I need a response for the following peers

 peer 1 

Epidemiology of Irritable Bowel Syndrome 

           Irritable bowel syndrome is a functional gastrointestinal disorder defined by abdominal discomfort associated with either symptom relief by defecation or symptoms related to stool form changes. As of 2015, the condition had a global prevalence of 11.2%, which had remained constant for the last 30 years (Endo, Shoji, & Fukudo, 2015). Furthermore, the odd ratio of IBS increased in comparison to men, while the prevalence was in no way associated with the socioeconomic statuses of individuals. The relative difference in terms of prevalence between sexes reflects a 5% absolute difference. The prevalence was 25% lower in adults above 50. Irritable bowel syndrome is associated with other conditions such as chronic fatigue syndrome, functional dyspepsia, gastroesophageal reflux disease, and psychiatric disorders such as anxiety and depression. 

Treatment Goals for the Patient 

           The treatment goals are to reduce the severity of the symptoms without the risk of adverse reactions from drug therapy and improve the quality of life (Wilkins, Pepitone, Alex, & Schade, 2012). The patient will also need to be ensured for psychological health and proper diet practices. The goal is to relieve the patient of intermittent diarrhea and the cramping discomfort, hence reduce the overall symptoms. 

The first line and second-line drug therapy for IBS 

           First-line drug therapy involves the administration of loperamide, which effectively decreases stool frequency while increasing its consistency. Loperamide functions by reducing the intestinal transit and enhances the water and ion absorption. It is a synthetic peripheral µ-opioid receptor agonist that inhibits peristalsis and has anti-secretory effects (Lucak, Chang, Halpert, & Harris,2017). Additionally, it improves stool consistency and decreases frequency. Its side effects include constipation, nausea, and dizziness. Second-line drug therapy would involve Alosetron (Lotronex) for severe diarrhea-predominant in women. It relieves abdominal pains and reduces frequency as well as urgency. Starting dose requires 0.5 mg BID, which may be increased to 1 mg BID after four weeks under great toleration of the first dose. Adverse effects of Alosetron include ischemic colitis and constipation. 

 peer 2 

Irritable bowel syndrome (IBS) is a persistent practical gastrointestinal disorder characterized by abdominal discomfort and impaired bowel habits. Symptom-based key elements are usually accustomed identify IBS. It’s believed that ten % of the common public occurs at IBS. IBS individuals typically state different upper as well as lower gastrointestinal signs and issues – in addition to an assortment of non gastrointestinal signs and complaints. The pathophysiology of IBS is still mostly unknown, but has long been linked to changes in bowel motor function, improved visceral sensitivity, and variations in the therapy of the main nervous system of visceral sensation.. IBS individuals commonly report considerable absence from work, decreased productivity, bad health related quality of daily life, along with substantial direct as well as indirect medical expenses. 

You will find 4 primary goals in the therapy of IBS patients: (one) to correct personalized IBS symptoms (i.e., abdominal pain as well as discomfort, swelling and diarrhea); (two) Improve general ibS symptoms (three) prevent IBS problems which normally include avoidable surgery, analysis threat methods as well as negative side effects of polypharmacy drugs; and also (four) lessen the effect of IBS on this particular individual by enhancing quality of living and also decreasing overall health costs. (Lacy, et al., 2016). IBS is categorized as the main phenotype of diarrhea (IBS D), primarily constipation (IBS C), blended design (Non-Subtyped phenotype or ibs-m) (IBS U) (Vanuytsel, Boeckxstaens and Tack, 2014). Therapy is going to be treated for treating these kinds of irritable bowel syndrome, based on the main design of stool. The objectives of pharmacotherapy are relieving abdominal pain and enhance intestinal feature. For individuals with main diarrhea, antidiarrheal agents (mainly loperamide) are beneficial. On the flip side, in individuals with constipation fiber supplements are able to file down stools. 

Including non pharmacological treatment method, such as lifestyle changes, herbal therapies and behavioral therapies, are utilized in the management of IBS, pharmacological treatment is dependent on the individual ‘s symptoms. In this particular situation, the individual has diarrhea, with cramps, accompanied by vomiting and nausea. In this particular situation, it seems that there’s a predominance of IBS diarrhea. The very first line of therapy contains antispasmodics and anti-dialyllism. 

Loperamide (guide 2mg) happens to be an antidiarrhea utilized in patients with IBS D. The original serving of adults is four mg, then simply two mg following every loose-fitting fezesolta, not exceeding eight mg/day for using oTC or maybe 16mg/day for recommended use. This particular medication advances the consistency of feces, lessens the frequency of feces and also boosts the firmness of the external anal sphincter, but doesn’t purify the symptoms of ibs (Woo, and also Robinson, 2016). 

Antispasmodices are utilized in the therapy of IBS to lessen discomfort and swelling since the anticholinergic effects of its, leads to slight muscle relaxation and also reduces discomfort, though they’ve unwanted side effects (Annahazi, Roka, Wittmann and Rosztoczy, 2014). Nevertheless, many individuals get better with antispasmodic medicines, particularly those whose symptoms are caused by dishes and also people who complain of tenesmus. When used for flour induced symptoms, anticholinergics must be given 30 60 minutes before meals therefore the drug ‘s highest serum levels coincide with good signs. Dicyclomine, hyosciamine as well as peppermint oil had been discovered to be beneficial compared to placebo. 

Tricyclic antidepressants (ATCs, like desipramine or amytriptyline, 10 15 mg/day) along with selective serotonin reuptake inhibitors (SSRIs) affect gastrointestinal motility via serotonergic and anticholinergic mechanisms and might thus affect intestinal habit problems in IBS. These medicines have become the 2nd type of therapy in IBS. The 5HT3 receptor antagonist, including Alosentron, ought to be worn whether earlier remedies fail and in serious diarrhea of the illness mainly in females (Higgins, Davis, and also Laine, 2004). Inhibition of 5HT3 receptors are able to bring down pain, swelling, and nausea. The serving is one mg twice or once one day. 

Here is the original questions if you needed

Jordan is a 35-year-old woman who presents with intermittent diarrhea with cramping that is relieved by defecation. The diarrhea is not bloody or accompanied by nausea and vomiting. Review of past medical history includes some childhood “stomach issues”, HTN, and a recent cholecystectomy. She works in the environmental department of a large hotel. . She denies alcohol and cigarette.

Diagnosis: Irritable Bowel Syndrome (IBS)

I.      Discuss the epidemiology of IBS?

II.     What is your treatment goals for this patient?

III.    Discuss First line and second line drug therapy for IBS. Please include pharmacotherapeutic information.

Describe components of a clinical based decision-making model impacted by clinical expertise and explain how clinical expertise informs evidence-based practice.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

Learning Materials

• Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.) Philadelphia, PA: Wolters Kluwer Health. ISBN: 978-1-4511-9094-6. Read Chapters 13 and 14.