CC March 2016 Irritable Bowel Syndrome with constipation (IBS-C)

echoecho's version from 2016-04-20 04:51


Question Answer
*** What is the first-line management of irritable bowel syndrome with constipaton (IBS-C)?1) activity modification with regular exercise 2) dietary modification with increasing soluble fiber 3) laxatives for symptom management 4) use of antispasmodic medications as an adjunct to first-line interventions
*** If the above treatment modalities fail to alleviate symptoms, the National Institute for Health and Care Excellence (NICE) guidelines states what?Linaclotide (Linzess) may be considered for treatment of refractory cases (at least 12 months of failed first-line therapies) of IBS-C in adults
What type of drug is Linaclotide (Linzess)?it is a selective guanylate cyclase-C agonist
What is the mechanism of action of Linaclotide (Linzess)?it acts as a pro-secretory agent by increasing intestinal fluid secretion and accelerating gastrointestinal motility
The use of Linaclotide (Linzess) has been associated with improvement in what two symptoms associated with IBS-C?pain and bowel symptoms
What is the most common side effect of Linaclotide?diarrhea
Close follow-up is recommended; patients should be re-evaluated within ____ months for possible dose titration?3
Linaclotide can also be used in those who have failed treatment with what other medication?Lubiprostone (Amitiza)
Linaclotide (Linzess) is indicated for individuals over the age of ____ years, and not recommended for children ___ through ___ years, and contraindicated in children < ____ years of age?18; 17; 6
What is the dose of Linaclotide (Linzess)?290 mg daily
Lubiprostone is approved for the treatment of IBS-C, but only with what gender?women
While direct comparisons to Linaclotide are not available, the NICE guidelines found that the evidence for the efficacy of lubiprostone was low quality and was there sufficient evidence to warrant a recommendation for use?no
What is the finding of using antidepressants in IBS-C?it has demonstrated a modse improvement in IBS symptoms though further long-term research is needed
What group of antidepressant classes have shown the most promise and have been studied most extensively, but neither class has FDA approval for the treatment of IbS and therefore their use is off-label??TCA and SSRIs
However, based on the most recent recommendations by the NICE, what medication may be considered as a second-line therapy options for patients with IBS?low dose TCAs (5-10 mg equivalent of amitriptyline (Elavil))
What medications can be considered if TCAs are ineffective, although evidence of benefit was weaker in the studies examining ____ efficacy?SSRI; SSRI
The need to individualize treatment for each patient in this way makes a strong _______ - ________ relationship especially important in managing IBS?physician-patient
*** SUMMARY = What is Linaclotide (Linzess)?a selective guanylate cyclase-C agonist (pro-secretory agent that increases intestinal fluid secretion and accelerates gastrointestinal motility) that has been associated with improvement in both pain and bowel symptoms associated with IBS-C
*** SUMMARY = Linaclotide is indicated for individuals > ____ years of age?18
*** SUMMARY = Evidence for the use of _____ is insufficient to warrant use according to NICE guidelines?lubiprostone (Amitiza)