MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC PETE KRECKEL, RPH

MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC PETE KRECKEL, RPH

MOVEMENT BEYOND LAXATIVES: EVOLVING PHARMACOLOGIC OPTIONS FOR IBS-C AND CIC ACTIVITY DESCRIPTION IBS-C and CIC are highly prevalent conditions that negatively impact Quality of Life and pose a significant economic burden on the healthcare system. Because so many patients self-treat the conditions, estimates of the number of Americans that suffer from IBS-C and CIC vary widely ranging from 2% to 27% of the population. Despite the $400 million dollars that are spent on laxatives each year, constipation still accounts for 2.5 million physician visits annually in the U.S. revealing a desperate need for improved patient counseling and knowledge of pharmacologic options beyond laxatives in pharmacies around the nation where millions of patients seek pharmacist recommendations. When traditional treatments, such as dietary manipulation and standard laxatives do not adequately treat or fail to treat IBS-C and CIC, pharmacists must be prepared to educate patients regarding the pharmacologic options available to relieve these frustrating and costly conditions. TARGET AUDIENCE The target audience for this activity is pharmacists and pharmacy technicians in hospital, community, and retail pharmacy settings. LEARNING OBJECTIVES After completing this activity, the pharmacist will be able to: Describe the impact and economic burden of IBS- C and CIC in the U.S. Review the FDA approved pharmacologic treatment options for IBS-C and CIC, beyond laxatives, to include novel targets, efficacy data, primary contraindications, and adverse effects. Outline the pharmacist s role in identifying inadequately treated patients and providing patient counseling regarding prescription treatment options that will facilitate communication with the physician. ACCREDITATION PHARMACY PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NURSING PharmCon, Inc. is approved by the California Board of Registered Nursing (Provider Number CEP 13649) and the Florida Board of Nursing (Provider Number 50-3515). Activities approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing. CE hours provided by PharmCon, Inc. meet the ANCC criteria for formally approved continuing education hours. The ACPE is listed by the AANP as an acceptable, accredited continuing education organization for applicants seeking renewal through continuing education credit. For additional information, please visit http://www.nursecredentialing.org/renewalrequirements.aspx Universal Activity No.: 0798-0000-15-114-H01-P&T Credits: 1.0 contact hour (0.1 CEU) Online Date: October 1, 2015 Offline Date: April 1, 2016 ACPE Expiration Date: August 6, 2018 ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY Forest Laboratories After completing this activity, the pharmacy technicians will be able to: Differentiate between IBS-C and CIC List medications used to treat IBS-C and CIC 1

ABOUT THE AUTHOR IBS-C and CIC are highly prevalent conditions that negatively impact Quality of Life and pose a significant economic burden on the healthcare system. Because so many patients self-treat the conditions, estimates of the number of Americans that suffer from IBS-C and CIC vary widely ranging from 2% to 27% of the population. Despite the $400 million dollars that are spent on laxatives each year, constipation still accounts for 2.5 million physician visits annually in the U.S. revealing a desperate need for improved patient counseling and knowledge of pharmacologic options beyond laxatives in pharmacies around the nation where millions of patients seek pharmacist recommendations. When traditional treatments, such as dietary manipulation and standard laxatives do not adequately treat or fail to treat IBS-C and CIC, pharmacists must be prepared to educate patients regarding the pharmacologic options available to relieve these frustrating and costly conditions. Pete Kreckel, RPh Adjunct Assistant Professor, Saint Francis University FACULTY DISCLOSURE It is the policy of PharmCon, Inc. to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer of any commercial product(s) and/or service(s) discussed in an educational activity. Pete Kreckel reports no actual or potential conflict of interest in relation to this activity. Peer review of the material in this CE activity was conducted to assess and resolve potential conflict of interest. Reviewers unanimously found that the activity is fair balanced and lacks commercial bias. Please Note: PharmCon, Inc. does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced and objective. Occasionally, authors may express opinions that represent their own viewpoint. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient or pharmacy management. Conclusions drawn by participants should be derived from objective analysis of scientific data presented from this monograph and other unrelated sources. 2

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ACTIVITY TEST 1) How many patients in the United States suffer from some form of chronic constipation? a. 15 million b. 32 million c. 48 million d. 84 million 2) Which of the following drug classes is most likely to cause constipation? a. First generation cephalosporins b. ACE inhibitors c. Glucocorticoids d. Opioids 3) Which of the following best describes the typical Chronic Idiopathic Constipation patient? a. Is likely to be male b. 20% self treat with OTC meds c. 13% take prescription medications d. Frequently complain of pain 4) Which of the following best describes the typical IBS-C patient? a. About 30% self treat with OTC meds b. Nearly 51% are managed with prescription meds c. Frequently complain of pain d. Physicians seldom use Over the Counter meds in favor of Rx treatment 5) Which of the mechanism of actions is most likely to relieve the pain associated with IBS-C? a. Activation of guanylate cyclase-c receptors b. Activation of Chloride channel Type-2 c. Antagonizing the mu opioid receptors in the gut d. Antagonizing the muscarinic receptors in the gut 6) Which of the following is NOT correct about the incidence of IBS-C? a. Women have more IBS-C than men b. Most patients are under age 50 c. It affects around 11 % of the population d. IBS is self limiting and patients seldom are financially impacted 7) Which of the following patients may not be treated with Lubiprostone (Amitiza)? a. Female with opioid induced constipation b. Female with IBS-C c. Male with CIC d. Male with IBS-C 14

8) Which of the following patients may not be treated with linaclotide (Linzess)? a. Female with opioid induced constipation b. Female with IBS-C c. Male with CIC d. Male with IBS-C 9) Which of the following treatments received superior to placebo for IBS-C Recommendation was strong, and a high quality of evidence? a. PEG-3350 (Miralax) b. Lincalotide (Linzess) c. Chronulac (Lactulose) d. Probiotics 10) When a patient presents at your pharmacy complaining of constipation, and complains of pain, which is your best approach? a. Start on docusate (Colace) with follow up in one week b. Recommend increased fiber, and possible OTC fiber supplement c. Begin stimulant laxative such as PEG-3350 (Miralax) d. Refer patient to a physician Please submit your final responses on freece.com. Thank you. 15