IBS Flashcards

Flashcards for review

Bulk Forming Laxative

Products such as psyllium hydrophilic colloids, methylcellulose, or polycarbophil, similar to dietary fiber, used as bulk forming laxatives.

Bulk Forming Laxative ADRs

Common ADRs include abdominal distention and flatus

Polyethylene Glycol (PEG)

MOA: Causes water retention in the stool; thereby increasing stool frequency.

Polyethylene Glycol (PEG) ADRs

ADRs: nausea, vomiting, flatulence, and abdominal cramping

Senna/Bisacodyl

MOA: Stimulate the mucosal nerve plexus of the colon, may also increase intestinal fluid secretion.

Senna/Bisacodyl ADRs

ADRs: May cause severe abdominal cramping and electrolyte imbalances

Lubiprostone (Amitiza)

MOA: Is a chloride channel activator that acts locally in the gut to open chloride channels on the GI luminal epithelium, which stimulates chloride-rich fluid secretion into the intestinal lumen.

Lubiprostone (Amitiza) ADRs

ADRs: Headache, nausea, diarrhea

Lubiprostone (Amitiza) Contraindications

Contraindications: Known or suspected mechanical gastrointestinal obstruction

Linaclotide (Linzess)/Plecanatide (Trulance)

MOA: minimally absorbed peptide agonist of the guanylate cyclase-C receptor that stimulates intestinal fluid secretion and transit.

Linaclotide ADRs

ADRs: Diarrhea, Abdominal pain, Flatulence

Linaclotide Black Box Warning

Box warning: Dehydration in kids <2 yrs (linaclodide) and <6yrs (plecanatide)

Rome Criteria for Diagnosis of IBS

Defined as recurrent abdominal pain, on average, at least one day per week in the last three months, associated with two or more criteria related to defecation, stool frequency, or stool form.

IBS-C Treatment: Bulking Agent

Begin with 1tbsp of psyllium with one meal daily and titrate to include fiber with2-3 meals/day.

Tenapanor (Ibsrela)

MOA: Sodium/Hydrogen Exchanger 3 (NHE3) Inhibitor

Tenapanor (Ibsrela) ADRs

ADRs: Diarrhea, Dizziness, Flatulence, abdominal distension, abnormal bowel sounds, Rectal hemorrhage

Tenapanor (Ibsrela) Black Box Warning

Black Box Warning: Risk of dehydration in pediatric patients

Loperamide (Imodium)

Acts only peripherally. MOA: Antisecretory; inhibits the calcium-binding protein calmodulin, and controls chloride secretion.

Eluxadoline (Viberzi)

MOA: Is a mixed mu-opioid receptor agonist, delta opioid receptor antagonist, and kappa opioid receptor agonist which acts locally to reduce abdominal pain and diarrhea.

Eluxadoline (Viberzi) ADRs

ADRs: Constipation, Nausea, Abdominal pain

Alosetron (Lotronex)

MOA: Selective serotonin 5-HT3 antagonist

Alosetron (Lotronex) REMS

Available under the REMS program because of increased risk of ischemic colitis and serious constipation

Antispasmodics

MOA: Have anticholinergic effects and decrease spontaneous activity of intestinal smooth muscle

Antispasmodics ADRs

ADRs: Dizziness, Nausea, Blurred vision, Xerostomia

Rifaximin

MOA: Rifaximin inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase

Rifaximin Use

Useful in patients with moderate to severe IBS without constipation, particularly those with bloating

Rifaximin ADRs

ADRs: nausea, increase in alanine aminotransferase (ALT)

Bile acid sequestrants Mechanism

bind with bile acids to form an insoluble complex that is eliminated in the stool

Peppermint oil Mechanism

Antiinflammatory, smooth muscle relaxant

ibs

A common gastrointestinal disorder affecting the large intestine, characterized by symptoms such as abdominal pain, bloating, and altered bowel habits.

IBS with predominant constipation

is a subtype of Irritable Bowel Syndrome where individuals primarily experience constipation along with abdominal discomfort and altered bowel habits.

IBS with predominant diarrhea

is a subtype of Irritable Bowel Syndrome characterized by frequent diarrhea, abdominal cramps, and an urgent need to have bowel movements.

IBS with mixed bowel habits

is a subtype of Irritable Bowel Syndrome where individuals experience a combination of both constipation and diarrhea, leading to varying symptoms.

IBS unclassified

is a subtype of Irritable Bowel Syndrome that does not fit neatly into the categories of IBS with predominant constipation or diarrhea, often presenting a mix of symptoms.

treatment for constipation predominant IBS

• bulk forming agent to help include fiber in diet

• if psyllium doesn’t work, use osmotic agents (PEG solution)

• last form of treatment is lubiprostone, linaclotide, teanpanor, or plecanatide.

treatment for diarrhea predominant IBS

• involves dietary changes to avoid trigger foods

• potential use of loperamide for symptom control

• bile acid sequesterant

• continued symptoms: use eluxadoline

IBS Abdominal pain treatment

antispasmodics, peppermint oil, and tricyclic antidepressants.