OTCs
Yes- you cannot use me during influenza/chickenpox, but also aspirin allergies-seriously?
Bismuth subsalicylate (PeptoBismol)
To dilute or not to dilute? Oral rehydration solution for diarrhea episodes should be served only this way
undiluted/not to dilute
My weight is measured in Daltons and i'm also preferred in pediatric constipation!
Polyethylene Glycol (PEG) 3350 (Miralax)
This group of antidepressants can help with IBS-pain, and global symptoms. We are anticholinergic though, so perhaps not ideal for the constipated type.
Eg. Amitriptyline, nortriptyline, doxepin,
Loperamide can be used for 48 hours until referral - but what is the dosing strategy?
I'm scoring 1's and 2's and 3's on my bristol stool scale- slowing increasing fiber is good, but to what amount?
20-30 grams/day
Failing OTCs for opioid induced constipation (OIC)? Naldemedine (symproic), naloxegol (movantik), and methylnaltrexone (Relistor) are part of this therapeutic class that are the next step.
PAMORAs
-or-
peripherally acting mu-opioid receptor antagonists
I'm actually an antibiotic, but help with IBS-D and even hepatic encephalopathy
Rifaximin (xifaxan)
Oh what a sweet smell you have! You can also help my IBS pain too?
Peppermint oil
Baby is dehydrated from diarrhea- and there's no commercial ORS available! WHO is the organization that recommends the recipe?
World Health Organization
I'm osmotic acting, just like PEG, but require a prescription for constipation. We are both safe in pregnancy or pediatrics, but people think i'm a gross viscous fluid. Oh- I'm used all the time for hepatic encephalopathy too.
Lactulose (Constulose)
Eluxadoline (Viberzi)- what a name. This peripherally acting opioid agonist for IBS-D should not be used in which population (3 accepted answers!)
Drinking >3 alcoholic drinks/day
Patients with pancreatitis
Removal of gallbladder (cholecystectomy)
“Viberzi- doesn’t sound like an opioid from what I can see, but i’ll take to hold on to whats left of me [prevent diarrhea] – unless I had a cholecystectomy”
Reduces tension for all family members! Infants, grandpa, and even pregnant mommy. It may take a little longer for my constipation, but hey, safety!
Docusate sodium
[reduces surface tension/emollient]
If dehydration is severe with diarrhea, IV fluids may be needed to reduce risk of which electrolyte accumulating with oral rehydration solutions?
Sodium; hypernatremia
5-HT4 agonists can increase colonic motility, and procalopride (Motegrity) is approved in adults with CIC. Yeah, don't use if bowel obstruction or intestinal perforation, but what is that mood warning about?
Suicidal thoughts/behavior: from Prescribing info
In the double-blind trials, one patient reported a suicide attempt 7 days after the end of treatment with MOTEGRITY 2 mg once daily; none were reported in patients on placebo. In the open-label trials, two patients reported a suicide attempt and another patient reported suicidal ideation. Completed suicide was reported in two patients, previously treated with MOTEGRITY 2 mg or 4 mg; both discontinued MOTEGRITY for at least one month prior to the event
5HT-3 blocker vs. 5HT-4 agonists --that will get confusing. These uncommon medications are just approved for women only with IBS and last line therapies. But if "Alosetron, sounds like ondansetron..." what IBS type is Alosetron (Lotronex) indicated for?
IBS-D.
“Alosetron- sounds and works like ondansetron; and nausea, vomiting, and diarrhea usually come along strong [together]”
Where did my vitamins go? This oil just increased my INR! I knew i should have trusted my pharmacist by avoiding it.
Mineral oil
Reduces vitamins ADEK
Avoid in pregnant/lactation, elderly, pediatrics
Sure avoid milk, ice cream, artificial sweeteners, and baked beans in IBS, but what does FODMAP stand for? Ouch my stomach hurts just thinking about that!
fermentable oligosaccharides, disaccharides, monosaccharids and polyols
Tough one! Sorry!
Secretagogues are classic add on's for chronic idiopathic constipation- lets see, there's Lubiprostone (Amitiza), Linaclotide (Linzess), and Plecanatide (Trulance). Which should definately be used with food to reduce nausea?
Ian's Helpful phrases?
“Amitiza with food- less nause-iza”
“Linzess with food- what a mess!” (inc AUC and more diarrhea)
Trulance- doesn't matter!
A person with IBS-D just started the following drugs- which of them most likely can lead to worsening diarrhea (select all that apply-no partial credit!)?
Colchicine, magnesium, verapamil, acetaminophen
Colchicine and magnesium cause diarrhea. antibiotics, procholinergics, metformin, glp1's, ppis, acei's, also reported.
Ca and Ca-channel blockers cause constipation. same with anticholinergics, opioids, iron