MANAGEMENT OF IRRITABLE BOWEL SYNDROME

Question 1

IBS - ___ or cramping and changes in bowel function. Bloating, gas, diarrhea, and constipation
* most ___ diagnosed GI disorder
* 1 in ___ americans
* chronic

Answer 1

• abdominal pain
• common
• 5

Question 2

T or F: IBS causes inflammation,
changes in bowel tissue, and increase risk of colorectal cancer

Answer 2

FALSE: IBS does not do all these things, unlike more serious intestinal diseases

Question 3

IBS is thought to be due to ___ or motor dysfunction of intestine
* vicera are hypersensitive and cause ___ independent of motility and psychological disturbance

Answer 3

somatovisceral
* pain

Question 4

co-morbid condtions to IBS (3)

Answer 4

• firomyalgia
• functional dyspepsia
• chronic fatigue syndrome

Question 5

Diagnosis

• ___ disease screening indicated for IBS-D and IBS-M
• ___ breath test can be considered if lactose

Answer 5

• Celiac
• Lactose

Question 6

T or F: colonoscopy, imaging and other testing is not indicated for IBS in the absence of alarm features

Answer 6

True

Question 7

Diagnosis

ROME IV diagnostic
must have at least ___ of the following:
* Increase in pain related to defecation
* Associated with change in frequency of stool
* Associated with change in appearance of stool

symptoms should occur at least ___ months prior to diagnosis

Answer 7

• 2
• 6 months

Question 8

Alarming features of IBS:
* rectal bleeding
* weight loss
* iron deficient anemia
* nocturnal symptoms
* family history of colorectal ___, IBD, or ___ disease
* onset at age >50 years

Answer 8

• cancer
• Celiac

Question 9

IBS Dietary Management

• 60-70% feel food sensitivity impacts IBS symptoms
• Low FODMAP diet
• fermentable ___ , ___ , ___ saccharides and polyols

Answer 9

• oligo, di, mono

Question 10

IBS non-pharm treatment

Answer 10

physical activity and cognitive behavioral therapy

Question 11

IBS-C tiered treatment

1. increase ___ and fluid intake
2. add ___ forming laxative
3. consider adding anti ___ or anti __ agent for cramping/pain
4. consider lubiprostone or linaclotide
5. cognitive behavioral therapy, consider ___
6. ____ - 4 agonist (last line)

Answer 11

• fiber
• bulk
• antispasmotic, anticholinergic
• antidepressants
• serotonin

Question 12

fiber, bulk-forming agentsand laxatives for IBS-C (2_

Answer 12

psyllium and PEG

Question 13

anti-spasmodic therapy IBS-C

• Hyoscyamine ( ___ )
• Dicyclomine ( ___ )
• blocks ___ action on parasympathetic receptors on smooth muscle, secretory glands and CNS sites
• improves ___

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Answer 13

• Levsin
• Bentyl
• ACh
• abdominal pain

Question 14

Antidepressants - SSRIs IBS-C

• MOA: reduce visceral___
• used at doses ___ than what is used for depression

Answer 14

• sensitivity
• lower

Question 15

Prosecretory agents IBS-C

Lubiprostone ( ___ )
* ___ channel activator
* dose: ___ mcg BID
* contraindicated if suspected intestinal ___
* take with food and water

Answer 15

Amitiza
* chloride
* 8 mcg
* block

Question 16

Prosecretory agents IBS-C

Linaclotide ( ___ )
* ___ agonist
* causes increased secretion of ___ and ___ into intestines, increases fluid, decreases transit time
* dose: ___ mcg
* administer 30 minutes before first meal, on ___ stomach

Answer 16

Linzess
* guanylate cyclase-C
* chloride, bicarbonate
* 290 mcg
* empty

Question 17

Prosecretory agents IBS-C

Tegaserod ( ___ )
5 - ___ agonist
* stimulates ___ and GI ___
* modulates visceral ___

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Answer 17

Zelnorm
* HT4
* peristalsis, secretioins
* sensitivity

Question 18

IBS-D treatment tier

1. ___ modifications
2. add loperamide or anti ___ (Dicyclomine), replace with ___ if pain persists, consider ___
3. add ___ - 3 antagonist (Alosetron)
4. cognitive therapy, antidepressants

Answer 18

• dietary
• antispasmotic, eluxadoline, rifaximin
• serotonin

Question 19

Anti-diarrheal agents IBS-D

• Loperamide ( ___ )
• Diphenoxylate/atropine ( ___ )
• inhibits ___ and GI __
• modulates viceral ___
• no effect on ___

Answer 19

• Imodium
• Lomotil
• peristalsis, secretions
• sensitivity
• abdominal pain

Question 20

Opioid Receptor Agonist IBS-D

Eluxadoline ( ___ )
* MOA: agonist to opioid receptors, but antagonist to δ-opioid receptor
* slows motility and relieves pain
* Contraindicated in patients with history of ___ or alcoholism
* schedule ___ due to euphoria
* metabolism by ___ enzymes

Answer 20

Viberzi
* pacreatitis
* IV
* CYP

Question 21

5-HT3 Receptor Antagonists IBS-D

Alosetron ( ___ )
* MOA: 5 - HT3 receptor antagonist, results in decrease visceral ___ and gastric ___
* Dose: initial dose 0.5 mg ___
* MAX: ___ mg
* black box warning: ischemic ___
* Hepatic metabolism by CYP ___ , ___ , and ___

Answer 21

Lotronex
* sensitivity, motility
* BID
* 2 mg
* colitis
* 1A2, 2C9, 3A4

Question 22

Additional Agents IBS-D

Rifaximin ( ___ )
* MOA: broad-spectrum ___
* Dose: ___ mg TID for 14 days
* may be repeated __

Answer 22

Xifaxan
* antibiotic
* 550 mg.
* twice

Question 23

Addition Agents IBS-D

• Peppermint oil
• Probiotics ___ and ___

Answer 23

Bifidobacterium and Lactobacillus

Question 24

Antidepressants-TCAS IBS-D

• 4 drugs
• reduce visceral ___
• ___ stress
• used at doses ___ than used for depression

Answer 24

Nortriptyline, Amitriptyline, Trimipramine, Desipramine
* sensitivity
* decrease
* lower