Continuing Education Case Study Quiz

Abstract

Goal—

The goal of this program is to educate pharmacists about the use of linaclotide for the treatment of irritable bowel syndrome and constipation.

Objectives—

At the completion of this program, the reader will be able to:

1. Describe the pharmacology and pharmacokinetics of linaclotide.

2. Discuss the risks associated with the use of linaclotide.

3. Discuss the potential benefit of linaclotide for an individual patient.

4. Apply the information on the use of linaclotide to a case study.

1. Linaclotide is approved by the US Food and Drug Administration (FDA) for the treatment of:

   1. Irritable bowel syndrome with constipation and chronic idiopathic constipation.

   2. Irritable bowel syndrome with constipation and chronic idiopathic diarrhea.

   3. Irritable bowel syndrome with diarrhea and chronic idiopathic constipation.

   4. Irritable bowel syndrome with diarrhea and chronic idiopathic diarrhea.

2. Linaclotide and its active metabolite are agonists of the guanylate cyclase type-B receptor.

   1. True

   2. False

3. By stimulating receptors found in the luminal surface of the intestine, linaclotide causes:

   1. Increased intestinal fluid secretion.

   2. Reduced bowel movement frequency.

   3. Reduced intestinal chloride secretion.

   4. Slowed colonic transit.

4. Linaclotide is an analog of the enterotoxin from which organism?

   1. Escherichia coli

   2. Shigella dysenteriae

   3. Vibrio cholerae

   4. Yersinia enterocolitica

5. Systemic absorption of linaclotide after oral administration was:

   1. 90%.

   2. 80%.

   3. 60%.

   4. Minimal.

6. Administration with food enhances linaclotide absorption.

   1. True

   2. False

7. In the Johnston JM et al study, which linaclotide dose was associated with the greatest mean change in the frequency of spontaneous bowel movements from pretreatment baseline to the end of the 12-week treatment period?

   1. 75 mcg

   2. 150 mcg

   3. 300 mcg

   4. 600 mcg

8. In the Rao S et al study, what percentage of linaclotide-treated patients experienced a reduction in abdominal pain for at least 9 of the 12 weeks?

   1. 6.3%

   2. 12.1%

   3. 27.1%

   4. 34.3%

9. Linaclotide is in Pregnancy Category:

   1. A.

   2. B.

   3. C.

   4. X.

10. The most common adverse effect of linaclotide that led to its discontinuation was:

    1. Abdominal distention.

    2. Abdominal pain.

    3. Diarrhea.

    4. Flatulence.

       Case History

       MM is a 33-year-old female with a history of depression, migraine headaches, and chronic abdominal pain. She is currently taking sertraline 50 mg once daily and an oral contraceptive containing ethinyl estradiol and norethindrone. MM also takes sumatriptan or an aspirin, acetaminophen, and caffeine combination product for migraines, which occur about twice a month. She was recently diagnosed with irritable bowel syndrome with constipation. Following a lack of symptom improvement with recommended dietary changes, her physician has decided to prescribe linaclotide.

11. What is the recommended starting dose of linaclotide for MM?

    1. 145 mcg once daily

    2. 145 mg once daily

    3. 290 mcg once daily

    4. 290 mg once daily

12. How should MM be told to take her medication?

    1. On an empty stomach at least 30 minutes prior to the first meal of the day

    2. At least 30 minutes after the consumption of the first meal of the day

    3. On an empty stomach at least 30 minutes before dinner

    4. At bedtime

13. Which of MM’s medications will interact with her linaclotide?

    1. Ethinyl estradiol/norethindrone

    2. Sertraline

    3. Sumatriptan

    4. No drug-drug interaction studies were conducted.

14. If MM experiences severe diarrhea while on linaclotide, what should be done?

    1. Her next dose should be held or linaclotide therapy stopped.

    2. She should be instructed to take loperamide.

    3. She should be instructed to follow the BRAT diet (bananas, rice, applesauce, and toast).

    4. Nothing needs to be done; diarrhea associated with linaclotide is usually self-limiting.

15. How should MM be told to store her linaclotide capsules?

    1. In a pill box, so she remembers to take her daily dose

    2. In the original container, without removing the desiccant

    3. In the supplied bottle, in the refrigerator

    4. All of the above are acceptable.

This CE activity is co-sponsored by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-13-003-H01-P has been assigned to this knowledge-based home-study CE activity (initial release date 02-01-13). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Statements of credit will be issued online upon completion of the evaluation and the post-test with a score of 70% or higher. No partial credit will be given.

Release Date: February 1, 2013

Expiration Date: February 1, 2015

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to:

• www.ProCE.com/HPJFDR

• Click to access the activity page to enroll and complete the Post-Test and Evaluation

With a passing grade of 70% or greater on the Post-Test, you will be able to print your CE statement of credit online.

For questions related to registering for and obtaining CE credit, contact ProCE at 630-540-2848 or Info@ProCE.com.