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CDM 2 Exam 3 > Lecture 9 - Diarrhea, constipation, IBS > Flashcards

Lecture 9 - Diarrhea, constipation, IBS Flashcards

1
Q

Constipation definition

A

Less than 3-5 bowel movements/week or > 3 days with no bowel movement

hard or lumpy stool

straining, incomplete pooping

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2
Q

Non-pharm tx for constipation

A

increase fiber intake to 20-35g/day..fruits/veggies/grains

maintain adequate fluid intake
exercise
correct underlying disease

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3
Q

Agents that cause softening of feces in 1-3 days

A

Bulk forming agents + osmotic agents:
Methylcellulose**, Polycarbophil, psyllium, polyethylene 3350

Emollients:
Docusate, Lactulose, Sorbitol

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4
Q

Agents that result in soft or semifluid stool in 6-12hrs

A

Bisacodyl
Senna
Magnesium sulfate = low dose

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5
Q

Agents that cause watery evacuation in 1-6hrs

A

used for extreme constipation, bowel prep. draw electrolytes into colon lumen..water follows…

Mag citrate
Mag hydroxide (milk of magnesia)
Mag sulfate = high dose
Sodium phosphates
Bisacodyl
Gavilyte= polyethylene glycol electrolyte prep
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6
Q

Lubiprostone (Amitiza) MOA

A

activates chloride channels in GI tract to increase intestinal fluid secretions

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7
Q

Lubiprostone (Amitiza) ADE + usages

A

Diarrhea
nausea

used for chronic constipation
IBS w/ constipation in females > 18yrs old

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8
Q

Linaclotide (Linzess) ADE + indications

A

Diarrhea
Abdominal pain

chronic constipation

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9
Q

Linaclotide taken on full or empty stomach?

A

empty stomach

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10
Q

Plecanatide (trulance) ADE + uses

A

diarrhea way less
some other like URI, farting, AST/ALT elev, sinusitis

Used for chronic constipation

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11
Q

Prucalopride (Motegrity) MOA

A

5-HT4 receptor agonist…stimulates peristalsis, increases colonic motility

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12
Q

Prucalopride (Motegrity) ADE

A

Most common: HA/N/D/abdominal pain

Less common: warning/precaution suicidal behavior

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13
Q

Prucalopride (Motegrity) Indications

A

chronic constipation

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14
Q

Prucalopride Dosing

A

w/ or w/o food

2mg/day, dose adjust for renal

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15
Q

Managing opioid induced constipation (> 4 wks)

A

Osmotic or stimulant laxative

Lubiprostone or opioid receptor antagonist

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16
Q

Managing acute constipation (< 3-6months)

A

add osmotic laxative if no relief trial 2-4weeks

Add stimulate laxative if no BM in 2 days or no relief

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17
Q

Managing chronic constipation ( > 6 months)

A

Trial of intestinal secretagogue

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18
Q

Acute Diarrhea

A

less than 14 days

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19
Q

Persistent Diarrhea

A

More than 14 days

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20
Q

Chronic Diarrhea

A

over 30 days

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21
Q

causes of Diarrhea

A

Bacteria
Viruses
Parasites
Medications - abx, laxatives, antacids, colchicine

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22
Q

Self-care exclusion criteria

A

Signs of systemic illness = fever, chills, anorexia
Signs of moderate/severe dehydration
chronic diarrhea
Diarrhea w/ blood or mucus in stool

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23
Q

non-pharm diarrhea treatment

A

Typically self limiting

water and electrolytes
bland diet as diarrhea decreases

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24
Q

Absorbants MOA

A

non-specific, absorbs nutrients/toxins/drugs and digestive juices

Well-tolerated

Questionable efficacy

25
1st line diarrhea
Peptobismol or Bismut subsalicylate precaution: interaction w/ anticoagulants, salicylic, reye syndrome ADE: darkening of stool + tongue
26
Loperamide (Anti-peristalsis agent) info (Immodium)
indicated: diarrhea + travelers Diarrhea Well tolerated Precaution: Beers Criteria, Dementia, Cognitive impairment.
27
Loperamide OTC dosing
4mg then 2 mg after each loose stool max: 16mg per day
28
Probiotics info
MOA: replace colonic microflora, restores normal function Dosage depend on formulation
29
Monitoring and follow-up for diarrhea
typically resolves in < 72hrs full resolution of symptoms in 3-7 days Medical referral is appropriate for signs and symptoms that are persistent or worsen
30
IBS characterized by....
Chronic abdominal pain Abdominal bloating/distension Change in bowel habits = constipation, diarrhea, mixed features
31
Potential IBS Risk factors
``` Gastroenteritis Psychosocial Factors Genetics Fibromyalgia, migraine Asthma ```
32
Signs and Symptoms of IBS
Abdominal pain Changes in bowel movements Upper GI symptoms Abdominal Distension
33
ALARM symptoms IBS
``` FEver GI/rectal bleeding Anemia Family history of IBD onset after age 50 unexplained weightloss Pain that is progressive/ sleep preventive Unrelenting diarrhea ```
34
IBS-C
IBS w/ predominant constipation
35
IBS-D
IBS w. predominant diarrhea
36
IBS-M
IBS with mixed bowel habits
37
IBS-U
IBS with unclassified bowel habits
38
Rome IV Diagnostic Criteria
Recurrent abdominal pain, atleast 1 day per week in the last 3 months associated with 2 or more of the following.... 1. Related to defecation 2. Associated w/ a change in stool frequency 3. Associated w/ change in stool form/appearance must be fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis
39
Goals of IBS treatment
improve specific symptoms improve quality of life prevent complications
40
non-pharm tx of IBS
1st line = Diet and Modification FODAMP diet exercise
41
for IBS-C use....
``` Bulk forming agents Osmotic Laxatives Plecanatide Lubiprostone = strong recommendation Linaclotide Tenapanor Tegaserod ```
42
Tenapanor (Ibsrela) MOA
acts locally = poor GI absorption Inhibits Na-H exchanger reduces Na absorption, increase lumen water secretion
43
Tenapanor (Ibsrela) ADE + dosing
diarrhea - 15/16% Severe in 2.5% take immediate before breakfast and dinner
44
Tegaserod (Zelnorm) MOA
5-HT4 receptor partial agonist the inc peristalsis and intestinal secretion
45
Tegaserod (Zelnorm) ADE
HA Diarrhea Chest pain, Heart attack and stroke*****
46
Tegaserod (Zelnorm) dosing
Females only...before meals for 4-6weeks ppl < 65 females without history of MI, CVA, TIA or angina
47
IBS-D drugs
Eluxadoline (Viberzi) Rifaximin (Xifaxan)** recommended for pretreatment Alosetron (Lotronex)
48
Eluxadoline (Viberzi) MOA
Mixed Mu and Kappa opioid receptor agonist, delta-opioid receptor antagonist Locally reduces abdominal pain and diarrhea
49
Eluxadoline (Viberzi) ADE
Constipation Abdominal pain Pancreatitis = rare
50
Eluxadoline (Viberzi) doses
D/c if constipation persist > 4 days
51
Rifaximin dosing
14 days, retreat up to 2 times
52
Alosetrone (Lotronex) info
approved w/ severe diarrhea in females refractory to conventional therapy. only available through MD Lotronex Prescribing program
53
Peppermint Oil
For global IBS symptoms limited commercial preparations generally well tolerated
54
Gut-directed psychotherapies
CBT CDH targets accompanying depression, anxiety, chronic pain
55
Probiotics for IBS
not recommended by AGA, low lvl of evidence supporting
56
Antiplasmatics...
thought to be somewhat beneficial
57
IBS-C treatment algo
1. osmotic laxatives = constipation 1. antispasmodics = abdominal pain 2. Secretagogues = 2nd line, Tegaserod = 3rd line 3. add low dose TCA, SNRI, CBT if no response
58
IBS-D treatment algo
1. Loperamide = diarrhea 1. antispasmodics = abdominal pain 2. Rifaximin = 2nd line, Alosetron = 3rd line 3. add low dose TCA, SNRI, CBT if no response

CDM 2 Exam 3 (13 decks)

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