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GI > PHARM: Drugs for IBS > Flashcards

PHARM: Drugs for IBS Flashcards

1
Q

What is the first line treatment of a patient with IBS?

A

education, reassurance, dietary modification (exclusion of gas producing foods), and increased physical activity

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2
Q

When is drug treatment warranted with IBS?

A

for moderate to severe symptoms that are not relieved by lifestyle changes

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3
Q

What type of IBS is treated with: Linaclotide, Lubiprostone, PEG?

A

IBS-C

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4
Q

What type of IBS is treated with: Alostetron, Loperamide, Anti-spasmodics (Atropine, Dicyclomine, Glycopyrrolate)

A

IBS-D

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5
Q

What type of IBS has: Hard or lumpy stools with ≥25% of BMs and loose watery stools with ≥25% of BMs?

A

IBS-M

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6
Q

What type of IBS has: Presence of loose or watery stools with with ≥25% of BMs and hard or lumpy stools with <25% of BMs?

A

IBS-D

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7
Q

What type of IBS has: Presence of hard or lumpy stools with ≥25% of BMs and loose watery stools with <25% of BMs?

A

IBS-C

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8
Q

MOA: Osmotic agent; binds water and causes it to be retained within the stool AND stimulates stretch receptors to increase cholinergic activity in the ENS.

A

PEG

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9
Q

MOA: Absorb liquid in GI tract; thereby altering intestinal fluid and electrolyte transport and causing stool expansion, increased peristalsis and bowel motility

A

Polycarbophil
Methylcellulose
Psyllium

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10
Q

MOA: Activates guanylate cyclase-C receptor to increase intracellular cGMP→ sitmulates secretion of Cl- and CHO3- from CFTR ion channel into intestinal lumen and the increased GI fluid increases the GI transit (via stretch)

A

Linaclotide

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11
Q

MOA: PGE1 derivative that directly activates plasma Cl- channel (ClC-2) to increase GI fluid secretion and accelerate motility (via stretch)

A

Lubiprostone

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12
Q

What drug is STRONGLY recommended for IBS-C?

A

Linaclotide

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13
Q

What is a contraindication for all IBS-C drugs?

A

Contraindicated in known/suspected obstruction.

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14
Q

What IBS-C drug is contraindicated in children <6?

A

Linaclotide

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15
Q

TOXICITY: Infrequent flatulence, nausea, abdominal pain, bloating and cramping

A

PEG

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16
Q

TOXICITY: Rarely abdominal pain or cramps, diarrhea, increased flatulence, N/V

A

Polycarbophil
Methylcellulose
Psyllium

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17
Q

TOXICITY: Diarrhea (usually within 2 weeks of treatment start)

A

Linaclotide

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18
Q

TOXICITY: Dose related nausea, HA, and diarrhea

A

Lubiprostone

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19
Q

MOA: Selective antagonist at 5-HT3 receptors extensively distributed on enteric neurons in GI tract.

A

Alosetron

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20
Q

MOA: Competitive post-ganglionic muscarinic receptor antagonist. (modulate activity in the enteric nervous system)

A

Atropine
Dicyclomine
Glycopyrrolate

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21
Q

MOA: Direct action on the circular and longitudinal muscles of the intestinal wall to slow motility. (modulates activity in the enteric nervous system)

A

Loperamide

22
Q

MOA: Selectively inhibits bacterial and mycobacterial DNA-dependent RNA polymerase. Reduces mucosal inflammation and barrier dysfunction induced by chronic stress by increasing population of lactobacillaceae.

A

Rifaximin

23
Q

Which drug for IBS-D has a BBW: not for pt w/ pre-existing colitis or severe constipation?

A

Alosetron

24
Q

What drug has severe constipation as an adverse effect (that can even lead to death)?

A

Alosetron

25
Q

What drug can rarely cause V tach and arrhythmia?

A

Alosetron

26
Q

Which drugs have systemic toxicity related to muscarinic antagonists: anhidrosis, flushing, bladder, vision and CNS dysfunction, s-TACH, impotence?

A

Atropine
Dicyclomine
Glycopyrrolate

27
Q

Does loperamide show any opiate-like or analgesic effects?

A

NO!

28
Q

What drug is a Oral rifampin analog?

A

rifaximin

29
Q

What is commonly seen with rifaximin treatment?

A

Increase in Lactobacilli and reduced segmented filamentous bacteria after treatment

30
Q

What types of adverse effects are seen with rifaximin?

A

GI symptoms: flatulence, N/V, fecal urgency, constipation, abdominal pain

31
Q

What is the ultimate pathway of action for drugs that are used in IBS-C?

A

increase stimulation of endogenous stretch receptors which, in turn, increases cholinergic activity, stimulate peristalsis and promote evacuation of the stool

32
Q

What is the ultimate pathway of action for drugs that are used in IBS-D?

A

by blocking neurotransmitter systems involved in gastric motility

33
Q

What is the important distinction between Lubiprostone and Linaclotide

A

Lubiprostone is a DIRECT activator of ClC-2 and Linaclotide is an INDIRECT activator of the CFTR (via increase in cGMP)*** Important

34
Q

What is the function of CIC-2 and CFTR?

A

channels are on apical surface of enterocytes that allow Cl- flow into the lumen

35
Q

What type of cells synthesize serotonin in the GI?

A

Enterochromaffin Cells

36
Q

List the function of intrinsic circuits of serotonin activity.

A

epithelial secretion/vasodilation OR for propulsive motility

37
Q

What are extrinsic circuits serotonin acts on?

A

vagal and spinal afferent fibers

38
Q

When does serotonin signaling end?

A

recovery phase

39
Q

What happens in the recovery phase?

A

5-HT is transported by SERT into epithelial cells where it is enzymatically degraded, or it enters the blood where it is transported into platelets and stored for further use

40
Q

What type of factors can also influence activity of the sympathetic and parasympathetic nervous systems and their effect upon modulating smooth muscle function in the intestinal wall?

A

psychosocial factors

41
Q

What is the MOA of tri-cyclic antidepressants?

A

reduce reuptake of NE and serotonin in CNS and some have strong anticholinergic activity

42
Q

What is the role of SSRIs?

A

enhance actions of 5-HT in CNS

43
Q

True or False: American Gastroenterological Association recommends using tricyclic antidepressants in the treatment of IBS

A

FALSE: they do NOT

44
Q

What can be used instead of TCAs to treat mood-related aspects of IBS?

A

SSRIs

45
Q

True or false: • Patients with both psychologic and drug treatment respond better than patients who have drug therapy alone

A

TRUE

46
Q

What may contribute to the increased activity of the enteric nervous system in IBS?

A

activation of inflammatory process

47
Q

What may signal the inflammatory process to begin in IBS?

A

dietary components or from the microflora in the intestinal lumen

48
Q

What substance is used by around 50% of IBS patients to self-medicate before seeking attention by a physician?

A

probiotics

49
Q

True or false: probiotics help with abdominal symptoms.

A

TRUE (in some studies)

50
Q

Are probiotics recommended in the treatment of IBS?

A

NO

GI (21 decks)

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