MANAGEMENT OF IRRITABLE BOWEL SYNDROME Flashcards
IBS - ___ or cramping and changes in bowel function. Bloating, gas, diarrhea, and constipation
* most ___ diagnosed GI disorder
* 1 in ___ americans
* chronic
- abdominal pain
- common
- 5
T or F: IBS causes inflammation,
changes in bowel tissue, and increase risk of colorectal cancer
FALSE: IBS does not do all these things, unlike more serious intestinal diseases
IBS is thought to be due to ___ or motor dysfunction of intestine
* vicera are hypersensitive and cause ___ independent of motility and psychological disturbance
somatovisceral
* pain
co-morbid condtions to IBS (3)
- firomyalgia
- functional dyspepsia
- chronic fatigue syndrome
Diagnosis
- ___ disease screening indicated for IBS-D and IBS-M
- ___ breath test can be considered if lactose
- Celiac
- Lactose
T or F: colonoscopy, imaging and other testing is not indicated for IBS in the absence of alarm features
True
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
- 2
- 6 months
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
- cancer
- Celiac
IBS Dietary Management
- 60-70% feel food sensitivity impacts IBS symptoms
- Low FODMAP diet
- fermentable ___ , ___ , ___ saccharides and polyols
- oligo, di, mono
IBS non-pharm treatment
physical activity and cognitive behavioral therapy
IBS-C tiered treatment
- increase ___ and fluid intake
- add ___ forming laxative
- consider adding anti ___ or anti __ agent for cramping/pain
- consider lubiprostone or linaclotide
- cognitive behavioral therapy, consider ___
- ____ - 4 agonist (last line)
- fiber
- bulk
- antispasmotic, anticholinergic
- antidepressants
- serotonin
fiber, bulk-forming agentsand laxatives for IBS-C (2_
psyllium and PEG
anti-spasmodic therapy IBS-C
- Hyoscyamine ( ___ )
- Dicyclomine ( ___ )
- blocks ___ action on parasympathetic receptors on smooth muscle, secretory glands and CNS sites
- improves ___
on BEERS list, avod in glaucoma
- Levsin
- Bentyl
- ACh
- abdominal pain
Antidepressants - SSRIs IBS-C
- MOA: reduce visceral___
- used at doses ___ than what is used for depression
- sensitivity
- lower
Prosecretory agents IBS-C
Lubiprostone ( ___ )
* ___ channel activator
* dose: ___ mcg BID
* contraindicated if suspected intestinal ___
* take with food and water
Amitiza
* chloride
* 8 mcg
* block
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
Linzess
* guanylate cyclase-C
* chloride, bicarbonate
* 290 mcg
* empty
Prosecretory agents IBS-C
Tegaserod ( ___ )
5 - ___ agonist
* stimulates ___ and GI ___
* modulates visceral ___
removed from marke in 2007
Zelnorm
* HT4
* peristalsis, secretioins
* sensitivity
IBS-D treatment tier
- ___ modifications
- add loperamide or anti ___ (Dicyclomine), replace with ___ if pain persists, consider ___
- add ___ - 3 antagonist (Alosetron)
- cognitive therapy, antidepressants
- dietary
- antispasmotic, eluxadoline, rifaximin
- serotonin
Anti-diarrheal agents IBS-D
- Loperamide ( ___ )
- Diphenoxylate/atropine ( ___ )
- inhibits ___ and GI __
- modulates viceral ___
- no effect on ___
- Imodium
- Lomotil
- peristalsis, secretions
- sensitivity
- abdominal pain
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
Viberzi
* pacreatitis
* IV
* CYP
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 ___
Lotronex
* sensitivity, motility
* BID
* 2 mg
* colitis
* 1A2, 2C9, 3A4
Additional Agents IBS-D
Rifaximin ( ___ )
* MOA: broad-spectrum ___
* Dose: ___ mg TID for 14 days
* may be repeated __
Xifaxan
* antibiotic
* 550 mg.
* twice
Addition Agents IBS-D
- Peppermint oil
- Probiotics ___ and ___
Bifidobacterium and Lactobacillus
Antidepressants-TCAS IBS-D
- 4 drugs
- reduce visceral ___
- ___ stress
- used at doses ___ than used for depression
Nortriptyline, Amitriptyline, Trimipramine, Desipramine
* sensitivity
* decrease
* lower
