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Colonoscopy and sigmoidoscopy

-IBS can be ruled out and ulcerative colitis or Chron’s disease can be diagnosed by testing stool samples, taking radiographs, and performing a colonoscopy or sigmoidoscopy

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IBD: Ulcerative Colitis (UC)

UC produces inflammation, ulcers and sores in the upper layers of the lining of the colon and rectum
Inflammation is limited to the colon and rectum rather than other areas of the GI tract
Most commonly occurs between ages of 15-45

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IBD: Chron’s Disease

Chron’s disease may cause chronic inflammation and ulceration of the entire GI tract
Inflammation and ulcers are DEEP within the intestinal wall
Most common in ages 15-45

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Similar Symptoms Between IBS, UC, and Chron’s Disease

Abdominal Pain
Diarrhea
Cramping

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Disease specific Symptoms: IBS

Erratic bowel movements
Abdominal pain relieved by having a bowel movement
Bloating
Constipation

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Disease Specific Symptoms: UC

Rectal bleeding
Anemia
Weight loss/loss of appetite
Fatigue
Loss of vitamins and minerals
Skin lesions
Joint pain
Fever

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Disease Specific Symptoms: Chron’s Disease

Rectal bleeding
Anemia
Weight/appetite loss
Loss of vitamins and minerals
Skin lesions
Joint pain
fever

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Drugs Used in the Treatment of IBS

Opioid antidiarrheals
Laxatives
Bulk forming Fiber supplements
Anticholinergics/antispasmodics
Misc agents
5-HT4 agonist
guanylate cylase-C agonist

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Opioid Antidiarrheals

-Control watery and frequent stools of IBS

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Antidiarrheals Examples

attapulgite
bismuth subsalicylate
cholestyramine
diphenoxylate/atropine
loperamide

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Generic: attapulgite

Kaopectate

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Generic: bismuth subsalicylate

Pepto Bismol

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Generic: cholestyramine

Cholestyramine

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Generic: diphenoxylate/atropine

Lomotil

Narcotic
Opioid antidiarrheal

Warning Labels

MAY CAUSE DIZZINESS AND DROWSINESS
AVOID ALCOHOL
TAKE WITH LOTS OF WATER

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Generic: loperamide

Imodium

-Opioid antidiarrheal

Warning Labels
-TAKE WITH LOTS OF WATER

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Opioid Antidiarrheals ADR”s

Sedation (Lomotil)
Constipation
Toxic megacolon

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Laxatives

-Used in moderation for alleviating constipation of IBS

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Stimulant Laxatives Examples

bisacodyl

- sennosides

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Generic: bisacodyl

Carters Little Pills
Correctol
Dulcolax

-Stimulant Laxative

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Generic: sennosides

Senokot
Ex-Lax

-Stimulant Laxative

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Osmotic Laxatives Examples

- PEG-3350 - electrolytes/PEG-3350 - lactulose - magnesium citrate - magnesium hydroxide - magnesium sulfate - picosulfate sodium/magnesium oxide/citric acid - sodium phosphates

Generic: polyethylene glycol (PEG-3350)

Lax-A-Day RestoraLAX -Osmotic Laxative

Generic: electrolytes/PEG-3350

``` Colyte Moviprep Kleanprep Bi-Peglyte Peglyte Golytley ``` -Osmotic Laxative

Generic: lactulose

lactulose -Osmotic Laxative

Generic: magnesium citrate

Citro-Mag -Osmotic Laxative

Generic: magnesium hydroxide

Milk of Magnesia -Osmotic Laxative

Generic: magnesium sulfate

magnesium sulfate -Osmotic Laxative

Generic: picosulfate sodium/magnesium oxide/citric acid

Pico-Salax Picoflo -Osmotic Laxative

Generic: sodium phosphates

Fleet Enema Fleet Phospho-Soda Oral Laxative -Osmotic Laxative

Bulk-Forming Fibre Supplements

- Soluble fibre supplements relieve constipation and diarrhea of IBS - Swell in the presence of liquid - Increase bulk or firmness of stool in patients with diarrhea

Bulk-Forming Fibre Supplements Examples

- psyllium - calcium polycarbophil - inulin

Generic: psyllium

Metamucil -Bulk-Forming Fibre Supplement

Generic: calcium polycarbophil

Prodiem Bulk fibre Therapy -Bulk-Forming Fibre Supplement

Generic: inulin

Benefibre -Bulk-Forming Fibre Supplement

Anticholinergic/Antispasmodic Drugs

-Used in the treatment of IBS when diarrhea and spasms are the primary symptoms

Anticholinergic/Antispasmodic Drugs Examples

- dicyclomine - hyoscine - glycopyrrolate - pinaverium - scopolamine - trimebutine

Generic: dicyclomine

Bentylol -Anticholinergic/Antispasmodic

Generic: hysocine

Buscopan -Anticholinergic/Antispasmodic

Generic: glycopyrrolate

Glycopyrrolate Injection -Anticholinergic/Antispasmodic

Generic: pinaverium

Dicetel -Anticholinergic/Antispasmodic

Generic: scopolamine

Scopolamine Injection -Anticholinergic/Antispasmodic

Generic: trimebutine

Modulon -Anticholinergic/Antispasmodic

Anticholinergic/Antispasmodic Drugs ADR's

- Blurred Vision - Photophobia - Urinary retention - Constipation - Drowsiness

Anticholinergic/Antispasmodic Drugs Warning Labels

- MAY CAUSE DROWSINESS | - CAUTION DRIVING

Serotonin (5-HT4) Agonist

- Selective for serotonin receptors in the GI tract that stimulate motility - Only indicated for use in women

Generic: prucalopride

Resotran -Serotonin (5-HT4) Agonist

Guanylate Cyclase-C Agonist Examples

-linaclotide

Generic: linaclotide

Constella Guanylate Cyclase-C Agonist

Lifestyle Modifications for IBS

- Eat small meals - Drink lots of water - Avoid alcohol - Avoid caffeinated beverages - Limited carbonated beverages - Avoid foods that worsen symptoms

Treatment of IBD

- Antiinflammatory agents for IBD may be topical for rectal application or oral - 5-aminosalicylate derivatives are a mainstay of therapy, especially in UC

Antiinflammatory Agents Examples

- 5-aminosalicylic acid (mesalazine/mesalamine) - olsalazine - sulfasalazine

`Generic: 5-aminosalicylic acid (mesalazine/mesalamine)

``` Asacol Mesasal Mezavant Pentasa Salofalk ``` -Antiinflammatory agent

Generic: olsalazine

Dipentum -Antiinflammatory agent

Generic: sulfasalazine

Salazopyrin -Antiinflammatory agent

Antiinflammatory Agents ADR's

- Nausea/vomiting - Heartburn - Headache - Watery diarrhea

5-aminosalicylic acid (mesalazine/mesalamine) | Warning Labels

- UNWRAP AND INSERT (suppository) - MAY DISCOLOR SKIN OR CLOTHING (suppository) - SHAKE WELL (Rectal suspension) - SWALLOW WHOLE; DONT CRUSH OR CHEW - TAKE WITH FOOD (delayed release)

Olsalazine Warning Labels

- SWALLOW WHOLE; DONT CRUSH OR CHEW | - TAKE WITH FOOD

Sulfasalazine Warning Labels

-SWALLOW WHOLS; DONT CRUSH OR CHEW -AVOID PROLONGUED EXPOSURE TO SUNLIGHT -DRINK LOTS OF FLUIDS TAKE WITH FOOD

Corticosteroids Used to Treat UC and Chron's Disease

- For moderate to severe IBD | - may be administered by mouth or rectally

Corticosteroids Examples

- betamethasone - budesonide - dexamethasone - hydrocortisone - methylprednisolone - prednisone

Generic: betamethasone

Betnesol Retention Enema - rectal - Corticosteroid

Generic: budesonide

Entocort Capsules Entocort Enema - Oral, rectal - Corticosteroid

Generic: dexamethasone

Decadron dexamethasone -oral --Corticosteroid

Generic: hydrocortisone

``` Cortef Cortenema Cotrifoam Proctofoam Solu-Cortef ``` - rectal, iv - Corticosteroid

Generic: methylprednisolone

Solu-Medrol Medrol - Oral, iv - Corticosteroid

Generic: prednisone

Winipred - Oral - Corticosteroid

Corticosteroid ADR's

- insomnia - Mood swings - Nausea - Weight gain - Acne - Thin skin - Infection - Hypertension - Local itching and burning (rectal)

Corticosteroids Warning Labels

- TAKE WITH FOOD - TAKE IN THE MORNING - DONT D/C ABRUPTLY

Immunosuppressants

-Used to induce remission is Chron's disease and UC

Immunosuppressants Examples

- azathioprine - cyclosporine - 6-mercaptopurine - methotrexate

Generic: azathioprine

Imuran -Immunosuppressant Warning Labels: -TAKE WITH FOOD

Generic: cyclosporine

Neoral Sandimune I.V -Immunosuppressant

Generic: 6-mercaptopurine

Purinethol -Immunosuppressant Warning Labels: - AVOID ALCOHOL - AVOID PREGNANCY

Generic: methotrexate

methotrexate Warning Labels: - AVOID ALCOHOL - AVOID PREGNANCY

Monoclonal Antibodies

- Common ending: "mab" | - Used to induce remission

Monoclonal Antibodies Examples

- adalimumab - infliximab - certolizumab - golimumab - natalizumab

Generic: adalimumab

Humira -Monoclonal antibody

Generic: infliximab

Remicade -Monoclonal antibody

Generic: certolizumab

Cimzia -Monoclonal antibody

Generic: golimumab

Simponi -Monoclonal antibody

Generic: natalizumab

Tysabri -Monoclonal antibody

Monoclonal Antibodies ADR's

- Nausea or stomach pain - Headache - Cheat pain - Hypertension