Treatment of IBS Flashcards
What are pharmacologic therapies directed at?
relieving abd pain & discomfort & improving bowel function
What is the MOA of 5-HT?
Secretion, sensitization, & motility
What is the MOA of linaclotide?
Guanlyate cyclase-c agonist
Stimulates intestinal fluid secretion & transit time
What does linaclotide improve?
abd pain/discomfort
What is an ADE of tegaserod (Serotonin 5-HT4 receptor agonist) ?
Increased # of CV deaths
Removed from market except in the emergency situation
What is the MOA of loperamide?
Treats IBS-D
Inhibits peristalsis, prolongs transit time, & reduces fecal volume
What sx are NOT relieved by loperamide?
bloating, abd discomfort
What are the dosing instructions for loperamide?
2mg 45 mins before a meal on regularly scheduled doses
What is the MOA of eluxadoline?
Mixed mu-opioid receptor agonist, delta-opioid receptor antagonist & kappa opioid receptor agonist
Reduces abd pain & diarrhea
What is 2nd line therapy for IBS-D?
Bile acid sequestrants
What are ADEs of bile acid sequestrants?
GI sx: bloating, flatulence, abd discomfort, constipation
What is the MOA of 5-HT3 receptor antagonists?
Reduce unpleasant visceral afferent sensation, including nausea, bloating, & pain
Inhibits colonic motility, esp in the left colon, increasing total colonic transit time
Alosetron (a 5-HT3 receptor antagonist) has been approved for what population?
Women w/ severe IBS-D who have not responded to conventional therapy
*Requires FDA-approved restricted-use program
Describe the efficacy of alosetron
Reduces abd pain, cramping, urgency, & diarrhea
What is an ADEs of alosetron?
Constipation (30%) Ischmic colitis (3/1000 pts, some fatal)
Describe the pharmacotherapy of chronic abd pain
TCAs appear helpful
Alter processing of visceral afferent info
Anticholinergic properties
Alter receptors for enteric NTs s/a serotonin
Name 2 antispasmodics (anticholinergics) that are used in IBS
Dicyclomine
Hyoscyamine
What are ADEs of antispasmodics (anticholinergics)?
Higher doses –> Dry mouth, visual disturbances, urinary retention, & constipation
What are possible causes of IBS?
Visceral hypersensitivity Altered bowel motility NT imbalance Infection Psychosocial
IBS treatment usually consists of low FODMAP diet. What does FODMAP stand for?
Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols
What are the 2 types of 5-HT that exist within the gut?
Serotonin type 3 & 4
What is the MOA of serotonin 5-HT4 receptor agonists (tegaserod)?
Stimulates release of NTs & increases colonic motility
What is eluxadoline contraindicated in?
Biliary d/o Pancreatitis Liver impairment Heavy alcohol use Those w/out gallbladder
What are ADEs of eluxadoline?
Nausea, constipation, abd pain
Pancreatitis
CNS depression
What is increased in those who suffer from diarrhea-predominant IBS?
Postprandial levels of 5-HT
