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Informatics in Pharmacy

Pancreatitis and Irritable Bowel Syndrome

August 12, 2018 By Dr. G, PharmD

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Pancreatitis:

  • The early stage has a systemic inflammatory response (SIRS) or organ damage. Late associated with local complications.
  • Signs:
    • Abdominal pain, nausea and vomiting, jaundice, fever
    • Local complications: necrosis, hemorrhage, pseudocyst, abscess, infection
    • Systemic complications: SIRs, acute respiratory distress, shock, organ failure
  • Causes:
    • Alcohol, gallstones, drugs (azathioprine, adenosine, diuretics, estrogens, exenatide, mesalamine, pentamidine, sitagliptin, tetracycline, Bactrim, valproic acid), hypertriglyceridemia, toxins, trauma and ischemia
    • M-ANNHEIM risk factors:
      • M- multiple risk factors
      • A-alcohol
      • N-Nicotine
      • N-Nutrition
      • H-Heredity
      • E-Efferent duct
      • I-Immunological
      • M-Misc
  • Treatment:
    • Acute:
      • Treatment is largely supportive.  Withhold oral intake, give IV fluids (lactated ringers usually), treat electrolytes, treat pain (no meperidine), IV ondansetron, promethazine or prochlorperazine.
      • Can resume oral feeding when no N&V.  Avoid TPN
      • No antibiotics
    •  Chronic
      • Abstinence from alcohol is essential.  Need non-narcotic and narcotic analgesia, but avoid APAP.
      • May need to supplement with pancreatic enzymes and change eating pattern to frequent, low-fat meals and fat-soluble vitamin supplementation. Give enzymes before or during meal.  Titrate to weight gain.

Irritable Bowel Syndrome:

There are three types of IBS, and most real-world cases are mixed.

Constipation:   Fiber osmotic laxatives 5-HT4 Agonists (metoclopramide) Cl Channel Activators (lubiprostone) Guanylate cyclase agonist Use stool softener and laxative firstDiarrhea:   Antidiarrheals first Cholestyramine 5-HT3 antagonists (alosetron)  Pain/Gas/Bloating:   anticholinergics antidepressants psychological treatment

Some notes:

  • lubiprostone is used in women with IBS
  • alosetron is for diarrhea-predominant IBS
  • tegaserod is for constipation induced IBS, it’s restricted due to cardiovascular side effects
  • linaclotide – constipation predominant IBS

Filed Under: Gastrointestinal

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020