Pathophysiology and Pharmacology6

DQ 6.1

Choose a medical condition from the gastrointestinal or genitourinary systems and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Choose a medical condition different from that of your fellow students. Pathophysiology and Pharmacology6

DQ 6.2

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

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Irritable Bowel Syndrome (IBS): Pathophysiology and Treatment

Irritable bowel syndrome (IBS) is a condition affecting the gastrointestinal tract that is hallmarked by repeated abdominal pains and changes in bowel habits. It is more common in women than in men (Huether & McCance, 2017). There is abscence of any overt organic pathological process and the changes in bowel activity alternate between diarrhoea and constipation (Hammer & McPhee, 2014). IBS patients are likely to have psychological symptoms like depression and anxiety. The exact pathophysiology of IBS is not yet well understood.

Pathophysiology

            The pathophysiologic evidence that is available points at changes in the gastrointestinal tract (GIT) normal flora (microflora). The others are altered immune responses, genetics and disturbances in the brain-GIT axis (Huether & McCance, 2017). The result is changes in motility, visceral sensitivity, and permeability. For those with the IBS of diarrhoea (IBS-D), there are abnormal secretions leading to faster colonic transit and raised intestinal permeability. On the other hand, those with IBS of constipation (IBS-C) have lowered transit times and reduced intestinal motility. These changes are attributed to altered regulation of the brain-gut axis and changes in the neuro-endocrine cells. Other pathophysiologic factors have been found to be food allergies and psychosocial factors like stress and trauma (epigenetic factors). Infectious processes may also play a part.

Patient Education

The patient education strategies that will be aimed at these patients with IBS will focus on several fronts. Avoiding stimulants will prevent interference with the brain-gut axis. Relaxing and avoiding stress will calm the nerves, while avoiding specific foods will eliminate the allergic trigger. Finally; eating fibre, drinking lots of water and exercise have also been shown to be helpful in keeping IBS symptoms at bay.Pathophysiology and Pharmacology6

 Drug Treatment of IBS: Lubiprostone (Amitiza)

Several medications can be used to manage the symptoms of IBS. One of these most important evidence-based drugs is Lubiprostone (Amitiza). The main aim of drug treatment in IBS is to relieve abdominal pain and discomfort; and improve bowel function (Katzung, 2018, p. 1,101). Lubiprostone (Amitiza) is is a calcium channel activator that is used in the treatment of IBS with dominant constipation (IBS-C). It acts by stimulating type 2 chloride channel (CIC-2) in the small intestines (Katzung, 2018, p. 1,099). This increases secretion of chloride-rich fluid into the intestines, increasing motility and shortening transit time. It is normally given in a dose of 8mcg twice daily.

 Monitoring Side Effects

The main side effects of Amitiza to be monitored are nausea, diarrhea, vomiting, lack of sleep, and headache. These side effects should be monitored to enable the titration of the dose to response and symptom severity. However, it might be wise to stop the medication when diarrhea, nausea and vomiting develop. These may lead to rapid development of fluid and electrolyte imbalance.

Drug Interactions

Lubiprostone (Amitiza) interacts with the opioid methadone. Methadone interacts with lubiprostone by interfering with its mode of action. This reduces the efficacy of Amitiza. In the clinical setting, therefore, prescription of both medications together should be avoided if possible.

References

Hammer, D.G., & McPhee, S.J. (Eds). (2014). Pathophysiology of disease: An introduction           to clinical medicine, 7^th ed. New York, NY: McGraw-Hill Education.

Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6^th ed. St. Louis,            MO: Elsevier, Inc.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. New York, NY:     McGraw-Hill Education.

Pathophysiology and Pharmacology6