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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
Q

1st line diarrhea

A

Peptobismol or Bismut subsalicylate

precaution: interaction w/ anticoagulants, salicylic, reye syndrome

ADE: darkening of stool + tongue

26
Q

Loperamide (Anti-peristalsis agent) info (Immodium)

A

indicated: diarrhea + travelers Diarrhea

Well tolerated

Precaution: Beers Criteria, Dementia, Cognitive impairment.

27
Q

Loperamide OTC dosing

A

4mg then 2 mg after each loose stool

max: 16mg per day

28
Q

Probiotics info

A

MOA: replace colonic microflora, restores normal function

Dosage depend on formulation

29
Q

Monitoring and follow-up for diarrhea

A

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
Q

IBS characterized by….

A

Chronic abdominal pain
Abdominal bloating/distension
Change in bowel habits = constipation, diarrhea, mixed features

31
Q

Potential IBS Risk factors

A 
Gastroenteritis
Psychosocial Factors
Genetics
Fibromyalgia, migraine
Asthma
32
Q

Signs and Symptoms of IBS

A

Abdominal pain
Changes in bowel movements
Upper GI symptoms
Abdominal Distension

33
Q

ALARM symptoms IBS

A 
FEver
GI/rectal bleeding
Anemia
Family history of IBD
onset after age 50
unexplained weightloss
Pain that is progressive/ sleep preventive
Unrelenting diarrhea
34
Q

IBS-C

A

IBS w/ predominant constipation

35
Q

IBS-D

A

IBS w. predominant diarrhea

36
Q

IBS-M

A

IBS with mixed bowel habits

37
Q

IBS-U

A

IBS with unclassified bowel habits

38
Q

Rome IV Diagnostic Criteria

A

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
Q

Goals of IBS treatment

A

improve specific symptoms
improve quality of life
prevent complications

40
Q

non-pharm tx of IBS

A

1st line = Diet and Modification
FODAMP diet
exercise

41
Q

for IBS-C use….

A 
Bulk forming agents
Osmotic Laxatives
Plecanatide
Lubiprostone = strong recommendation
Linaclotide
Tenapanor
Tegaserod
42
Q

Tenapanor (Ibsrela) MOA

A

acts locally = poor GI absorption
Inhibits Na-H exchanger
reduces Na absorption, increase lumen water secretion

43
Q

Tenapanor (Ibsrela) ADE + dosing

A

diarrhea - 15/16%
Severe in 2.5%

take immediate before breakfast and dinner

44
Q

Tegaserod (Zelnorm) MOA

A

5-HT4 receptor partial agonist the inc peristalsis and intestinal secretion

45
Q

Tegaserod (Zelnorm) ADE

A

HA
Diarrhea
Chest pain, Heart attack and stroke*****

46
Q

Tegaserod (Zelnorm) dosing

A

Females only…before meals for 4-6weeks

ppl < 65 females without history of MI, CVA, TIA or angina

47
Q

IBS-D drugs

A

Eluxadoline (Viberzi)
Rifaximin (Xifaxan)** recommended for pretreatment
Alosetron (Lotronex)

48
Q

Eluxadoline (Viberzi) MOA

A

Mixed Mu and Kappa opioid receptor agonist, delta-opioid receptor antagonist

Locally reduces abdominal pain and diarrhea

49
Q

Eluxadoline (Viberzi) ADE

A

Constipation
Abdominal pain
Pancreatitis = rare

50
Q

Eluxadoline (Viberzi) doses

A

D/c if constipation persist > 4 days

51
Q

Rifaximin dosing

A

14 days, retreat up to 2 times

52
Q

Alosetrone (Lotronex) info

A

approved w/ severe diarrhea in females refractory to conventional therapy.

only available through MD Lotronex Prescribing program

53
Q

Peppermint Oil

A

For global IBS symptoms

limited commercial preparations

generally well tolerated

54
Q

Gut-directed psychotherapies

A

CBT
CDH

targets accompanying depression, anxiety, chronic pain

55
Q

Probiotics for IBS

A

not recommended by AGA, low lvl of evidence supporting

56
Q

Antiplasmatics…

A

thought to be somewhat beneficial

57
Q

IBS-C treatment algo

A
  1. osmotic laxatives = constipation
  2. antispasmodics = abdominal pain
  3. Secretagogues = 2nd line, Tegaserod = 3rd line
  4. add low dose TCA, SNRI, CBT if no response
58
Q

IBS-D treatment algo

A
  1. Loperamide = diarrhea
  2. antispasmodics = abdominal pain
  3. Rifaximin = 2nd line, Alosetron = 3rd line
  4. add low dose TCA, SNRI, CBT if no response

CDM 2 Exam 3 (13 decks)

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