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NU 560 - Adv. Pharmacotherapeutics > Unit 4 Exam > Flashcards

Unit 4 Exam Flashcards

1
Q

Non-contraceptive benefits of combination oral contraceptives

A

Decreased risk of ovarian, endometrial and colon cancer.

Decrease benign breast disease and ovarian cysts.

Decrease risk of endometriosis, fibroids, ovulation pain, PMS, PMDD, cramps, migraines and anemia.

Improves acne and hirsutism.

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2
Q

When to start oral contraceptives?

A

Day 1 start: first day of menses.

Sunday start: Sunday after menses (no weekend menstruation).

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3
Q

How long to use back up birth control after starting oral contraceptives?

A

7 days

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4
Q

Serious Side Effects of Oral Contraceptives

A

VTE

MI/Stroke (especially if over 35 and smoking)

Liver disorders

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5
Q

Minor Side Effects of Oral Contraceptives

A

Breast tenderness
N/V
HA
Bloating
Acne
Mood changes
Spotting

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6
Q

Side Effects of Progestin-Only Contraceptives

A

Irregular bleeding
Acne
Breast tenderness
Mood changes
HA/Migraines
N/V
Ovarian cysts
Weight gain
Fluid retention
Acne

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7
Q

ACHES Acronym

A

severe Abdominal pain (gallbladder).

Chest pain (PE or MI)

Headache (stroke, HTN, migraine)

Eye problems (stroke or HTN)

Severe leg pain (DVT)

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8
Q

Depo-Provera Dosing Schedule

A

Initiated within the first 5 days after menses.

Given every 13 weeks (if missed, perform pregnancy test).

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9
Q

Depo-Provera Side Effects (6)

A

Weight gain
HA
Dizziness
Nervousness
Amenorrhea
Irregular bleeding

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10
Q

Depo-Provera Long Term Effects

A

Can cause significant loss of bone mineral density (reversible after stopping).

Increase calcium and vitamin D intake and increase exercise.

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11
Q

Depo-Provera Population

A

Issue with daily compliance.

Safe in hx of CV disease, stroke, thromboembolism, PVD and hemoglobinopathies (sickle cell).

Slow reversal: 70% conceive within first year, 90% within first two years. Not a good option if someone wants to conceive after stopping birth control.

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12
Q

IUD Education

A

Highly effective (<1%) and easily reversible.

Hormonal (progestin-only) and non-hormonal options.

Only maintenance is checking strings after each period to ensure placement.

No associated decline in fertility.

Placed in office.

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13
Q

IUD Population

A

Dysmenorrhea
Menorrhagia
Anemia

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14
Q

Side Effects of IUDs

A

PID
Ectopic pregnancy
Uterine perforation
Expulsion
Ovarian cysts
Irregular bleeding
Amenorrhea
Pelvic pain

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15
Q

Contraindications for IUDs

A

Suspected pregnancy
Uterine abnormalities
PID
Unexplained vaginal bleeding

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16
Q

What contraceptive method has decreased efficacy in patients with high BMI?

A

Xulane Transdermal Patch (Noregestromin and ethyl estradiol)

Increased failure rates and increase VTE risk if over 198lbs or BMI >30.

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17
Q

Best Practices for Emergency Contraception

A

Stops ovulation from occurring.

Should be utilized within 120 hours (5 days) of unprotected sex.

After use of any regimen, pregnancy test should be performed if no menstruation occurs within 21 days.

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18
Q

Types of Emergency Contraceptives

A

Copper IUD

Levonorgestrel (LNg or Plan B or Julie)

Ulipreistal Acetate (UPA) “Ella”

Combinded estrogen progestin (Yuzpe regimen)

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19
Q

Copper IUD

A

Most effective (>99%) and can remain in place for continued contraception.

Up to 10 years.

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20
Q

Levonorgestrel (LNg) “Plan B or Julie”

A

94% effective

Given as single dose (1.5mg) or split dose (0.75 mg) 12 hours apart.

Most effective within first 3 days and less effective in those more than 165 lbs.

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21
Q

Ulipristal Acetate (UPA) “Ella”

A

98% effective.

Progesterone receptor antagonist - inhibits follicle rupture even near ovulation.

Single dose (30mg)

Most effective within first 3 days and less effective in those more than 195lbs.

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22
Q

Combined Estrogen Progestin (Yuzpe regimen)

A

Less effective than LNg and UPA

Given in two doses (100 mcg ethinyl estradiol plus 0.5 mg LNg followed by repeat dose 12 hours later)

Side effects: N/V

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23
Q

Treatment Order for Vulvovaginal Candidiasis (VVC)

A

1st line - OTC antifungals 1-7 days; or single dose oral fluconazole (150mg)

2nd line - Assess w/ cultures; treat with 7-14 days of topical antifungal; OR oral fluconazole 150 mg every 72 hours x 3 doses.

3rd line - Treat with 10-14 days topical azole; OR oral fluconazole with maintenance therapy for 6 months (150 mg PO weekly); monitor liver function.

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24
Q

Treatment Order for Trichomoniasis

A

1st line - Metronidazole or Tinidazole (2g single dose); OR metronidazole 500 mg BID x 7 days; treat sex partners and avoid sex until therapy complete AND symptoms free.

2nd line - Try alternative first line treatment; if recurrent failure, consult specialist.

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25
Q

Treatment Order for Bacterial Vaginosis

A

1st line - PO metronidazole (500 mg BID x 7 days); OR topical clindamycin cream (2% intravaginally x 7 days); OR metronidazole gel (0.75% intravaginally x 7 days).

2nd line - Treat recurrence with same or difference first line regimen; metronidazole gel (0.75% twice per week x 6 months).

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26
Q

Education Regarding Treatment of Bacterial Vaginosis

A

Metronidazole/Tinidazole - AVOID ALCOHOL: N/V if ingested during treatment or within 72 hours.

Clindamycin - May weaken latex condoms and diaphragms.

Avoid tight fitting clothes, allow vaginal ventilation, avoid douching or other hygiene products (esp. scented) that may alter pH.

Proper instillation of vaginal creams and suppositories - best to perform at bedtime, wear a pad or panty liner on underwear.

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27
Q

Hormone Therapy for Patient WITH Uterus

A

Progestin + synthetic estrogen (oral or transdermal)

*Estrogen alone can lead to endometrial hyperplasia and risk of endometrial cancer.

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28
Q

Hormone Therapy for Patient WITHOUT Uterus

A

Estrogen alone

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29
Q

Contraindications for Hormone Therapy in Menopause (6)

A

Estrogen-dependent neoplasia

Thrombophlebitis/thromboembolic disorder

Pregnancy

Undiagnosed vaginal bleeding

Uncontrolled HTN

Acute liver disease

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30
Q

Monitoring Considerations for Patients Taking Hormone Therapy (7)

A

Follow up 4-8 weeks after initiation and then 3-6 months.

Decision to continue HT reviewed yearly.

Note any vaginal bleeding, ensure mammograms/PAPs/DEXA UTD

Height/weight, lipids, BP, breast exam, full pelvic exam.

Should be dc’d 1-3 years after menopause.

Discontinue gradually (4-6 week intervals) to reduce rebound symptoms.

Use beyond 3-5 years no recommended d/t increased risk of breast cancer.

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31
Q

Best Treatment of Vasomotor Symptoms in Menopause when HT is Contraindicated

A

SSRI (Zoloft, Lexapro)
SNRI (Effexor, Pristiq)
Gabapentin
Clonidine
Progestin only

Paroxetine (Paxil) FDA approved for moderate to severe VMS.

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32
Q

Best Route/Treatment for GU Syndromes of Menopause (GSM)

A

HT - Low dose vaginal estrogen OR transdermal estrogen or ospemifene (nonestrogen): lower risk of VTE compared to PO.

Non-HT - Vaginal lubricant and moisturizers and continued sexual intercourse.

Routes: Vaginal tablets, rings or cream.

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33
Q

Medications Used to Treat Pelvic Inflammatory Disease (6)

A

Cephalosporins (“Cef-“)
Doxycycline
Clindamycin
Gentamycin
Probenecid
Metronidazole

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34
Q

IV Treatment Used to Treat Pelvic Inflammatory Disease (PID)

A

Ceftriaxone + doxycycline + metronidazole

Cefotetan + doxycycline

Cefoxitin + doxycycline

Ampicillin-sulbactam + doxycycline

Clindamycin + gentamincin

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35
Q

IM or PO Treatment Used to Treat Pelvic Inflammatory Disease (PID)

A

Ceftriaxone + doxycycline + metronidazole

Cefoxitin + probenecid + doxycycline + metronidazole

3rd gen cephalosporin + doxycycline + metronidazole

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36
Q

Treatment of Gonorrhea for Patients with Cephalosporin Allergy

A

Gentamycin IM + Azithromycin PO

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37
Q

Suppressive Therapy for Genital Herpes

A

Acyclovir (more frequent dosing d/t decrease bioavailability; pregnancy).

Valacyclovir (Used in pregnancy)

Famciclovir

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38
Q

Treatment of Pregnant Patients with Chlamydia

A

Azithromycin 1g PO x 1 dose (Amox is alternative)

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39
Q

Considerations of treatment of chlamydia in pregnant patients

A

Doxy is contraindicated in 2nd-3rd trimester

Retest 3-4 weeks after treatment and again after 3 months to make sure it is not going to be passed to child during birth

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40
Q

Patient-Applied treatments for genital warts

A

Imiquimod (Aldara)

Podofilox (Condylox)

Sinecatechins (Green tea extract product)

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41
Q

Treatment of pregnant patients with syphilis and allergy to penicillin

A

PCN G = only effective treatment

Desensitize mom to PCN and then treat with PCN G.

Allows temporary tolerance.

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42
Q

Treatment of erectile dysfunction

A

1st line - Phosphodiesterase-5 inhibitors (PDE-5)

2nd - line refer to urologist.

Complementary - Yohimbine, ginkgo bilboa, ginseng, HCG, L-arginine

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43
Q

Examples of PDE-5 Inhibitors

A

Tadalafil (Cialis)

Vardenafil (Levitra)

Sildenafil (Viagra)

Avanafil (Stendra)

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44
Q

Contraindications of PDE-5 Inhibitors (12)

A

Concurrent use of NITRATES

Alpha-blockers

Unstable angina

Hypotension

Uncontrolled HTN

Recent stroke

Arrhythmia

MI within 6 months

Severe HF

Renal failure

Liver failure

Potent CYP450 inhibitor

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45
Q

Antimuscarinics MOA

A

Inhibit binding of Ach at muscarininc receptors M3 on detrusor smooth muscle cells, causing relaxation and increase bladder filling capacity.

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46
Q

Antimuscarinics Adverse Effects

A

Anticholinergic side effects (xerostomia, constipation, urinary retention).

*Can’t see, can’t spit, can’t pee, can’t shit.

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47
Q

Antimuscarinics Contraindications

A

Narrow angle glaucoma

Urinary retention

Use of other drugs metabolized by CYP-450

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48
Q

Antimuscarinics Examples

A

Oxybutynin (Ditropan)

Tolterodine (Detrol)

Solifenacin (Vesicare)

49
Q

1st Line Treatment of Uncomplicated UTI

A

Nitrofurantoin (Macrobid) - Avoid in 1st trimester and last 30 days in pregnancy.

TMP-SMZ (Bactrim) - Avoid in sulfa allergy.

Fosfomycin (Monurol) - x1 dose, dissolved in water.

50
Q

2nd Line Treatment of Uncomplicated UTI

A

Increase Bactrim dose to x7 days

Ciprofloxacin (Cipro) - Achilles tendon rupture

Levofloxacin (Levaquin) - Achilles tendon rupture.

51
Q

3rd Line Treatment of Uncomplicated UTI

A

Treat based on urine culture results.

Cefalexin (Keflex), Amoxicillin, Augmentin.

52
Q

Treatment of Complicated UTI for Males/post-menopausal women/catheters

A

Ciprofloxacin (Cipro)

Levofloxacin (Levaquin)

53
Q

Treatment of Complicated UTI for Pregnant Women

A

Amoxicillin

Cephalexin (Keflex)

Nitrofurantoin/Bactrim (Not is 1st trimester or last 30 days).

54
Q

Geriatric Considerations for UTI Treatment

A

Commonly asymptomatic - 1st sign is AMS

Increased UTIs in postmenopausal d/t loss of estrogen and increased pH

Fecal incontinence, incomplete bladder emptying, malnutrition and increased urine pH

***Nitrofurantoin not recommended (CrCl 40 ml/min)

55
Q

Pregnancy Considerations for UTI Treatment

A

Take all UTIs SERIOUSLY

Treat asymptomatic UTIs

30% untreated develop pyelonephritis

Changes during pregnancy increase risk

NO bactrim or nitrofurantoin during 1st trimester and last 30 days.

Urine cx 1 week after treatment and every 4-6 weeks

56
Q

Children Considerations for UTI Treatment

A

UTI can indicate GU anomaly

Treat quickly to reduce risk of renal scarring in kids <5

Kids <3 with 1st UTI should have renal US

1st line - Augmentin, cephalexin, cefpodoxime and bactrim.

57
Q

Reason for treatment of prostatitis

A

Required d/t inflammation of the prostate can restrict the urinary outflow via the urethra.

58
Q

1st line treatment of prostatitis

A

***Fluroquinolones (Ciprofloxacin; Levofloxacin)

Sulfas (Bactrim)

59
Q

2nd line treatment of prostatitis

A

Doxycycline (Vibramycin) or Azithromycin or Clarithromycin

60
Q

Adjunctive treatment of prostatitis

A

Sitz baths

Analgesic stool softeners

Antipyretics

Rest

Prostatic massage

Voiding in warm bath

Limit caffeine/alcohol

61
Q

Alpha-Adrenergic Blocker MOA

A

Relax smooth muscle of prostate and bladder neck, decreasing bladder resistance to urinary flow.

62
Q

Alpha-Adrenergic Blocker Side Effects

A

Orthostatic hypotension

Somnolence/drowsiness (take at night)

Fluid retention

HA

Dizziness

Weakness

63
Q

Alpha-Adrenergic Blockers Examples + Side Effects (“-osin”) (4)

A

Terazosin (Hytrin) - Causes somnolence, take at bedtime.

Doxazosin (Cardura) - Avoid in CHF/renal failure.

Tamsulosin (Flomax) - Contraindicated in prostate CA.

Silodosin (Rapaflo) - Contraindicated in hepatic/renal failure.

64
Q

5-Alpha Reductase Inhibitor MOA

A

Blocks 5-alpha reductase, weakening prostate growth by inhibiting conversion of testosterone to DHT which lessens LUTS.

65
Q

5-Alpha Reductase Inhibitor Examples + Side Effects (“-eride”)

A

Finasteride (Proscar) - Impotence and decrease libido

Dutasteride (Avodart) - Orthostatic hypotension, priapism, increase risk of prostate CA.

66
Q

5-Alpha Reductase Inhibitor Considerations

A

***Not to be handled by pregnant women

Can affect genitalia of the fetus

67
Q

Other BPH Medical Treatments

A

5-Alpha Reductase Inhibitor + Alpha-Adrenergic Blockers (Combo)

PDE-5 Inhibitors (contraindicated w/ nitrates and alpha-blockers)

Supps/Herbals - Saw palmetto, pygeum, zinc

68
Q

Monitoring of Medical Treatment of BPH

A

Decrease in AUA score by 3-4 is significant

BP should be monitoring during first 2 weeks

Keep open communication regarding sexual health

If side effects occur, try a different agent.

69
Q

Treatment Order of BPH

A

1st line - AUA <7 = watchful

2nd line - AUA >7 = AAB or 5ARI or PDE5

3rd line - 5ARI + AAB

4th line - Refer to urology for surgical intervention

70
Q

Risk factors with long-term use of H2RAs

A

Reduced efficacy

Tachyphylaxis

Tolerance

*Intermittent use preferred

71
Q

Risk factors with long-term use of PPIs

A

Hypergastrinemia

Fractures with osteoporosis

GI infections (C. Diff + bacterial gastroenteritis)

Vitamin B12 deficiency

Hypomagnesemia

72
Q

Treatment regimen for NSAID-induced PUD

A

1st line - PPI, H2RA, Sucralfate (if NSAID can dc’d)

If NSAID cannot be dc’d - treat with PPI x8 weeks with NSAID (or misoprostol)

If NSAID can be dc’d - treat with PPI for 4 weeks

Misoprostol contraindicated in pregnancy.

73
Q

Considerations for NSAID-induced PUD

A

Test for H. pylori and if present, treat accordingly

Find another pain management modality (dc NSAID)

Use enteric-coated NSAIDs, take with meals, add misiprostol (cytotec), switch to a selective COX-2 inhibitor

74
Q

Antacid Examples

A

Calcium-carbonate (Tums)

Mag Salts

Aluminum salts

75
Q

Antacid Adverse Events

A

Rebound hyperacidity (w/ mag)

Constipation (w/ aluminum)

*No contraindications

76
Q

Antacid education

A

Take 1-4 hours after administration of: iron, sulfonylureas, tetracyclines and quinolones.

Alters rate and absorption.

Do not heal ulcers. Only symptom relief.

77
Q

Treatment N/V due to drugs, ketoacidosis or uremia

A

Phenothiazines (Compazine; phenergan)

Metoclopramide (Reglan)

78
Q

Treatment N/V due to GI Disorders (Obstruction/Gastroparesis)

A

Metoclopramide (Reglan)

79
Q

Treatment N/V due to Visceral Pain

A

Analgesics

80
Q

Treatment N/V due to Motion Sickness or Vestibular Inflammation

A

Antihistamines/Anticholinergics (Hydroxizine, meclizine, dramamine).

81
Q

Treatment N/V due to Higher Brain Stem Function (Emotions, Sights, Smells, and Tastes).

A

Benzodiazepines

Dronabinol

Corticosteroids?

82
Q

Treatment Order for N/V

A

1st line - Phenthiazine (mild/mod)

2nd line - Antihistamine/anticholinergics (mild)

3rd - re-evaluate physiological cause

83
Q

Anti-motility Agents MOA

A

Lomotil - Decrease GI motility

Loperamide - Opioid receptor agonist, acts on myenteric plexus of the large intestines

84
Q

Contraindication to Anti-motility Agents

A

Infectious diarrhea (fevers, bloody diarrhea, fecal leukocytes)

Caution in hepatic dysfunction

Lomotil - Risk of HTN crisis if used with MAOIs.

85
Q

ADsorbents Ex + MOA

A

Kaopectate

Binds to diarrhea and toxins to solidify stool (add a dose after each BM).

86
Q

ABsorbents Ex + MOA

A

Fibercon

Absorbs H2O in the GI tract to make stool less watery.

87
Q

Semisynthetic Antibiotics Use + Ex

A

Rifaximin (Xifaxin)

For noninvasive strains of E. coli

Best for travelers diarrhea

88
Q

Semisynthetic Antibiotics Side Effects

A

Peripheral edema

Nausea

Fatigue

Dizziness

HA

Muscle spasm

89
Q

Treatment of Diarrhea in Pediatrics

A

***Oral rehydration is PRIORITY

Antidiarrheal agents are not recommended in children 1 month to 5 years.

Lomotil - not for children under 4

90
Q

Atypical Antidiarrheal-Antisecretory Agents Example

A

Subsalicylate (Pepto-Bismol + Kaopectate)

91
Q

Subsalicylate (Pepto-Bismol + Kaopectate) MOA

A

Not well understood.

Anti-inflammatory action, antacid and antibiotic properties.

92
Q

Subsalicylate (Pepto-Bismol + Kaopectate) Contraindications

A

Caution in hypersensitivity to ASA

Not used in kids with flu or chicken pox = ASA-induced Reye-Syndrome

93
Q

Subsalicylate (Pepto-Bismol + Kaopectate) Adverse Events

A

Black stools

Dark tongue

Tinnitus

94
Q

Subsalicylate (Pepto-Bismol + Kaopectate) Interactions

A

May interact with other medications that interact with ASA (e.g. warfarin).

95
Q

Steps/Goal of Laxative Use

A

First - attempt lifestyle modifications = diet, exercise, bowel training habits (same time every day). Eliminate secondary cause.

Second - Add pharmacological agent.

Goal = increase water content of fees and increase motility using the lowest dose of laxative for least amount of time.

96
Q

Agents that increase GI motility

A

Stimulant laxatives

Saline laxatives

Bulk forming laxatives

Hyperosmolar laxatives

97
Q

Agents that decrease GI motility

A

Anti-motility agents (Imodium and Lomotil)

98
Q

Stimulant Laxatives MOA

A

Increase peristalsis, effects smooth muscle of intestines.

Ex. Bisacodyl, Sennakot

99
Q

Saline Laxatives MOA

A

Draw water into the intestines through osmosis = increases intraluminal pressure = increase motility

Ex. Mag citrate, milk of mag, fleet enema.

100
Q

Bulk Forming Laxatives MOA

A

Binding to the fecal contents + pull water into the stool = stimulates movement of the intestines.

Ex. Metamucil, Citrucel

101
Q

Hyperosmolar Laxatives MOA

A

Osmotic pressure by drawing fluid from less conectrated graident to a more concentrated gradient = increased osmotic pressure = stimulates intestinal motility

Ex. Lactulose, Sorbitol, Miralax

102
Q

Treatment Order for Gastric Motility Managment

A

1st line - Bulk-forming laxatives (all constipation)

2nd line - Mag Hydroxide (saline laxative)

3rd line - Stimulant laxative

103
Q

Gastric Motility OTC Management

A

Do not use more than 7 days in a row

Increase oral fluid intake

104
Q

Gastric Motility Management Pediatrics

A

Pharm tx is controversial

PEG preperation or mineral oil

NO ENEMAS <2 y/o

105
Q

Gastric Motility Management Women/Pregnancy

A

Docusate for Pregnancy

Castor oil can stimulate contractions

106
Q

Gastric Motility Management Elderly

A

Bowel obsessed

Eliminate causative agent (antipsychotics, TCAs, calcium).

High risk of electrolyte imbalances with laxatives

107
Q

Treatment Order of IBS-C

A

1st line - Linaclotide or lubiprostone + osmotic laxative to avoid diarrhea.

2nd line - Osmotic laxative

3rd line - Stimulant laxative short term for resistant cases

108
Q

Treatment Order for IBS-D

A

1st line - Loperamide

2nd line - Diphenoxylate HCL (short term); rifaximin (long term)

109
Q

Management of IBD (7)

A

Resume normal ADLs

Restore general physical/mental well-being

Maintain appropriate nutritional status

Maintain remission

Decrease frequency and severity of exacerbations

Decrease medication side effects

Increase life expectancy

110
Q

Crohn’s Disease Management

A

Mild - Aminosalicylate OR rectal corticosteroid.

Moderate - PO + rectal aminosalicylate AND short term steriod.

Severe - IV corticosteroid AND Cyclosporine

Fulminant - IV corticosteroid AND/OR cyclosporine, infliximab or adalimumab

Patho: Chronic inflammatory disease characterized by transmural lesion located at ANY point in the GI tract.

111
Q

Ulcerative Colitis Management

A

Mild - Combo PO + rectal aminosalicylates

Moderate - ADD corticosteroid

Severe - Req hospitalization, DC oral/topical agents, add corticosteroids

If no resolution in 7-10 days = IV cyclosporine, infliximab, adalimumab, vendolizumab

Patho: Chronic disease of mucosal inflammation LIMITED to the colon and rectum.

112
Q

Aminosalicylates MOA

A

Decrease inflammation in the GI tract by inhibiting prostaglandin synthesis (quick onset - 1 week).

Ex. Azulfidine (Sulfasalazine); Mesalamine (Asacol)

113
Q

Corticosteroid MOA

A

Immunosuppression and prostaglandin inhibition when disease fails to respond to aminosalicylates.

Ex. Prednisone; methylprednisolone

114
Q

Immunosuppressive Agents MOA

A

Decrease production of various inflammatory mediators.

Ex. Cyclosporine, Methotrexate

115
Q

Antibiotics MOA

A

Link between IBD and infectious cause.

Abx that act against gram (-) and mycobacterium organisms with low side effect profile.

Ex. Metronidazole (Flagyl); Ciprofloxacin (Cipro)

116
Q

Biologics: Tumor Necrosis Factor (TNFa) Inhibitors MOA

A

Over-expression of immunologic cytokines including TNF seen in CD.

TNF inhibitors neutralize soluble forms of TNF and inhibit its binding to TNF receptors.

Ex. Infliximab (Remicade); Adalilimumab (Humira); Certolizumab (Cimzia)

117
Q

Biologics: Selective Adhesion Molecules Inhibitors MOA

A

Prevent migration of inflammatory lymphocytes into gut mucosa

Ex. Naralizumab (Tysabri); Vedolizumab (Entyvio)

118
Q

Treatment of Hepatic Encephalopathy

A

1st line - Lactulose

2nd line - Rifaximin

3rd line - Polyethylene glycol (Miralax)

119
Q

Rome III Criteria for IBS

A

Diagnostic criteria must be fulfilled for last 4 months with symptom onset at least 6 months prior to diagnosis.

Recurrent abd pain or discomfort at least 3 days/month in the last 3 months associated with two of the following:
- Improvement with defection
- Onset associated with change in frequency of stool
- Onset associated with a change in form (appearance of stool)

NU 560 - Adv. Pharmacotherapeutics (5 decks)

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