IBS- Madras - Exam 3

The definition of IBS is that you must have the following symptoms with no structural or biochemical factors for at least ___ months.

• ________________ pain

• defecation problems- _____________, ______________, or alternating between both

• bloating

• abdominal distention

• urinary symptoms

must have the following symptoms for AT LEAST 3 MONTHS!

• abdominal pain

• defecation problems- constipation, diarrhea, or alternating between both

• other sym listed above

What are 3 subtypes of IBS?

1. IBS alternating between diarrhea and constipation

2. IBS-C (IBS with constipation)

3. IBS-D (IBS with diarrhea)

What are some nonpharm tx for IBS?

• avoid caffeine and diet triggers

• avoid alcohol

• moderate fat intake

• exercise

What classes of antidepressants are used in IBS? What drugs belong to that class?

1. Tricyclic antidepressants- Amitriptyline, desipramine, nortriptyline, imipramine, doxepin, trimipramine

2. SSRIs

Tricyclic antidepressants have what ADRs?

ANTICHOLINERGIC

What are anticholinergic ADRs?

THINK DRY!!!!!!

• urinary retention

• dry mouth

• constipation

• drowsiness

• blurry vision

Are tricyclic depressants or SSRIs approved for IBS tx? If so what is the indication?

no

What antispasmodic agents are used in IBS?

dicyclomine, hyoscyamine, peppermint oil

What is an ADR of antispasmodic agents?

constipation

Is Rifaximin approved for IBS tx? If so what is the indication?

YES! Approved for IBS with DIARRHEA

Rifaximin can increase ______s and effect _______.

a. ASTs, blood glucose

b. ALTs, RBCs

c. ALTs, INR

d. ASTs, IBS

c. (increase ALTs and effect INR)

What are the recommendations and approval for Loperamide?

• NOT RECOMMENDED 1st LINE for treating IBS-D

  • DO NOT USE IN CONSTIPATION (IBS-C) ONLY FOR IBS-D

• NOT APPROVED FOR IBS

What are the recommendations and approval for Lomotil (Diphenoxylate and Atropine)?

• NOT RECOMMENDED AT ALL

• NOT APPROVED

Answer the following about Alosetron:

• brand name

• class

• indication

• Lotronex

• 5HT3 receptor antagonist

• indicated FOR WOMEN ONLY with SEVERE DIARRHEA IBS

  • must have chronic IBS (≥6 months)

  • no GI tract problems

What is classified as “severe” diarrhea?

≥1 of the following:

• frequent and severe abdominal pain/discomfort

• frequent bowel urgency or fecal incontinence

• disability/restriction of daily activities

For Alosetron (Lotronex), what is the starting dose? When is it discontinued?

starting dose is 0.5mg BID, if after 4 weeks symptoms not controlled, can increase to 1mg BID for 4 weeks, if symptoms not controlled then D/C

What is the BOXED WARNING for Alosetron (Lotronex)?

• "serious GI effects, ischemic colitis, and serious constipation have caused hospitalization, transfusions, and death”

• D/C ASAP if constipation or ischemic colitis develops

1. Can any physician prescribe Alosetron?

2. Are electronic prescriptions allowed?

3. Are refills permitted?

1. NO! the physician must be in program

2. YES! e prescriptions are allowed

3. YES! refills are permitted

Alosetron cannot be used with what drug? With what drug does it increase levels?

C/I with Fluvoxamine

Increases Ketoconazole levels

What laxatives can possibly sometimes be used in IBS?

• bulking agents

• Miralax/PEG

Answer the following about Eluxadoline:

• brand name

• INDICATION

• ADR

• C/I with alcohol

• other contraindications (not that important)

• Viberzi

• For IBS with DIARRHEA IN ADULT MEN AND WOMEN

• Sphincter of Oddi spasm

• cannot use if drink 3 or more alcoholic drinks a day

• other C/I: sphincter of Oddi dysfunction, pancreatitis, hepatic impairment, constipation

What are some drug interactions with Eluxadoline? (idk if she will ask)

• GEMFIBROZIL

• Cyclosporine

• Antiretrovirals (-avir)

• Ciprofloxacin

• Fluconazole

• Alosetron (bc of constipation)

• anticholinergics (bc of constipation)

• opioids (bc of constipation)

• lower dose of Rosuvastatin

Answer the following about Lubiprostone:

• brand name

• indication

• class

• administration

• ADR

• Pregnancy concerns

• Amitiza

• IBS with CONSTIPATION in women ≥18 YO

• Cl- channel activator

• admin w/ food and water

• ADR: dyspnea

• CANNOT be pregnant

Answer the following about Linaclotide:

• brand name

• INDICATION

• Administration

• difficulty swallowing?

• Linzess

• IBS for constipation in adult MEN AND WOMEN

• give once daily on empty stomach 30 min before a meal

• can put in water/applesauce

Answer the following about Plecanatide:

• brand name

• INDICATION

• class

• C/I and BBW

• difficulty swallowing?

• Trulance

• IBS with CONSTIPATION in adult MEN AND WOMEN

• GC-C agonist

• Do not use <6 YO or ages 6-18 YO

• can put in applesauce or water

Answer the following about Tenapanor:

• brand name

• class

• indication

• administration

• drug interaction with ____________.

• Ibsrela

• 3NHE3 inhibitor

• IBS WITH CONSTIPATION IN ADULTS

• give IMMEDIATELY BEFORE BREAKFAST AND DINNER

• drug interaction with enalapril

Which IBS medications should be kept in their original container?

• Linaclotide

• Plecanatide

• Tenapanor

SUMMARY:

What is the indication for each of the following drugs:

1. Rifaximin

2. Alosetron

3. Eluxadoline

4. Lubiprostone

5. Linaclotide

6. Plecanatide

7. Tenapanor

1. IBS-D (IBS with diarrhea in adults)

2. IBS-D (Only indicated for women with severe diarrhea IBS)

3. IBS-D (IBS with diarrhea in adults)

4. IBS-C (IBS with constipation in WOMEN ONLY )

5. IBS-C (IBS with constipation in adults)

6. IBS-C (IBS with constipation in adults)

7. IBS-C (IBS with constipation in adults)

PRACTICE:

What are the main ADRs of drugs like Amitriptyline and Lomotil?

anticholinergic (dry)

PRACTICE:

Which IBS medications are only indicated for women?

1. Alosetron

2. Lubiprostone

PRACTICE:

Which of the following is not true about Alosetron?

a. Refills are allowed

b. electronic prescriptions are allowed

c. any physician is allowed to write an rx

d. approved for women with severe diarrhea

c

PRACTICE:

With which of the following drugs should not be used if you’re an alcoholic?

a. Viberzi

b. Lotronex

c. Amitizia

d. Ibsrela

a.

PRACTICE:

A pt. walks into the urgent care complaining of problems going to the bathroom. He complains that for the past week or two he’s had lower abdominal pain, constipation, and diarrhea in a cycle. He had some tests done and there are no structural or chemical abnormalities. Can he be diagnosed with IBS?

no- need symptoms for at least 3 months