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Pharmacology II > Nausea and Vomiting, Constipation, Diarrhea, and IBS > Flashcards

Nausea and Vomiting, Constipation, Diarrhea, and IBS Flashcards

1
Q

What are the causes of nausea and vomiting?

A 
GI irritation
Motion Sickness
Vestibular Disease
Hormone Disturbance
Drugs and Radiation
Exogenous toxins
Pain
Psychogenic factors
Intracranial pathology
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2
Q

What can result from vomiting?

A

Dehydration

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3
Q

What are the findings with dehydration?

A

Increased thirst and dry mouth
Less frequent urination
Tachycardia
Pinching skin takes longer to go down

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4
Q

What are the non-pharmacologic therapies for N/V?

A 
Rehydrate (oral rehydration solutions)
Avoid Dairy
BRAT diet (24hr fluid diet, Banana, Rice, Apple Sauce, Toast (dry)
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5
Q

What are the pharmacologic therapies for N/V?

A

5-HT3 antagonists
Dopamine Antagonists
Antihistamines
Cannabinoids

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6
Q

What are the rpharmacological therapies that play a role in the chemo zone?

A

5-Ht3 antagonists

Dopamine Antagonists

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7
Q

What are the 5-HT3 Antagonists used for N/V?

A

Ondansetron (Zofran)- most common
Granisetron (Kytril)
Dolasetron (Anzemet)

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8
Q

Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet)- MOA and ROA

A

5-HT3 Antagonists
Antagonism of the 5-HT3 receptor in the chemo-receptor trigger zone
ROA- oral, rectal, IM, IV

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9
Q

Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet)- Indications

A

5-HT3 Antagonists
Treatment and prevention of postoperative N/V
Chemotherapy- induced N/V

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10
Q

Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet)- ADRs

A

HA
Dizziness
Diarrhea
ABD pain

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11
Q

What are the dopamine antagonists used for N/V?

A

Metoclopramide (reglan)
Trimethobenzamide (tigan)
Phenothiazines- Prochlorperazine (compazine), promethazine (phenergen)

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12
Q

Metoclopramide (reglan), Trimethobenzamide (tigan), Phenothiazines- Prochlorperazine (compazine), promethazine (phenergen)- MOA

A

Dopamine Antagonists
Antagonist of D2 receptors of the CTZ
At higher doses metoclopramide also blocks 5-HT3 receptors
ALSO PROMOTES GASTRIC EMPTYING AND SMALL INTESTINE PERISTALSIS- PROKINETIC EFFECT

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13
Q

Metoclopramide (reglan), Trimethobenzamide (tigan), Phenothiazines- Prochlorperazine (compazine), promethazine (phenergen)- contraindications

A 
GI- HEMORRHAGE, OBSTRUCTION OR PERFORATION
Cautious use in pts w/ depression
Pheochromocytoma
Seizure
Use w/ caution in children
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14
Q

Metoclopramide (reglan), Trimethobenzamide (tigan), Phenothiazines- Prochlorperazine (compazine), promethazine (phenergen)- ADRs

A

EXTRAPYRAMIDAL EFFECTS
RESTLESSNESS, ANXIETY, DROWSINESS, FATIGUE, HALLUCINATIONS
CV- HTN, HPOTN, AV BLOCK, BRADYCARDIA
AGRANULOCYTOSIS

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15
Q

What is the antihistimine used for N/V?

A

Promethazine (Phenergen)

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16
Q

Promethazine (Phenergen)-MOA

A

Antihistamine
Blocks H1-> effectiness appear to be with motion sickness and vestibulochoclear dz
Antagonist of D2 receptors in the CTZ

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17
Q

Promethazine (Phenergen)- ADRs

A

Dry mouth, dizziness
PARKINSONIAN SYMPTOMS (DYSKINESIA, DYSTONIAS, AKATHISIA)
NEUROLEPTIC MALIGNANT SYNDROME
Blood dyscrasias

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18
Q

Promethazine (Phenergen)- Cautions

A

BPH
Urinary retention
Glaucoma

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19
Q

What is another agent used for N/V other than antihistamines, dopamine antagonists, and 5-HT3 antagonists?

A

Cannabinoids (Dronabinol (Marinol)

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20
Q

Dronabinol (Marionol)- MOA and Side effects

A

MOA is not well defined

SE- drowsiness, sedation, increased appetite

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21
Q

What is dronabinol (marinol) used to stimulate?

A

Appetite in patients that aren’t eating

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22
Q

What does the normal motility (peristalsis) in the intestines do?

A

Acts to mix bowel contents thoroughly

To propel them in a caudal direction

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23
Q

What control is the regulation of normal intestinal motility under?

A

Neuronal and Hormonal

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24
Q

What does the vagus nerve of the intestinal (enteric) system do?

A

Stimulated peristaltic movements
Relaxes digestive sphincters
Promotes GI secretion

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25
Q

What are the vagus nerve fibers that influence secretion?

A

Meissner’s plexus

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26
Q

What are the vagus nerve fibers that influence motility?

A

Myenteric plexus

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27
Q

What are the classes of drugs for GI motility?

A 
Laxatives
Antidiarrheal agents
Prokinetic Agents
Antiemetic agents
Antispasmotics
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28
Q

How many bowel movements daily is considered normal?

A

2-3

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29
Q

What is the medical definition of constipation?

A

2 or more of the following:

  • Straining >25% of the time
  • Lumpy or hard stools > 25% of the time
  • Feeling of incomplete evacuation >25% of time
  • 2 or fewer BM in 1 wk
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30
Q

What are the metabolic causes of constipation?

A

Hypothyroid
Hypercalcemia
Hypokalemia
Diabetes

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31
Q

What are the GI disorder causes of constipation?

A

Tumors
IBS
Diverticulitis

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32
Q

What are the neurogenic causes of constipation?

A

Trauma to brain/spinal cord
CNS tumor
Parkinson’s

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33
Q

Can pregnancy cause constipation?

A

Yes

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34
Q

What medications cause constipation?

A 
Opiates
Ca and Al antacids
Iron
Calcium channel blockers
Clonidine
Anticholinergics- antihistamines, antiparkinsonians, TCA
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35
Q

What is the best non-pharmacologic management and prevention of constipation?

A 
DRINK PLENTY OF WATER AND FLUIDS 
P juices (Pear, prune, peach)
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36
Q

What are the non-pharmacologic management and prevention of constipation?

A

DRINK PLENTY OF WATER AND FLUIDS
Adequate excercise
HIGH FIBER DIET

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37
Q

What does a high fiber diet include?

A

Insoluble-shorten intestinal transit time and increase stool bulk (whole grain and bran)
Water soluble fiber- more moist stool and less effect on transit time (fresh fruit and vegetables)

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38
Q

What are laxatives used for?

A

To hasten transit time in the gut and encourage defecation

To clear the bowel prior too medical and surgical procedures

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39
Q

What are the types of laxatives?

A 
Bulk-forming laxatives
Emollients and lubricants
Saline Cathartics
Osmotic laxatives
Stimulant laxatives
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40
Q

What are the bulk-forming laxatives?

A

Psyllium (metamucil)
Methylcellulose (Citrucel)
Polycarbophil (Fibercon)

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41
Q

Psyllium (metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)- MOA

A

Bulk forming laxatives
Increases the volume of non-absorbable solid residue with water, distending the colon and stimulation peristaltic activity increasing the rate of colonic transit

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42
Q

Psyllium (metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)-Primary Uses and contraindications

A

CONSIDERED 1ST LINE FOR BEDRIDDEN OR GERIATRIC WITH CHRONIC CONSTIPATION, GOOD IN PREGNANCY
Contraindication- pts w/ stenosis, ulceration or adhesions, and fecal obstruction

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43
Q

Psyllium (metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)- ADRs

A

Flatulence
ABD distention
Gastrointestinal obstruction

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44
Q

Psyllium (metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)- drug interactions

A

BINDS DRUGS & REDUCES ABSORPTION- SEPARATE FROM OTHER MEDICATION ADMIN

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45
Q

Psyllium (metamucil), Methylcellulose (Citrucel), Polycarbophil (Fibercon)- other uses

A
  • The ability of these agents to absorb water makes them useful for RELIEVING SX OF MILD DIARRHEA
  • Several months use can RELIEVE SX OF IBS
  • LOWERING CHOLESTEROL
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46
Q

If you give metamucil or other bulk forming laxatives first how many hours do you need to wait to give medications?

A

4 hours

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47
Q

If you give medications first how many hours must you wait to give metamucil or other bulk-forming laxatives?

A

2 hours

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48
Q

What are the emollient laxatives?

A

Docusate Sodium (colace)

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49
Q

Docusate sodium (Colace)- MOA

A

Emollient
Surfactant brings water into stool, facilitates mixing of aqueous and fatty materials within intestine, increase H20 and electrolyte secretion in small/ large bowel

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50
Q

Docusate sodium (Colace)- uses

A

To avoid straining
After MI, rectal surgery, opiates
1ST LINE PREGNANT WOMEN
Onset 1-3 days

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51
Q

Docusate sodium (Colace)- contraindications

A

Fecal impaction

Signs and sx of appendicitis

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52
Q

What are the lubricants used as laxatives?

A

Mineral oil

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53
Q

Mineral Oil- MOA

A

Lubricant
Coats stool (allows easier passage), inhibits colonic absorption of water
Onset- 6hrs-3 days (oral or rectal)

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54
Q

Mineral Oil- Use and contraindications

A

Used mainly for prevention (to avoid straining and after MI or rectal surgery)
CHRONIC USE IS DISCOURAGES
CAUTION-AVOID IN ELDERLY, ASPIRATION RISK AND DECREASE ABSORPTION OF FAT-SOLUBLE VITAMINS (DEAK)
May leak from anal sphincter

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55
Q

What are the osmotic agent laxatives?

A

Lactulose and sorbitol

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56
Q

Lactulose- MOA

A

Osmotic agent
Disaccharide that is metabolized by bacteria in the colon to low-molecular weight acids = osmotic effect
Not considered a 1st line therapy

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57
Q

Lactulose- Uses and SE

A

MOST COMMONLY USED IN PTS W/ HEPATIC ENCEPHALOPATHY
Side effects- flatulence, cramps, electrolyte imbalance
Oral dose soften stools in 1-3 days

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58
Q

Sorbital- MOA

A

Osmotic agent
Monosaccharide creates an osmotic gradient when used as a 70% solution
Hyperglycemia
Oral dose soften stool in 1-3 days

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59
Q

What are the saline cathartics used as laxatives?

A 
Magnesium hydroxide (milk of magnesia)
Magnesium sulfate (Epsom salts)
Sodium phosphate (fleets enema)
Magnesium citrate (citrate of magnesia)
60
Q

Magnesium hydroxide (milk of magnesia), Magnesium sulfate (Epsom salts), Sodium phosphate (fleets enema), Magnesium citrate (citrate of magnesia)- MOA

A

Saline cathartics
Mg++ or Na+ salts are POORLY ABSORBED; THEY INCREASE THE WATER CONTENT OF THE BOWEL THROUGH OSMOSIS
Onset- 30min-6hrs (oral), 5-30min (rectal)

61
Q

Magnesium hydroxide (milk of magnesia), Magnesium sulfate (Epsom salts), Sodium phosphate (fleets enema), Magnesium citrate (citrate of magnesia)- Contraindications

A

Impaired renal function
Mg and Na accumulation
CHF
No sodium for HTN pts

62
Q

Caster oil- MOA and use

A

MOA- metabolized to ricinoleic acid (stimulates secretory pathways)
Decreased glucose absorption
Promotes intestinal motility
Not for routine use

63
Q

Glycerin Suppository- MOA, Use, ADRs

A 
MOA- osmotic action in rectum
Onset <30 min
May cause rectal irritation
Very safe laxative and can be used in children
Intermittent use
64
Q

Can you use a glycerin suppository in children?

65
Q

What are the glycerin/hyperosmotic meds used for laxatives?

A 
Polyethylene Glycol (miralax)
Polyethylene glycol (PEG, GoLYTELY)
66
Q

Polyethylene Glycol (Miralax)- MOA and use

A

Glycerin/hyperosmotic
MOA- osmotic
Use- 17g mixed in water or juice, usually 2wk duration but chronic is okay
Relatively safe, OK for children

67
Q

Polyethylene glycol (PEG, GoLYTELY)- MOA

A

Glycerin/hyperosmotic

Osmotoc agent that causes retention of water resulting in softer stool and more frequent defecation

68
Q

Polyethylene glycol (PEG, GoLYTELY)- USE

A

For COLONIC CLEANSING BEFORE DIAGNOSTIC PROCEDURES

Note- 4 liters over 3 hrs, NOT FOR CHRONIC USE. AVOID IN PTS W/ INTESTINAL OBSTRUCTION

69
Q

What are the stimulant laxatives?

A

Diphenylmethane derivatives- Bisacodyl (dulcolax)

Anthraquinone laxatives- Senna (Senokot)

70
Q

Bisacodyl (Dulcolax) MOA

A

Stimulant laxative
Diphenylmethane derivative
Stimulate nerve plexus of the colon
onset 6-8 hrs PO; 1-6 hrs PR

71
Q

Bisacodyl (Dulcolax)- Contraindications and ADRs

A

SHOULD NOT TAKE W/IN 1 HR OF ANTACIDS, MILK OR MILK PRODUCTS
Intestinal cramping
CAN CAUSE FLUID AND ELECTROLYTE INBALANCE
PINK COLORED URINE AND FECES
Long term use- could cause damage to the nerve plexi resulting in deterioration of intestinal function
ATONIC COLON

72
Q

Senna (Senokot)- MOA

A

Stimulant laxative
Anthraquinone laxative
MOA- increased peristalsis

73
Q

Senna (Senokot)- ADRs

A

YELLOW-BROWN TO RED COLORED URINE
LARGE DOSES CAN PRODUCE NEPHRITIS
Long term use- CAN CAUSE DAMAGE TO THE NERVE PLEXI (resulting in deterioration of intestinal funciton), STONIC COLON

74
Q

Senna (Senokot)- contraindications

A

Contraindications- PREGNANCY AND ACUTE INTESTINAL INFLAMMATION

75
Q

Lubiprostone (Amitiza)- MOA

A

Chloride-channel activator…works by increasing fluid secretion locally in the small intestine by activating the ClC-2 chloride channel

76
Q

Lubiprostone (Amitiza)- Side effects and contraindications

A

Side effects- nausea and diarrhea

Contraindications- INTESTINAL OBSTRUCTION AND PREGNANCY

77
Q

Methylnaltrexone- MOA

A

Peripherally acting antagonist of mu
Expensive
Does not cross the blood brain barrier
Reduced the effects of opioids peripherally (not centerally)

78
Q

What is methynaltrexone specific to?

A

The cause of constipation. Beneficial if you have an opioid cause constipation

79
Q

What should be prescribed to diabetics for constipation?

A

Sugar-free products (metamucil)
60% of diabetics have constipation
No increase in mortality

80
Q

What should you prescribe to pregnant women with constipation?

A

Bulk forming laxatives or emollients

AVOID MINERAL OIL, CASTOR OIL, and OSMOTICS

81
Q

What should you recommend for opiate use?

A

Exercise, adequate fluid, fiber

82
Q

What should you prescribe for elderly with constipation?

A

Bulk forming laxatives, enemas, glycerin, lactulose
“P juices” (pear, peach, prune)
Best to AVOID saline laxative due to potential change in electrolytes

83
Q

What should you prescribe to kids with constipation?

A

Usually a change of diet and habits
“P juices “ (pear, peach, prune)
<5 y/o glycerin suppositories, malt soup extract (mix w/ juice or breast milk), dark corn syrup, MOM, bisacodyl
Senna or mineral oil
AVOID stimulants and excessive use of enemas

84
Q

What is acute diarrhea?

A

Diarrhea for < 3 days

85
Q

What is chronic diarrhea?

A

Diarrhea for >14 days

86
Q

Is diarrhea usually a healthy response?

A

Yes

Don’t use symptomatic agents too early

87
Q

When should you not use anti-motility agents?

A

IN DYSENTERY OR IF C.DIFF IS POSSIBLE

88
Q

What does rotavirus consist of? Who does it affect? and how can it be prevented?

A

Watery diarreah lasting 3-7 days, 1/3 have fever
Nearly every child in US infected by age 5
Vaccine (RotaTeq) approved in 2006 given at 2, 4, and 6 months PO

89
Q

What are the four clinical groups of diarrhea?

A

Secretory
Osmotic
Exudative
Altered intestinal transit

90
Q

What diarrhea is caused by a stimulating substance that either increases secretion or decreased absorption of large amounts of water and electrolytes?

A

Secretory Diarrhea

91
Q

Does fasting alter stool volume in secretory diarrhea?

92
Q

How is secretory diarrhea clinically recognized?

A

By large stool volume

>1L/day with normal ionic contents/osmolality

93
Q

What diarrhea is described as poorly absorbed substances that lead to retention of intestinal fluids resulting in diarrhea?

94
Q

How is osmotic diarrhea clinically recognized?

A

If diarrhea stops when patient does NOT eat

95
Q

What type of diarrhea is caused by inflammatory disease that discharge mucus, serum proteins, and blood into the gut?

96
Q

What type of diarrhea is due to reduced contact time in the small intestine (intestinal resection or bypass surgery could cause this), premature colon (metoclopramide and erythromycin), and bacterial overgrowth?

A

Altered intestinal transit

97
Q

What drugs are known to induce diarrhea

A 
Laxatives
Antacids containing Mg
Antieoplastics
Colchicine
NSAIDS
Orlistat
ABX- clindamycin, broad spectrum ABX
Antihypertensives- ACEI
Cardiac agents- Digoxin
Cholinergics
PPIs- esomeprazole
H2- Blockers- famotidine
98
Q

What is the biggest offender for C. Diff?

A

Clindamycin

99
Q

What is the presentation for patients with diarrhea?

A

N/V, ABD pain, HA, fever, chills, Malaise
Weight loss
Dehydration

100
Q

How can you prevent diarrhea?

A

Sanitation
Hygiene WASH YOUR HANDS!!!!
Strict food and water handling

101
Q

What are the non-pharmacologic tx for diarrhea?

A
  • Discontinue consumption of solid foods and dairy for 25 hours (osmotic)
  • W/ N/V- mild low residue diet, as BM decrease begin bland diet
  • Rehydrate- oral rehydration solutions, LR, D5W, NS
  • Maintain electrolytes
102
Q

What is the biggest concern with diarrhea?

A

Dehydration

103
Q

How do you rehydrate a healthy adult?

A

Any beverage + NaCl source (salted crackers)

104
Q

How do you rehydrate kids?

A

Commercial oral rehydration solutions
Pedialyte
Apple juice, chicken broth, sport drinks are DISCOURAGED…. hypertonic and low electrolyte concentration

105
Q

What are the rehydration rates?

A
  • Up to 2 years: 50-100ml after each loose stool and between if possible
  • 2 years or more: 100-200ml after each loose stool and between if possible
  • Continue extra fluid until diarrhea cessation
  • May need IV fluids for severe dehydration
106
Q

What is the pharmacologic therapy for antimotility?

A

Diphenoxylate
Loperamide
Paregoric
Difenoxin

107
Q

What is the pharmacologic therapy for adsorbents?

A

Kaolin-pectin mix
Polycarbophil
Attapulgite

108
Q

What is the pharmacologic therapy for antisecratory?

A

Bismuth subsalicylates

109
Q

What is the pharmacologic therapy for anticholinergic?

110
Q

What is the pharmacologic therapy for bacterial replacement?

A

Lactobacillus

111
Q

What is the pharmacologic therapy for enzymes?

112
Q

What is the pharmacologic therapy for ABX?

A

Metroniddazole

Vancomycin

113
Q

Opiates and Derivates, Loperamide, Diphenoxylate, Paregoric, Difenoxin- MOA

A

Antimotility
Slow intestinal transit
Prolong contact and absorption
Increase gut capacity

114
Q

Opiates and Derivates, Loperamide, Diphenoxylate, Paregoric, Difenoxin- Cautions

A

Addiction potential

Worsen diarrhea if infectious

115
Q

Lomotil- Onset and Contraindications

A

Clinical benefit usually w/in 48 hrs
If no benefit in 10 days, change therapy
Contraindications- C. diff or entertoxin

116
Q

Loperamide (Imodium)- MOA

A

Acts directly on intestinal muscles to inhibit peristalsis, prolonging transit time

117
Q

Loperamide (Imodium)- Onset and contraindications

A

Clinical benefit usually w/in 48 hrs
Contraindications- Pts w/ a fever exceeding 101 F (38.3c), acute ulcerative colitis, ABX associated colitis, and children under 2

118
Q

Kaolin-pectin, polycarbophil, attapulgite- MOA

A

Adsorbents
Absorb nutrients, toxins, drugs, and digestive juices
Effectiveness unproven in trials, many do not require RX.

119
Q

Cholestryamine (Questran)- MOA

A

Absorbs bile salts and C. diff toxin

120
Q

Pepto-Bismol-MOA and Onset

A

Bismuth subsalicylate
Stimulates absorption of fluid and electrolytes across the intestinal wall
Onset- <48 hrs

121
Q

Pepto-Bismol- Side effects

A

Not for kids Reyes syndrome
Blackened stool and tongue
Salicylism
Can induce gout attacks in susceptible patients

122
Q

Pepto-Bismol- Interactions

A

Anticoagulants and tetracycline; May interfere with radiologic studies.

123
Q

Octreotide (Sandostatin)- MOA

A

Antisecretory
Blocks the release of serotonin, direct inhibitory effects
Reduces motility and facilitates water absorption from the gut

124
Q

Octreotide (Sandostatin)- Use and onset

A

Official indication- control sx in pts with metastic vasoactive intestinal peptide-secreting tumor associated diarrhea
Off labe use- tx of refractory diarrhea
Onset- 1-3 days up to a week

125
Q

Octreotide (Sandostatin)- ADRs

A

BRADYCARDIA

HYPERGLYCEMIA

126
Q

Atropine- MOA

A

Anticholinergic

Blocks vagal tone and prolongs gut transit time

127
Q

Atropine- ADRs and contraindications

A

ADR-anticholinergic side effects

Contraindicated- glaucoma, prostatic hypertrophy

128
Q

Lactobacillus-MOA

A

Bacterial replacement

Restores normal flora and intestinal function

129
Q

Lactobacillus- ADRs and contraindications

A

Intestinal flatus

Contraindicated in immuno-compromised patients

130
Q

Lactase Enzymes-MOA and Use

A

MOA- replaces lactase enzyme deficiency

Use- only useful in lactose intolerance

131
Q

Zinc

A

Substantial data supporting zinc in diarrhea as adjunct to ORS
Reduction of Stool output
Reduction of diarrhea duration
MOA is unknown, possibly action on intestinal ion transport

132
Q

What type of diarrhea is described as 4-5 loose/watery stools per day w/ cramping, +/- fever, lasting 3-4 days without treatment?

A

Travelers Diarrhea

133
Q

What is travelers diarrhea mostly consist of and when does it occur?

A

> 80% bacterial

>90 occur in the 1st 2 weeks of travel

134
Q

What are the risks associated with travelers diarrhea?

A
  • Ingestion of contaminated foot or drink
  • High risk foods- undercooked veggies, unpeeled fruit, raw/undercooked meat
  • Risk- meals eat at home < restaurants
  • Age: small children and 21-29 y/o
  • Type of infection correlated with destination, season, type of travel
135
Q

What is the prophylaxis for traveler’s diarrhea?

A

Dietary counseling
Bismuth subsalicylate (Pepto-Bismol)
ABX- effective but irresponsible prophylaxis, give false sense of security.
Resistance is a huge problem w/ ABX

136
Q

What is the treatment for traveler’s diarrhea?

A

Rehydration is key

ABX- Cipro OR azithromycin

137
Q

Noscomial Diarrhea- C.diff

A

Hospitalized or recent ABX use
Toxin may be present for several weeks
Handwashing

138
Q

How do you treat C. diff?

A

Metronidazole

Vancomycin (orally)

139
Q

What is characterized by lower abdominal pain, disturbed defecation, and bloating with absence of structural or biochemical explaining factors?

A

Irritable Bowel Syndrome (IBS)

140
Q

What are the contributing factors of IBS?

A 
Genetics
Motility Factors
Inflammation
Colonic Infections
Mechanical irritation to local nerves
Stress
141
Q

How does IBS present?

A
  • Lower abdominal pain
  • Abdominal bloating and distention
  • Diarrhea symptoms >3 stools/day- extreme urgency and mucus passage
  • Constipation symptoms <3 stools/wk- straining and incomplete evacuation
  • Psychological- depression, anxiety
  • Urinary sx
  • Fatigue
  • Dyspareunia
  • Concurrent conditions- fibromyalgia, functional dyspepsia, chronic fatigue syndrome
142
Q

What is the manning diagnosis criteria of IBS?

A

Chronic Or recurrent abdominal pain >6months with 2 or more of the following:
-Ab pain relieved by defecation
-Ab pain associated with more freq stool
-Ab distention
-Feeling of incomplete evacuation after defecation
Mucus in stools

143
Q

What is the rome III criteria of IBS

A

Recurrent abdominal pain or discomfort >3 days/month in the last 3 months associated with 2 or more of the following:

  • Relieved with defecation
  • Onset associated with change in frequency of stool
  • Onset associated with change in form of stool
144
Q

How do you treat constipation predominant IBS?

A

Stress management and pt education
Increase dietary fiber and fluid
Next add bulk forming laxative and consider antispasmodics
Add Serotonin-4 agonist (Tegaserod)

145
Q

How do you treat diarrhea predominant IBS?

A

Stress management and pt education
Lactose and caffeine free diet as well as avoiding other causative foods
Add loperamide or another antispasmodic
Add 5-HT3 antagonist (Alosertron)

Pharmacology II (23 decks)

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