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bnf 2021 > 1 GI > Flashcards

1 GI Flashcards

1
Q

What is the cause of coeliac disease?

A

Adverse reaction to gluten
(= a protein found in
WHEAT, BARLEY & RYE)

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2
Q

What is coeliac disease ?

A

Autoimmune condition associated with chronic inflammation of the small intestine (unable to absorb nutrients)
Gluten (= protein in barley, wheat and rye)

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3
Q

Coeliac disease symptoms?

A

Abdominal pain
Diarrhoea
Bloating
Risk of malnutrition CA & vitamin D

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4
Q

Coeliac disease Tx

A

There is no treatment
Life long gluten-free diet
Mineral and supplements given only by specialist NEVER SELF MEDICATE!!!!

Prednisolone as initial treatment management while awaiting specialist advice

Assess for risk OSTEOPOROSIS

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5
Q

Ulcerative colitis, where does it start and where does it end?

A

Colon only

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6
Q

Crohns disease, start and end

A

From mouth to anus

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7
Q

Antacids ok to give in hypertension

Aka low NA+ preps

A

Maalox
Altacite plus
Mucogel
co-magaldrox

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8
Q

Proprantheline (tx ibs)

CI

A 
Pregnancy 
Down syndrome 
Hypertension 
Heart failure 
Age under 12 and over 65
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9
Q

Drugs causing BEZOAR formation

A

Sucralfate suspension

aluminum hydroxide gel

enteric-coated aspirin

guar gum

cholestyramine

enteral feeding formulas

psyllium preparations

nifedipine XL

meprobamate

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10
Q

IBS

which 3 conditions

A

Short bowel syndrome

Constipation

Diarrhoea

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11
Q

IBD

which conditions

A

Crohn’s disease

Ulcerative colitis

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12
Q

When are

Methylnatrexone or naloxegol prescribed in constipation

A

Opioid induced constipation
last option
Specialist

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13
Q

When are

Co-danthramer (red urine)
And
Co-danthrusate

Prescribed in constipation and for who?

A

opioid constipation usually

In palliative care only as they are carcinogenic

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14
Q

Examples of

Bulk forming laxatives

When will they start working

A

Sterculia

Ispaghula husk (allergy-check)

Methylcellulose

24-72 hrs

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15
Q

Example of an

Osmotic laxative

How long till they start workingqq

A

Magnesium hydroxide

Lactose

Macrogol (laxido,cosmocol,movicol)

48-72 hrs

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16
Q

Examples of

Stimulating laxatives

How long till they start working

A 
Bisacodyl 
Co-danthramer 
Senna (yellow urine) 
Glycerin suppository (also softener)
Sodium picosuffate 
Docusate sodium

6-12 hrs

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17
Q

Examples of

Stool Softeners + SE

A

Liquid paraffin (not recommended)

Methyl cellulose

SE:
Malabsorption of fat soluble vits A,D,E,K
Anal seepage
Lipid pneumonia

—————
Other class laxatives can also be softeners:
Docusate, glycerin suppository

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18
Q

When is

Prucalopride - lubiprostone
Serotonin receptor agonist- Chlorine channel antagonist

Given in constipation

A 
When 2 different class laxatives 
(Stimulating + osmotic) are given at highest recommended, tolerated dose for 6 months
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19
Q

Constipation tx

Opioid induced

Which laxative to avoid?

A
  1. Two different class laxatives (stimulant + Osmotic)
  2. In palliative pts: co-danthramer/ co-danthrusate
  3. Specialist: methyl naltrexone or naloxgel

Avoid bulk forming laxative in opioid constipation

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20
Q

Constipation in child tx

A
  1. Macrogel +diet + exercise
  2. Add stimulant
  3. Add lactose or stool softener
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21
Q

Constipation in pregnancy and breastfeeding Tx

A
  1. Bulk forming (if fibre supplement fail)
  2. Osmotic (lactose)
  3. Senna / bisacodyl (POM)
  4. Docusate sodium or glycerin suppository

Note: senna CI near term, unstable pregnancy

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22
Q

Pregnancy and senna

A

CI

near term

Unstable pregnancy

(POM)

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23
Q

Isphagula husk (bulk forming laxative)

Allergy causing

Give 3 examples

A

Rhinitis

Bronchospasm

Anaphylactic shock

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24
Q

CI

omeprazole

A

Most effective acid secretion PPI

Best taken in morning hour before breakfast

CI in
Esomeprazole / omeprazole ❌clopidogrel

Gastric cancer (can mask!)

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25
Q

Lactulose CI in:

A

MR-EC preparations (⬇️ stool ph)

IBS

Mesalazine

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26
Q

Sulfasalazine SE

A 
headache 
Nausea
Watery diarrhoea 
Indigestion 
Skin rash - itch 
Fever
Metallic taste 
Yellow body fluids 
Discoloured contact lens( harmless)
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27
Q

Corticosteroids SE

A 
Diabetes 
Hypertension 
Fluid retention 
Upset stomach 
Weight gain 
Immunosuppressant 
Osteoporosis

CI kidney + liver problems

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28
Q

Monoclonal antibody
(Adalinmumab, inflicimab)

SE

A 
Allergy 
Flu symptoms 
Fever
Chills
N+V 
Fatigue 
Diarrhoea 
Muscle ache 
Hypotension (low BP)
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29
Q

loperamide CI

A 
Under 12
Pregnancy 
Active UC!!!!!
Severe pain 
Bloody diarrhoea 
Liver failure 
Water retention 
Conditions with low gut mobility
Antibiotics related colitis (clindamycin) 
16mg max daily!
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30
Q

Tamsulosin otc age:

A

45-75 yr

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31
Q

GTN ointment SE

A

Headache

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32
Q

Pancreatin inactivated by

A

Heat

Gastric acid

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33
Q

Iron SE

A

Loose stool

Dark stool

Sore skin

34
Q

H.pylori fist time eradication duration

How effective %?

A

1 week

More than 90% effective

> 90%

35
Q

Anti-muscarinics indicated in (treat)

CI?

A

Asthma/COPD

Motion sickness

Dysmenorrhea

Arrhythmias

CI in ulcerative colitis

36
Q

Lactulose CI

A

IBS

MR /EC

Mesalazine

37
Q

What’s CI in Crohn’s disease

A

Loperamide

Codeine

38
Q

MAB infliximab is as effective as ….
in Crohn’s disease

If IV corticosteroids CI in pts

A

Ciclosporin

39
Q

Monoclonal antibodies

To check for what infection before starting?

A

Tuberculosis TB

Take sexual contraception until 18weeks AFER treatment with MAB

40
Q

Before taking

aminosalicylates:

Such as:

Balsalazide (Colazal, Giazo)
Mesalamine (Apriso, Asacol, Delzicol, Lialda, Pentasa)
Olsalazine (Dipentum)
Sulfasalazine (Azulfidine, Sulfazine

As for allergy to….?

A

Aspirin

41
Q

What is external manifestation in IBS

A

Pain in joints, eyes , skin, osteoporosis and arthritis

42
Q

antimuscarinic drugs

Examples

A 
Antipsychotics (clozapine, quetiapine)
Atropine.
Benztropine.
Biperiden.
Chlorpheniramine.
Certain SSRIs (Paroxetine)

But used as antispasmodic
Dicyclomine
propantheline
Hyocine

43
Q

Antimuscarinics

MOA

SE

A

reduce colonic motility by inhibiting parasympathetic stimulation of the myenteric and submucosal neural plexuses. They also inhibit gastric emptying.

SE:

Dry mouth with difficulty swallowing and thirst.
dilation of the pupils with difficulty accommodating and sensitivity to light - i.e. blurred vision.
increased intraocular pressure.
hot and flushed skin.
dry skin

CANT: SEE,SPIT,PEE,POOP

44
Q

What is ulcerative colitis

A

UC occurs when the lining of your large intestine (also called the colon), rectum, or both becomes inflamed.

45
Q

Diverticulitis tx

A 
Bowel rest 
Only if:
Infection present 
Or
Immunosuppressed

Antibiotics
IV- gram negative or aerobic

46
Q

Diverticula disease tx

A

High fibre diet

Bulk forming laxatives—>methycellulose

47
Q

Ulcerative colitis

(Proctitis/ proctigmoiditis)
(Inflam rectal/ rectal+colon)

CI

A 
1. aminosalicylates
     Balsalazine
     Olsalazine
     Mesalazine 
     Sulfalazine

ALTERNATIVELY: ORAL Prednisolone or rectal corticosteroids

  1. ADD
    oral prednisone (after 4 weeks with aminosalicylate)
    ADD
    Tacrolimus if no response after 2-4 weeks

CI: loperamide and codeine

48
Q

Ulcerative colitis
Extensive (high up in colon)
Left sided colitis (down the colon)

A

ORAL

  1. High dose aminosalicylates PLUS rectal

Or oral beclometase

Alternative: oral prednisone alone

  1. ADD
    oral prednisone (after 4 weeks with aminosalicylate)
    ADD
    Tacrolimus if no response after 2-4 weeks

CI: loperamide and codeine

49
Q

Ulcerative colitis tx

SEVERE

A

Oral prednisone

Alternatively: 
Monoclonal antibodies (MAB)
  adalimumab
  Infliximab No improvement? 
1. Stat hospital MEDICAL EMERGENCY 
IV Corticosteroids ( + assess need for surgery)

Alternatively: IV Ciclosporin OR surgery
If IV ciclosporin CI give: infliximab

  1. If no improvement within 72hrs of hospital admission

IV Ciclosporin PLUS IV corticosteroids OR Surgery

50
Q

Ulcerative colitis
Maintaining remission Tx

Proctitis/ proctsigmoiditis

And

Extensive colitis / left sided colitis

A

Reals AS alone (more effective than with oral)

Low dose oral AS
Azathioprine / mercaptopurine

But : if 2+ flare ups in 12months required IV corticosteroids

After one severe flare up

Remission not maintained after oral AS

—-> continue MAB if effective/Tolerated in acute flare up

51
Q

Crohn’s disease

A

1+ acute flare up in 12 months or first presentation:

  1. CORTICOSTEROIDS
    Prednisolone
    Methyl Prednisolone
    IV hydrocortisone

Alternatively in patients with: right sided colonic disease: budesonide or AS

2+ acute flare ups in 12 months (maintaining remission of CD)
Azathioprine or mercaptopurine
Alternatively: methotrexate
Alternatively: MAB
After surgery:
Azathioprine OR mercaptopurine OR AS

52
Q

Short bowel disease

MR/EC suitable?

Deficiency of what vits?

A

Not suitable

Vits: A, E, D, K; zinc, selenium, magnesium, essential fatty acids

53
Q

Diarrhoea

What is it and red flags

A

Increased frequency or volume or both
Acute 14 days or less
Chronic 14+

Red flag: weight loss, rectal bleeds, travel, antibiotics, recent hospital visit

54
Q

Diarrhoea

Causing bacteria

A

Food poisoning:
Salmonella
Campylobacter
E-coli

55
Q

Loperamide SE

A 
Qt prolonged 
Cardiac arrest 
Dizziness,
Headache, 
Doesn’t cross BBB
56
Q

Dyspepsia

Symptoms

A 
Upper abdominal pain
Fullness
Early satiety 
Bloating
Belching
Nausea
57
Q

Dyspepsia

Immediate referral:

A

A L A R M

Aneamia

Loss of weight

Anorexia

Recently changed, unexplainable dyspepsia in 55+, not responding to tx

Melena (blood in stool)

58
Q

In-Investigated dyspepsia tx

A
  1. Antacid
  2. PPI for 4wks
  3. H.pylori test if no improvement
59
Q

Investigated dyspepsia

Tx

A
  1. H.pylori test if Positive (eradication therapy)

2. PPI or H2 antagonist for 4wks (if test negative)

60
Q

Aluminium and magnesium salts are

Long or short acting

A

Long

61
Q

Calcium containing antacids

Can cause:

A

Constipation
Rebound acid secretion

hypocalcemia
Alkalosis
Milk alkali syndrome (Hugh blood ca)

62
Q

Milk alkali syndrome symptoms

A 
high urine output.
headache and confusion.
fatigue.
nausea.
pain in your abdomen
63
Q

Antacids

How should they be taken

A

2 hours before and after medicines
Especially:

Tetracyclines
Quinolones
Bisphosphates

64
Q

PPI

Examples

A 
Esomeprazole 
Lansoprazole (30-60mints before food)
Omeprazole ✅ pregnancy
Pantoprazole 
Rabepazole

“Best in morning, swallow whole, don’t chew or crush”

“2hrs before or after food”

65
Q

PPI

SE

A 
Can mask gastric cancer 
Increased risk fractures (osteoporosis)
Increased GI infections c.difficile 
Abdominal pain, nausea, constipation 
Subacute cle 
1 year after taking PPI 
Low mg 3mths-1yr
PPI + digoxin  = toxicity

Take Ca + Vit D
Or bisphosphate

66
Q

Omeprazole and methotrexate

A

Toxic

Omeprazole decrease methotrexate clearance

67
Q

Ppl treatment (duration)

A

Shortest duration and lowest dose

68
Q

PPI withdraw

A

Resolves by it self usually

If not give steroids

69
Q

Suralfate

Tx for benign ulcers/stress ulcers

A

1 house before food

& enteral feeds

70
Q

H2 Antagonist

Examples

SE

A

ALWAYS rule out malignancy
ESP in pts 55+

Cimetidine
Ranitidine
Famotidine
Nizatidine

SE:
Headaches
Rashes
Dizziness
Diarrhoea 
Confusion + psychological reactions 
Depression 
Hallucinations in elderly + very ill
71
Q

Hyoscine butylbromide injection

Nausea in palliative care

CI

A

Tachycardia
Cardiac disease
Hypotension
Anaphylaxis

CAN CAUSE DEATH

72
Q

Misoprostol
(Rxed in elderly for ulcers that can’t leave NSAIDS)
Postagladin

A

Tetrogenic in pregnancy

Avoid MG in antacid

73
Q

NSAIDs treating ulcers tx

A
  1. Withdrawal NSAIDs if possible

2. PPIs or H2A or misoprostol

74
Q

NSAIDs risk factors

A

Age 65+
History of peptic ulcers
Other GI complications

Co-morbidities:
Diabetes
Cardiovascular disease
Hepatic/renal impairment

Taking other meds:
Bisphosphate
Corticosteroids
SSRI’s

75
Q

NSAIDs

If pts have 3+ risk factors

A 
Continue PPI (after healing) 
Or H2A or misoprostol

ADD cox2 selective NSAIDs

76
Q

GORD

Gastro oesophageal reflux disease

A

Heart burn and bring up acid

77
Q

GORD tx

Mild

Severe

Pregnancy

Children

A

Mild:
Antacids + alginates
PPI - H2A

Severe
PPI for 4-6wks
Maintain remission with low PPI/H2A

Pregnancy
Antacids or alginate
Omeprazole

Children
Resolves after 12-18 months
Thicker feeds or alginates

78
Q

Food allergies

Symptoms

Tx

A

Symptoms:
Vomiting, rashes, anaphylactic shock, colic, diarrhoea

Causes:
Egg, fish,milk,nuts

Tx:
Sodium cromogilcate
Chlorphenamine
Adrenaline (epipen)

79
Q

Pancreatin

Causes
How to take

A

Cystic fibrosis
Chronic pancreatitis
Zollinger-Ellison syndrome
Coeliac disease

How to take:
Distribute food intake increase frequency and decrease quality

Avoid: difficulty to digest food: lentils,beans,avoid reduced fat foods

Starch, fat, protein

Take with food
If mixed with food or drink have it within 1 hr

ME/EC = increase pancreatin doses

80
Q

Pancreatin

SE

A

Increased or decreased Uric acid
(Severe joint pain, AKI)

NV, abdominal pain, skin around mouth irritation/buccal mucosa (perioral skin)

81
Q

Pancreatin

Fibrossing colonopathy in cystic fibrosis

A

With increased doses of pancreatin

At risk male, severe CF, laxative use

Nutrizym 22
Pancrease HL contra indicated in kids 15 and under

Pts stat report SE abdominal pain

82
Q

Stoma

A

MR/EC Not suitable

Avoid sorbitol (laxatives)

(Take K+ supplement (liquid = better) (digoxin?)

Split daily doses
Avoid laxatives
Can have bulk forming

Increased doses codeine /loperamide can be used

bnf 2021 (20 decks)

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