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PHAR154 > Irritable Bowel Syndrome > Flashcards

Irritable Bowel Syndrome Flashcards

1
Q

True or false: in the doctors office there is testing to show abnormalities to prove IBS

A

false
no tests, its a diagnosis of exclusion
the bowel looks fine, yet there are issues

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2
Q

What is the old term for IBS?

A

spastic colon

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3
Q

What percentage of people in the Western world suffer from IBS?

A

10-20%
more common: women in North America, men in Asia

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4
Q

Where does IBS rank for lost days of work?

A

2nd only behind the common cold
only 15% of people seek medical care

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5
Q

What is the etiology of IBS?

A

brain-gut axis–>emotional expression thru gut 5-HT
sufferers seem to “over-react” to various stimuli such as stress, diet (fructose, gluten, etc), certain activity
previous gut infection (eg TD)
linked with depression
no abnormalities on physical exam

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6
Q

What are the symptoms of IBS?

A

> 6 months of duration
pain/spasms
-most common symptom, less severe post-BM
bloating/fullness
urgency
constipation<–>diarrhea
-IBS-C is most common type
mucous in stool (but no bleeding)
bloating/distention
-15-30% in general population, 75-90% in women

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7
Q

What are the patterns of IBS?

A

IBS-D
->25% of BMs are 6 or 7 on Bristol
IBS-C
->25% of BMs are 1 or 2 on Bristol
IBS-mixed
patterns can change over time

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8
Q

How many stools per week do IBS-D sufferers average?

A

18 stools/week
50% were watery

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9
Q

True or false: simethicone will be a great add for IBS patients

A

false

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10
Q

What are some other conditions to keep in mind when you are thinking a case might be IBS?

A

lactose intolerance
IBD
gluten intolerance
drug-induced
colorectal cancer
IBS is more common than all these

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11
Q

What are some dietary changes an IBS sufferer can make?

A

fiber (mainly IBS-C, tiny bits on the IBS-D front)
reduce fatty foods
avoid offending foods

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12
Q

What is the acronym to help remember the foods that might irritate an IBS patient?

A

FODMAP
fermentable
oligosaccharides (fructans, galactans)
disaccharides (lactose)
monosaccharides (fructose)
AND
polyols (sugar alcohols)

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13
Q

What is the use of Beano?

A

prevent gas formation via beans + long chain carbs
adding an enzyme (a-d-galactosidase) to breakdown stuff and prevent gas
take before food
NOT FOR IBS

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14
Q

What is the use of Lactaid?

A

breaks down sugars to prevent osmotic force and gas
milk, ice cream, etc
NOT FOR IBS

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15
Q

What is often a critical non-pharm component of managing IBS?

A

the psychological angle
strong patient-physician relationship
many people with IBS have coexisting anxiety or depression

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16
Q

Describe the use of bulk-forming agents in IBS.

A

psyllium is recommended for IBS-C
-2 to 4 tbsp with fluids
-start with 1 tbsp
PEG 3350 has less proof (likely to change)
might help with IBS-D too (stool consistency)
if this fails can use senna/bisacodyl for breakthrough

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17
Q

True or false: using a bulk-forming agent for IBS-C will help with the spasms/pain

A

false
this is where the frustration comes in for patients

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18
Q

How do smooth-muscle relaxants work for IBS?

A

create less spasm/better coordination
work best if used regularly (not prn)

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19
Q

Which variant of IBS are smooth muscle relaxants best for?

A

can try in IBS-C or IBS-D

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20
Q

What are examples of smooth muscle relaxants for IBS?

A

pinaverium
-calcium channel antagonist–>muscle relaxation
-selective for intestinal smooth muscle
trimebutine
-opiate receptor agonist/5 HT3 antagonist

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21
Q

Which variant of IBS are anti-diarrheals used for?

A

IBS-D

22
Q

How is loperamide used for IBS-D?

A

2-4mg up to QID
outcome=decreased diarrhea, no help for pain

23
Q

True or false: years of use of loperamide for IBS-D is safe

A

true

24
Q

Which anti-diarrheal has an increased risk for side effects and is therefore rarely used?

A

diphenoxylate

25
Q

If someone has a fear that sudden urgency and need to defecate may occur in a setting where toilets are not available, what could be a good move?

A

take 2-4mg of loperamide approx 45 min ahead of time

26
Q

True or false: if a patient has IBS-D, they will have that variant forever and will never experience IBS-C

A

false
patterns can change in same patient over time

27
Q

Describe the use of peppermint oil for IBS.

A

mildly effective
smooth muscle relaxant
-can be tried for IBS-C or IBS-D
“for pain, spasms, bloating, gas”
enteric caps
try for one month, have low expectations

28
Q

What is IBgard?

A

medical food specially formulated for the dietary management of IBS
contains ultra purified peppermint oil

29
Q

What might be a good Rx option for an IBS-D patient who also experiences depression?

A

TCAs for pain/diarrhea
-amitriptyline or desipramine at lower doses
-anti-cholinergic=constipation

30
Q

Are SSRIs used for IBS?

A

can be recommended if IBS+depression but unclear benefits
-would be for IBS-C
-better for depression
can be helpful in short-term, but ideal to stop prolonged use

31
Q

How much of the bodys serotonin is produced in the gut?

A

90%

32
Q

What is alosetron?

A

5 HT3 antagonist–>decreased gut motility
for IBS-D women only (decreased diarrhea/pain)
d/c in 2001 because of severe constipation–>ischemic colitis

33
Q

What is tegaserod?

A

5-HT4 partial agonist–>prokinetic agent
IBS-C and abdominal pain in women
main se=diarrhea (12%)
d/c in 2007 (cardiac risk)

34
Q

What are all the options we have for IBS-D only?

A

loperamide
bulk-forming lax
buscopan/bentylol
rifaximin
eluxadoline
TCAs

35
Q

What are all the options we have for IBS-C?

A

laxatives (bulk-forming, PEG, stim)
linaclotide
lubiprostone
tenapanor
plecanatide
SSRIs

36
Q

What are the options we have that can be used in both IBS-D and IBS-C?

A

pinaverium
trimebutine
peppermint oil
probiotics

37
Q

How does linaclotide work?

A

guanylate cyclase C agonist–>acts locally on GIT to stimulate fluid secretion, increase colonic transit, and reduce abdominal symptoms
very low oral bioavailability

38
Q

What is linaclotide used for?

A

treatment of moderate-severe IBS-C in adults
improves constipation, bloating, abdominal pain
must be older than 6

39
Q

What is the most common adverse effect of linaclotide?

A

diarrhea
generally well tolerated

40
Q

Aside from IBS-C, what is another use of lubiprostone?

A

constipation caused by opioids

41
Q

What is eluxadoline?

A

mu-opioid receptor agonist
used for IBS-D to reduce abdominal pain and diarrhea

42
Q

What is the role in therapy of probiotics for IBS?

A

can try one and add to existing meds
dont know what to expect
pick the ones that have IBS on the label

43
Q

True or false: anti-cholinergics are first line agents in IBS

A

false
less effect and more side effects than smooth muscle relaxants

44
Q

What are the anti-cholinergics that are sometimes used for IBS?

A

Bentylol (dicyclomine)
Buscopan (hyoscine)

45
Q

True or false: the packaging of Buscopan has IBS as an indication

A

false

46
Q

Will someone be put on Buscopan long-term?

A

no
used for short-term relief of cramping

47
Q

How does lubiprostone work?

A

chloride channel activator
-increasing amount of fluid within intestines–>easier passage of stools

48
Q

What is the use of tenapanor?

A

IBS-C
-acts locally in GIT to inhibit NHE3=increase in BM and decrease in abdominal pain

49
Q

What is currently the only Health Canada approved medication indicated for IBS-D?

A

eluxadoline (Viberzi)

50
Q

What is plecanatide?

A

guanylate cyclase C agonist (same MOA as linaclotide)
IBS-C

51
Q

What is rifaximin?

A

short-term therapy for IBS-D (helps with diarrhea and abdominal pain)
modulates gut microbiota by reducing GI bacterial load
nausea is most common AE

52
Q

What is the dosing of Bentylol/Buscopan?

A

1-2 10mg tablets per day up to a maximum of 6 tablets per day
stress/allergy listed on package, not IBS

PHAR154 (18 decks)

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