Treatment of IBS

Question 1

What are pharmacologic therapies directed at?

Answer 1

relieving abd pain & discomfort & improving bowel function

Question 2

What is the MOA of 5-HT?

Answer 2

Secretion, sensitization, & motility

Question 3

What is the MOA of linaclotide?

Answer 3

Guanlyate cyclase-c agonist

Stimulates intestinal fluid secretion & transit time

Question 4

What does linaclotide improve?

Answer 4

abd pain/discomfort

Question 5

What is an ADE of tegaserod (Serotonin 5-HT4 receptor agonist) ?

Answer 5

Increased # of CV deaths

Removed from market except in the emergency situation

Question 6

What is the MOA of loperamide?

Answer 6

Treats IBS-D

Inhibits peristalsis, prolongs transit time, & reduces fecal volume

Question 7

What sx are NOT relieved by loperamide?

Answer 7

bloating, abd discomfort

Question 8

What are the dosing instructions for loperamide?

Answer 8

2mg 45 mins before a meal on regularly scheduled doses

Question 9

What is the MOA of eluxadoline?

Answer 9

Mixed mu-opioid receptor agonist, delta-opioid receptor antagonist & kappa opioid receptor agonist

Reduces abd pain & diarrhea

Question 10

What is 2nd line therapy for IBS-D?

Answer 10

Bile acid sequestrants

Question 11

What are ADEs of bile acid sequestrants?

Answer 11

GI sx: bloating, flatulence, abd discomfort, constipation

Question 12

What is the MOA of 5-HT3 receptor antagonists?

Answer 12

Reduce unpleasant visceral afferent sensation, including nausea, bloating, & pain

Inhibits colonic motility, esp in the left colon, increasing total colonic transit time

Question 13

Alosetron (a 5-HT3 receptor antagonist) has been approved for what population?

Answer 13

Women w/ severe IBS-D who have not responded to conventional therapy

*Requires FDA-approved restricted-use program

Question 14

Describe the efficacy of alosetron

Answer 14

Reduces abd pain, cramping, urgency, & diarrhea

Question 15

What is an ADEs of alosetron?

Answer 15

Constipation (30%)
Ischmic colitis (3/1000 pts, some fatal)

Question 16

Describe the pharmacotherapy of chronic abd pain

Answer 16

TCAs appear helpful

Alter processing of visceral afferent info

Anticholinergic properties

Alter receptors for enteric NTs s/a serotonin

Question 17

Name 2 antispasmodics (anticholinergics) that are used in IBS

Answer 17

Dicyclomine

Hyoscyamine

Question 18

What are ADEs of antispasmodics (anticholinergics)?

Answer 18

Higher doses –> Dry mouth, visual disturbances, urinary retention, & constipation

Question 19

What are possible causes of IBS?

Answer 19

Visceral hypersensitivity 
Altered bowel motility 
NT imbalance 
Infection 
Psychosocial

Question 20

IBS treatment usually consists of low FODMAP diet. What does FODMAP stand for?

Answer 20

Fermentable 
Oligosaccharides 
Disaccharides
Monosaccharides
And
Polyols

Question 21

What are the 2 types of 5-HT that exist within the gut?

Answer 21

Serotonin type 3 & 4

Question 22

What is the MOA of serotonin 5-HT4 receptor agonists (tegaserod)?

Answer 22

Stimulates release of NTs & increases colonic motility

Question 23

What is eluxadoline contraindicated in?

Answer 23

Biliary d/o 
Pancreatitis
Liver impairment 
Heavy alcohol use 
Those w/out gallbladder

Question 24

What are ADEs of eluxadoline?

Answer 24

Nausea, constipation, abd pain

Pancreatitis

CNS depression

Question 25

What is increased in those who suffer from diarrhea-predominant IBS?

Answer 25

Postprandial levels of 5-HT