GI Motility 3

Question 1

Definition of what?

• A chronic functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits in the absence of an organic disease

Answer 1

IBS

Question 2

What are the 5 sxs of IBS?

Answer 2

• Abdominal pain
• Distention
• Bloating
• Indigestion
• defecation sx

Question 3

What are the 3 “subcategories” of IBS?

Answer 3

• pain associated with diarrhea (IBS-D)
• pain associated with constipation (IBS-C)
• pain and diarrhea alternating with constipation (IBS-M)

Question 4

Tx of IBC-C

Answer 4

• 1st: soluble fiber: Psyllium/ispaghula
• 2nd: PEG

Question 5

Which drug?

• Improves constipation, but not abdominal pain
• ADE: bloading and abd discomfort

Answer 5

PEG

Question 6

Which drug?

• stimulates the type 2 chloride channel (ClC-2) in the small intestine: inc. chloride-rich fluid secretion into the intestine

Answer 6

Lubiprostone (Amitiza)

Question 7

What type of pt would you use Lubiprostone with?

Answer 7

approved for tx of women >18 yo w/IBS-C

Question 8

In what types of pts should Lubiprostone be avoided?

Answer 8

women of child-bearing age

Category C for preggos

Question 9

Which drug?

Stimulates intestinal fluid secretion and transit time

-significant improvement in abdominal pain and discomfort

MC side effect = diarrhea

Answer 9

Linaclotide

Question 10

Which drug?

•Significant improvement in secondary endpoints of abdominal pain/discomfort, bloating, straining, stool consistency, number of CSBMs (complete & spontaneous bowel movements) per week, compared with placebo

Answer 10

Linaclotide (Linzess)

( Guanylate Cyclase-C Agonist )

Question 11

What is the box warning on Plecanatide?

Answer 11

risk of serious dehydration in pediatric pts

Question 12

What does Plecanatide tx?

Answer 12

IBS-C (Chronic idiopathic constipation)

Question 13

Which drug?

Increased # of CV deaths observed

voluntarily removed from the market except in emergencies

emergency tx of IBS-C in women <55

Answer 13

Tegaserod

Question 14

What is the initial therapy for IBS-D (diarrhea)

Answer 14

Loperamide

Question 15

• dec. stool frequency and consistency, but NOT bloating or abdominal discomfort
• Take before a meal

Which drug?

Answer 15

Loperamide (IBS-D)

Question 16

Which drug?

•A mixed mu-opioid receptor agonist, delta-opioid receptor antagonist and kappa opioid receptor agonist

Answer 16

Eluxadoline

(tx for IBS-D)

Question 17

Which drug?

•Acts locally to reduce abdominal pain and diarrhea

• NO constipating side effects
• abuse potential

Answer 17

Eluxadoline (IBS-D)

Question 18

What is 2nd line therapy for IBS-D? (3 drugs)

Answer 18

Bile acid sequestrants

• Cholestyramine
• Colestipol
• Colesevelam

Question 19

What are the 4 SE of Bile Acid Sequestrants

(2nd line therapy for IBS-D)

Answer 19

Gastrointestinal SEs

• Bloating
• Flatulance
• Abdominal discomfort
• Constipation

Question 20

Name the 4 5-HT3 Antagonists

Answer 20

• Ondanetron
• Granisetron
• Dolasetron
• Palonosetron

Question 21

can cause fatal ischemic colitis

restricted to women with IBS-D who haven not responded to conventional therapies

requires FDA approved restricted-use program

Which drug?

Answer 21

Alosetron

Question 22

Tx of chronic abdominal pain in IBS

• Which treatment is helpful?

Answer 22

Tricyclic antidepressants

(Amitriptyline or Desipramine)

Question 23

Which drug?

• may alter central processing of visceral afferent information
• (anticholinergic properties)
• alters receptors for enteric neurotransmitters such as serotonin

Answer 23

Tricyclic Antidepressants

(Amitriptyline or Desipramine)

For chronic abdominal pain

Question 24

What are the 2 commonly used antispasmodics?

Answer 24

• Dicyclomine
• Hyoscymine

Question 25

Antispasmodics work primarily through which activities? (For IBS)

Answer 25

Anticholinergic activities

Question 26

Higher doses of Antispasmodics (dicyclomine & hyoscymaine) have additional effects such as what? (4)

Answer 26

**Significant additional anticholinergic effects** * dry mouth * visual disturbances * urinary retention * constipation