IBS, UC, Chron's Disease - Chapter 22 Flashcards

1
Q

Irritable Bowel Syndrome (IBS)

A

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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2
Q

What causes IBS

A
  • food allergies or sensitivities
  • Stress
  • Antibiotic use
  • Chronic alcohol use
  • Bile acid malabsorption
  • Abnormally low levels of serotonin
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3
Q

Inflammatory Bowl Disease (IBD)

A
  • 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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4
Q

Causes of IBD

A
  • 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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5
Q

Colonoscopy and sigmoidoscopy

A

-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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6
Q

IBD: Ulcerative Colitis (UC)

A
  • 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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7
Q

IBD: Chron’s Disease

A
  • 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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8
Q

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

A
  • Abdominal Pain
  • Diarrhea
  • Cramping
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9
Q

Disease specific Symptoms: IBS

A
  • Erratic bowel movements
  • Abdominal pain relieved by having a bowel movement
  • Bloating
  • Constipation
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10
Q

Disease Specific Symptoms: UC

A
  • Rectal bleeding
  • Anemia
  • Weight loss/loss of appetite
  • Fatigue
  • Loss of vitamins and minerals
  • Skin lesions
  • Joint pain
  • Fever
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11
Q

Disease Specific Symptoms: Chron’s Disease

A
  • Rectal bleeding
  • Anemia
  • Weight/appetite loss
  • Loss of vitamins and minerals
  • Skin lesions
  • Joint pain
  • fever
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12
Q

Drugs Used in the Treatment of IBS

A
  • Opioid antidiarrheals
  • Laxatives
  • Bulk forming Fiber supplements
  • Anticholinergics/antispasmodics
  • Misc agents
  • 5-HT4 agonist
  • guanylate cylase-C agonist
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13
Q

Opioid Antidiarrheals

A

-Control watery and frequent stools of IBS

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14
Q

Antidiarrheals Examples

A
  • attapulgite
  • bismuth subsalicylate
  • cholestyramine
  • diphenoxylate/atropine
  • loperamide
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15
Q

Generic: attapulgite

A

Kaopectate

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16
Q

Generic: bismuth subsalicylate

A

Pepto Bismol

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17
Q

Generic: cholestyramine

A

Cholestyramine

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18
Q

Generic: diphenoxylate/atropine

A

Lomotil

  • Narcotic
  • Opioid antidiarrheal

Warning Labels

  • MAY CAUSE DIZZINESS AND DROWSINESS
  • AVOID ALCOHOL
  • TAKE WITH LOTS OF WATER
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19
Q

Generic: loperamide

A

Imodium

-Opioid antidiarrheal

Warning Labels
-TAKE WITH LOTS OF WATER

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20
Q

Opioid Antidiarrheals ADR”s

A
  • Sedation (Lomotil)
  • Constipation
  • Toxic megacolon
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21
Q

Laxatives

A

-Used in moderation for alleviating constipation of IBS

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22
Q

Stimulant Laxatives Examples

A
  • bisacodyl

- sennosides

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23
Q

Generic: bisacodyl

A

Carters Little Pills
Correctol
Dulcolax

-Stimulant Laxative

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24
Q

Generic: sennosides

A

Senokot
Ex-Lax

-Stimulant Laxative

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25
Q

Osmotic Laxatives Examples

A
  • PEG-3350
  • electrolytes/PEG-3350
  • lactulose
  • magnesium citrate
  • magnesium hydroxide
  • magnesium sulfate
  • picosulfate sodium/magnesium oxide/citric acid
  • sodium phosphates
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26
Q

Generic: polyethylene glycol (PEG-3350)

A

Lax-A-Day
RestoraLAX

-Osmotic Laxative

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27
Q

Generic: electrolytes/PEG-3350

A
Colyte
Moviprep
Kleanprep
Bi-Peglyte
Peglyte
Golytley

-Osmotic Laxative

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28
Q

Generic: lactulose

A

lactulose

-Osmotic Laxative

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29
Q

Generic: magnesium citrate

A

Citro-Mag

-Osmotic Laxative

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30
Q

Generic: magnesium hydroxide

A

Milk of Magnesia

-Osmotic Laxative

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31
Q

Generic: magnesium sulfate

A

magnesium sulfate

-Osmotic Laxative

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32
Q

Generic: picosulfate sodium/magnesium oxide/citric acid

A

Pico-Salax
Picoflo

-Osmotic Laxative

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33
Q

Generic: sodium phosphates

A

Fleet Enema
Fleet Phospho-Soda Oral Laxative

-Osmotic Laxative

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34
Q

Bulk-Forming Fibre Supplements

A
  • 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
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35
Q

Bulk-Forming Fibre Supplements Examples

A
  • psyllium
  • calcium polycarbophil
  • inulin
36
Q

Generic: psyllium

A

Metamucil

-Bulk-Forming Fibre Supplement

37
Q

Generic: calcium polycarbophil

A

Prodiem Bulk fibre Therapy

-Bulk-Forming Fibre Supplement

38
Q

Generic: inulin

A

Benefibre

-Bulk-Forming Fibre Supplement

39
Q

Anticholinergic/Antispasmodic Drugs

A

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

40
Q

Anticholinergic/Antispasmodic Drugs Examples

A
  • dicyclomine
  • hyoscine
  • glycopyrrolate
  • pinaverium
  • scopolamine
  • trimebutine
41
Q

Generic: dicyclomine

A

Bentylol

-Anticholinergic/Antispasmodic

42
Q

Generic: hysocine

A

Buscopan

-Anticholinergic/Antispasmodic

43
Q

Generic: glycopyrrolate

A

Glycopyrrolate Injection

-Anticholinergic/Antispasmodic

44
Q

Generic: pinaverium

A

Dicetel

-Anticholinergic/Antispasmodic

45
Q

Generic: scopolamine

A

Scopolamine
Injection

-Anticholinergic/Antispasmodic

46
Q

Generic: trimebutine

A

Modulon

-Anticholinergic/Antispasmodic

47
Q

Anticholinergic/Antispasmodic Drugs ADR’s

A
  • Blurred Vision
  • Photophobia
  • Urinary retention
  • Constipation
  • Drowsiness
48
Q

Anticholinergic/Antispasmodic Drugs Warning Labels

A
  • MAY CAUSE DROWSINESS

- CAUTION DRIVING

49
Q

Serotonin (5-HT4) Agonist

A
  • Selective for serotonin receptors in the GI tract that stimulate motility
  • Only indicated for use in women
50
Q

Generic: prucalopride

A

Resotran

-Serotonin (5-HT4) Agonist

51
Q

Guanylate Cyclase-C Agonist Examples

A

-linaclotide

52
Q

Generic: linaclotide

A

Constella

Guanylate Cyclase-C Agonist

53
Q

Lifestyle Modifications for IBS

A
  • Eat small meals
  • Drink lots of water
  • Avoid alcohol
  • Avoid caffeinated beverages
  • Limited carbonated beverages
  • Avoid foods that worsen symptoms
54
Q

Treatment of IBD

A
  • Antiinflammatory agents for IBD may be topical for rectal application or oral
  • 5-aminosalicylate derivatives are a mainstay of therapy, especially in UC
55
Q

Antiinflammatory Agents Examples

A
  • 5-aminosalicylic acid (mesalazine/mesalamine)
  • olsalazine
  • sulfasalazine
56
Q

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

A
Asacol
Mesasal
Mezavant
Pentasa
Salofalk

-Antiinflammatory agent

57
Q

Generic: olsalazine

A

Dipentum

-Antiinflammatory agent

58
Q

Generic: sulfasalazine

A

Salazopyrin

-Antiinflammatory agent

59
Q

Antiinflammatory Agents ADR’s

A
  • Nausea/vomiting
  • Heartburn
  • Headache
  • Watery diarrhea
60
Q

5-aminosalicylic acid (mesalazine/mesalamine)

Warning Labels

A
  • 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)
61
Q

Olsalazine Warning Labels

A
  • SWALLOW WHOLE; DONT CRUSH OR CHEW

- TAKE WITH FOOD

62
Q

Sulfasalazine Warning Labels

A

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

63
Q

Corticosteroids Used to Treat UC and Chron’s Disease

A
  • For moderate to severe IBD

- may be administered by mouth or rectally

64
Q

Corticosteroids Examples

A
  • betamethasone
  • budesonide
  • dexamethasone
  • hydrocortisone
  • methylprednisolone
  • prednisone
65
Q

Generic: betamethasone

A

Betnesol Retention Enema

  • rectal
  • Corticosteroid
66
Q

Generic: budesonide

A

Entocort Capsules
Entocort Enema

  • Oral, rectal
  • Corticosteroid
67
Q

Generic: dexamethasone

A

Decadron
dexamethasone

-oral

–Corticosteroid

68
Q

Generic: hydrocortisone

A
Cortef
Cortenema
Cotrifoam
Proctofoam
Solu-Cortef
  • rectal, iv
  • Corticosteroid
69
Q

Generic: methylprednisolone

A

Solu-Medrol
Medrol

  • Oral, iv
  • Corticosteroid
70
Q

Generic: prednisone

A

Winipred

  • Oral
  • Corticosteroid
71
Q

Corticosteroid ADR’s

A
  • insomnia
  • Mood swings
  • Nausea
  • Weight gain
  • Acne
  • Thin skin
  • Infection
  • Hypertension
  • Local itching and burning (rectal)
72
Q

Corticosteroids Warning Labels

A
  • TAKE WITH FOOD
  • TAKE IN THE MORNING
  • DONT D/C ABRUPTLY
73
Q

Immunosuppressants

A

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

74
Q

Immunosuppressants Examples

A
  • azathioprine
  • cyclosporine
  • 6-mercaptopurine
  • methotrexate
75
Q

Generic: azathioprine

A

Imuran

-Immunosuppressant
Warning Labels:
-TAKE WITH FOOD

76
Q

Generic: cyclosporine

A

Neoral
Sandimune I.V

-Immunosuppressant

77
Q

Generic: 6-mercaptopurine

A

Purinethol

-Immunosuppressant

Warning Labels:

  • AVOID ALCOHOL
  • AVOID PREGNANCY
78
Q

Generic: methotrexate

A

methotrexate

Warning Labels:

  • AVOID ALCOHOL
  • AVOID PREGNANCY
79
Q

Monoclonal Antibodies

A
  • Common ending: “mab”

- Used to induce remission

80
Q

Monoclonal Antibodies Examples

A
  • adalimumab
  • infliximab
  • certolizumab
  • golimumab
  • natalizumab
81
Q

Generic: adalimumab

A

Humira

-Monoclonal antibody

82
Q

Generic: infliximab

A

Remicade

-Monoclonal antibody

83
Q

Generic: certolizumab

A

Cimzia

-Monoclonal antibody

84
Q

Generic: golimumab

A

Simponi

-Monoclonal antibody

85
Q

Generic: natalizumab

A

Tysabri

-Monoclonal antibody

86
Q

Monoclonal Antibodies ADR’s

A
  • Nausea or stomach pain
  • Headache
  • Cheat pain
  • Hypertension