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Example of antispasmodic/anticholinergic
- Dicyclomine hydrochloride (Bentyl)
- Hyoscyamine sulfate (Levsin)
Hallmark of IBS
abdominal discomfort or pain
Common symptoms in IBS
- abdominal discomfort or pain that is relieved after a bowel movement (Hallmark Sx)
- Alternating periods of diarrhea and constipation
- Change in stool frequency
- Passing Mucus from rectum
Colitis aka ....
Irritable bowel disease.
45% of patients stated that IBS interfered with ......
To dx IBS patient must have sx for how long?
12 weeks for the last 12 months. Does not have to be consecutive 12 weeks.
DX of IBS must have 2 of the following sx
- 1. Relieved after BM
- 2. Onset associated with change in frequency of stool
- 3. Onset associate with change in form of stool.
MOA of antispasmodic/anticholinergic drugs/ anti muscarinic drugs.
decrease motility, relax smooth muscle tone in GI tract, decrease secretions
Drugs only for the tx of IBS in women
- Tegaserod (Zelnorm)- constipation main sx
- Alosetron (Lotronex)- severe IBS and have not responded to other tx (diarrhea is main sx)
Cornerstone of tx for IBS
Diet with adequate fiber
Fluid and fiber have to be increased.
Pain in IBS treated with
Treatment for constipation with IBS
bulk forming laxatives
Geriatrics and antispasmodics
- lower doses
- may have adverse affects such as agitation, confusion, excitement, or delusions.
- At risk for falls from OD
Patient Education for antispasmodics
- refrain from activities that require mental alertness
- stay out of hot and humid environments
- take 30-60 min before meal
20-40 mg qid ac and hs
Geriatrics- 10mg and slowly increase
Black box warning
- potential serious GI adverse reactions
- -ischemic collitis
- -serious constipation
Discontinue immediately if patient develops colitis (even if GI specialist started)
- severe GERD
- prevention of chemo n/v
stimulates upper GI tract
Accelerates gastric emptying.
Patient education and Reglan
- NO ETOH
- Do not operate heavy machinery
- Notify provider of any EP symptoms (tardive dyskinesia)
Two drugs used to treat ulcerative colitis
used to dissolve gallstones when patients refuse surgical intervention or are high risk surgery candidates.
Can be used prophylactically as gallstone prevention.