Irritable Bowel Syndrome (IBS)

Question 1

Things to Assess for Irritable Bowel Syndrome (IBS)

Answer 1

• Recent exacerbating factors
  1. Medication changes
  2. Dietary changes
• Workup for serious illness
• Stressors
• Malingering: disability, requests for opiates
• Psychiatric comorbidities

Question 2

Key to Optimum Therapy for Irritable Bowel Syndrome (IBS)

Answer 2

• Establish a therapeutic relationship with patient
• Be non-judgmental
• Establish realistic expectations
• Involve the patient in treatment decisions
• Patient education of proposed mechanisms of IBS

Question 3

for IBS with Abdominal Pain and Bloating, what classes of medication can you use?

Answer 3

Antispasmodic Agents

Antidepressants

Question 4

Antispasmodic Agents work via their ______ activity in GI smooth muscle

Answer 4

anticholinergic

Question 5

Antispasmodic Agents drug names

Answer 5

o	Dicyclomine (Bentyl)
o	Hyoscyamine

Question 6

how are Antispasmodic Agents used/dosed?

Answer 6

• Used on PRN basis and/or in anticipation of stressors

Question 7

Antispasmodic Agents ADRs

Answer 7

like other anticholinergic

Question 8

Antidepressants can be used for IBS with Abdominal Pain and Bloating because of their ____ effects.

Answer 8

analgesic

Question 9

Antidiarrheal Agents used in IBS

Answer 9

1. Loperamide
2. cholestyramine, colestipol, colesevelam
3. Rifaximin (Xifaxan)
4. Eluxadoline (Viberzi)
5. 5-HT3 antagonist

Question 10

Loperamide Can be dosed ___ minutes before meals

Answer 10

45

Question 11

Rifaximin (Xifaxan) is an antibiotic that has been used to treat what in the past?

Answer 11

Antibiotic that has been used in past for hepatic encephalopathy and traveler’s diarrhea

Question 12

Rifaximin (Xifaxan) MOA

Answer 12

inhibits RNA synthesis by binding to DNA-dependent RNA polymerase

Question 13

Rifaximin (Xifaxan) can be used for how many weeks?

Answer 13

2 weeks

Question 14

Eluxadoline (Viberzi) MOA

Answer 14

mixed mu-opioid receptor (these receptors cause constipation) agonist, delta opioid receptor antagonist, and kappa opioid receptor agonist

Question 15

Eluxadoline (Viberzi) disease CI/warnings

Answer 15

o	Biliary duct obstruction
o	Sphincter of Oddi dysfunction
o	Pancreatitis
o	Alcoholism
o	3+ drinks per day
o	GI obstruction

Question 16

Eluxadoline (Viberzi) should NOT be used in patients who do not have a ______ due to increase risk of serious pancreatitis

Answer 16

gallbladder

Question 17

what IBS Antidiarrheal Agent is on the FDA REMS program

Answer 17

Alosetron (Lotronex)

Question 18

Alosetron (Lotronex) MOA

Answer 18

5-HT3 receptor antagonist

Question 19

Alosetron (Lotronex) BBW

Answer 19

o Severe constipation with serious complications (e.g., obstruction, ileus, perforation, impaction)
o Acute ischemic colitis

Question 20

Alosetron (Lotronex) warnings

Answer 20

o Hepatic impairment

o Elderly

Question 21

can Alosetron (Lotronex) be used in both males and females?

Answer 21

no just females

Question 22

in IBS-C Treatment, what should you start with?

Answer 22

Start with a trial of fiber

Question 23

in IBS-C Treatment, if fiber is not working what is next line of treatment?

Answer 23

OTC PEG (miralax)

Question 24

For patients with IBS-C who fail fiber and miralax, what drugs can be used next?

Answer 24

o	Lubiprostone (Amitiza)
o	Linaclotide (Linzess)
o	Plecanatide (Trulance)

Question 25

Tegaserod (Zelnorm) belongs to what class of drugs?

Answer 25

5-HT4 (partial) agonist

Question 26

Tegaserod (Zelnorm) MOA

Answer 26

action on receptor leads to stimulation of the peristaltic reflex and intestinal secretion

Question 27

Tegaserod (Zelnorm) ADRs

Answer 27

serious CV ADRs- fatal cardiac arrhythmias and other cardiovascular conditions

Question 28

for patients with IBS-C that have Mild symptoms, how should you treat?

Answer 28

patient education, dietary/lifestyle modification

Question 29

for patients with IBS-C that have Moderate symptoms, how should you treat?

Answer 29

above plus drug therapy according to symptoms

Question 30

for patients with IBS-C that have Severe or intractable symptoms, how should you treat?

Answer 30

best to refer to GI, need more thorough work up, endoscopy, etc.–>things you can’t do in primary care.