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3+4 Flashcards

1
Q

5 Advantages of the oral mucosal drug delivery system

A 
Accessible 
self-administer
Highly hydrated environment to dissolve 
Reduces chance of systemic side effects
Oral mucosa repairs rapidly
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2
Q

5 disadvantages of oral mucosal drug delivery system

A 
Saliva washes away drug
mastication/speech can dislodge it
Can choke it 
small surface area
Highly enzymatic environment
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3
Q

What is oral thrush

A

Its a fungal infection by candidas albicans of the oropharynx

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4
Q

Who in oral thrush common in

A

Patients with dentures, xerostyomia, DM, Taking immunosupressant drugs, anaemias

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5
Q

What does oral thrush look like

A

Creamy white patches in mouth
Can be scraped off tongue leaving a red tongue
Unpleasant taste in mouth
burning sensation

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6
Q

How do you treat oral thrush

A

Nystatin or miconazole- topcial application

Systemically give fluconazole

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7
Q

How long does it take for a mouth ulcer to go

A

10-14 days

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8
Q

List the local causes of mouth uclers

A

Mechanical trauma, chemical/thermal injury

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9
Q

What are apthous ulcer

A

Most common type of mouth ulcer

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10
Q

Causes of aphthous ulcers

A

May have a genetic component or due to
Oral trauma,
changes in hormone levels, ex smokers, lack of B12 and folate

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11
Q

Which medications can cause mouth ulcers

A

Nicorandil, NSAID like ibuprofen and oral NRT

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12
Q

Describe appearance of minor aphthous ulcer

A

less than 10mm, pale yellow but look red bc they’re swollen
Can have up to 5 at a time
7-10 days
no scarring

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13
Q

Describe appearance of MAJOR aphthous ulcer

A 
larger than 10mm
1/2 at a time 
2 weeks-months
leaves a scar
v painful and difficulty eating
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14
Q

Describe appearance of herpetiform ulcer

A

1-2mm
multiple at the same time- can join together
1 week-2 months

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15
Q

Management advice of aphthous uclers

A 
Self-limiting
avoid spicy, hot, acidic foods
Use a straw
very soft toothbrush 
Change form of medication
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16
Q

OTC meds for aphthous ulcer

A

Chlorhexidine mouthwash- healing and prevention
Local anaesthetic- pain relief
Analgesic oral rinse, benzydamine spray (difflam) or choline salicylate gel (bonjela- not under 16)
Hydrocortisone mucoadhesive tabs buccal tabs

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17
Q

Rx meds for aphthous ulcers

A

Doxycycline/ strong steroid mouthwashes

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18
Q

Which 4 meds cause dry mouth

A

Antimuscarinics, TCAs. antipsychotic, antihistamines,

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19
Q

Which drugs can cause stomatitis

A

NSAIDs cause aphthous like ulcers

Methotrexate, doxorubicin- chemotherapy assocuated mucostitis

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20
Q

What is gingival hyperlasia

A

Overgrown of gum tissue

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21
Q

What drugs cause gingival hyperplasia

A

Phenytoin, CCB, sodium valproate, cyclosporine

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22
Q

What drugs angiodema

A

ACEI

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23
Q

Describe the pain of dyspepsia(indigestion)

A

epigastric pain, above umbilicus and located centrally, pain behind breast bone

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24
Q

What is a sharp burning sensation in the epigastric region and behind breast bone called

A

Heartburn/acid reflux

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25
Q

What is the pain like in colic

A

waves of severe pain on top of a constant diuller main- occurs when organ is spasm

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26
Q

What are the symptoms of a peptic ulcer

A

Pain related to meals signifies a lesion on the stomach

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27
Q

What is a duodenal ulcer

A

pain 1-2hrs after food- worse at night

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28
Q

What is a gastric ulcer

A

Epigastric or central pain few mins after food

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29
Q

Pain immediately on eating

A

Reflux or oesphagitis

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30
Q

Which type of ulcer is relieved by food

A

Duodenal ulcer

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31
Q

When do you need referral in over 55s

A 
Hx of gastric ulcer
Hx of gastric surgery
Family history of Gatric cancer
Pernicious anaemia
NSAID use
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32
Q

What are the alarm symptoms

A 
Epigastric mass
Iron deficiency anaemia
Persistent vomiting
progressive dysphagia 
Significant GI bleeding
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33
Q

Management of dyspepsia and acid reflux

A 
Small frequent meals
avoid bending
don't eat before bed
reduce weight, alcohol, caffeine, chocolate and fat
Stop smoking
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34
Q

Why are antacids used in dyspepsia

A

Fast act in supressing symptoms

Used for isolated episodes

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35
Q

What are the side effects of magnesium salts

A

Can cause diarrhoea

Can increase sodium which can cause HF/hypertension

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36
Q

How are aluminium salts different to Mg

A

Al are longer acting

can lead to constipation

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37
Q

Side effects of calcium salts

A

Fast acting, lead to constipation

Can cause acid rebound which causes the release of gastrin causing more acid

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38
Q

Name a side effect and an give an example of a Bismuth salts

A

Constipation

Pepto-bismol

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39
Q

How long does it take before relief of symptoms using a PPI

A

2 days

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40
Q

When are alginates used

A

Relief in GORD

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41
Q

How do alginates work

A

Form a floating viscous gel, on top of stomach contents protecting the mucous membrane of the oesophagus

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42
Q

What is domperidone

A

stimualtes GI peristalsis

OTC max 1 week for nausea, hearburn and dyspepsia

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43
Q

Simeticone

A

Small bubbles in stomach coalese allowing gas to be eliminated

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44
Q

Treatment for uninvestigated dyspepsia

A

Full dose PPI for 4 weeks
if no response test for H pylori and treat infection using 2 AB and 1PP
Leave 2 week washout period after PPI- test again

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45
Q

Risk factors of GORD

A

Pregnancy, smoking, alcohol, obesity, large meals

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46
Q

What happens in GORD

A

The lower eosophageal sphincter relaxes transiently causing heartburn

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47
Q

Management of mild symptoms of GORD

A

Use antacids and alginates

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48
Q

Drug management for Severe cases of GORD

A

PPI/surgery

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49
Q

How does the surface of the esophageal mucousal act as defense mechanism

A

Mucous and unstirred water trap bicarbonate which acts as a weak buffer

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50
Q

What are the cardiac features of pain of GORD

A

Gripping/crushing pain
Radiates to neck or left arm
Worse with exercise
Accompanied by dysponea

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51
Q

How does esophageal damage occur

A

When drug remains on esophagus for too long

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52
Q

Which common drugs cause oesphageal injury

A

Doxycycline, tetracycline, clindamycin, aspirin, KCL, ferrous sulphate, quinidine NSAIDs

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53
Q

Which drugs can worsen GORD

A

Smooth muscle relaxants

nitroglycerins, antimuscarins, beta agonsits, aminophyllines, benzo’s

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54
Q

Which 3 biphosphonates need to be taken in caution in those with oespahgeal problems

A

Ibandronate, risedronate, alendronate

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55
Q

What is a peptic ulcer

A

Lesion in the mucosa of the digestive tract

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56
Q

Describe a H. pylori associated ulcer

A

Spiral-shaped, gram negative bacterium found in gastric antrum of the human stomach

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57
Q

What are the risk factors for H. Pylori associated ulcer

A

Low social class, overcrowding and bed sharing

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58
Q

How does a NSAID associated ulcer occur

A

prostaglandins produce protective mucous layer for the stomach, nsaids reduce PG, increasing risk of gastric irritation and ulceration

59
Q

Which NSAIDs have the highest risk of uclers

A

Piroxicam, keoprofen and ketorolac

60
Q

When are you most at risk of developing NSAID associated ulcer

A

1st month highest risk

within the first 3 months also high risk

61
Q

What are the 6 alarm symptoms for Ulcers/GI bleeding

A 
Unexplained weight loss
Epigastric pain
Significant GI bleeding
Progressive dysphagia
Iron deficiency anaemia 
Persistent vomiting
62
Q

How does misoprostal prevent ulcers

A

Stimulates protective mechanisms and reduces acid secretion

63
Q

Treatment of NSAID associated ulcer

A

Stop NSAID
Full dose PPI for 4-8 weeks
H pylori eradication +ve
Add PPI with NSAID or use a selective COX 2I e.g. celecoxib

64
Q

Test for H pylori

A

c13 urea breath test: if +ve use eradication treatment
1st line,PPI, Clarithomycin, amoxicillin/metronidazole
2nd line swap amoxicillin/metronidazole, whichever wasn’t used first line

65
Q

Highest risk of NSAID associated ulcer

A 
Over 65
Hx of peptic ulcer
taking other meds with GI effects
Serious co-morbidities e.g. Diabetes, CVD,
ADD IN PPI FOR THESE
66
Q

Explain the mechanism of H2 receptor antagonist

A

Competitive inhibitors at Histamine at parietal cell

67
Q

Mechanism of Misoprostal

A

Inhibits gastric acid secretion by direct action on parietal cells through binding to PG receptor
Increases bicarbonate,
reduces pepsin

68
Q

What are the 2 main symptoms of gastroenteritis

A

Vomitting and diarrhoea

69
Q

What is the name of the virus that causes gastroenteritis in

children and older children

A

Children: noravirus

Older children: rotavirus

70
Q

Which is the common type of bacteria causing gastroenteritis

A

Campylobacter

71
Q

Which parasites cause gastroenteritis

A

Cryptosporidium, entamoeba histolytiva, giardia

72
Q

What bacteria is found in reheated rice

A

Bacilius cereus

73
Q

Where is staphylococcus aureus found in

A

Cooked meat and cream products

74
Q

What is found in reheated meat dishes

A

Clostridium perfringens

75
Q

Risk factors for gastroenteritis

A

OVER 65S, BABIES, CHILDREN, IMMUNOCOMPROMISED

76
Q

What is the most common and serious complication with gastroenteritis

A

Dehydration and electrolyte disturbances

77
Q

What are common symptoms of UC and Crohns

A

Diarrhoea, abdominal pain, rectal bleeding, malnutrition an wieght loss

78
Q

Where is the inflammation in Chrons

A

Affects any par of the intestine, and extends into the submucosa and deeper layers

79
Q

Where is the inflammation in UC

A

Localized to the colonic mucosa

80
Q

What is the peak age for IBD

A

20-40 and then again at middle age

81
Q

In CD, which gene has a mutation

A

Mutation in NOD2 gene

82
Q

which disease is more prevalent in smoker

A

CD is more common in smokers

83
Q

Which part of the intestine does UC affect

A

Large intestine

84
Q

What happens in UC to the mucosa

A

Mucosa is ulcerated, reduced goblet cells and increased paneth cells

85
Q

What happens to the colonic crypts in UC

A

Become distorted and branched rather than short and straight

86
Q

In which part of the tissue if there an increase in inflammatory cells

A

Lamina propia

87
Q

in CD is the inflammation continuous

A

No it’s interspersed

88
Q

What is the mechanism for diarrhoea in IBD

A

Lack of bile salt absorption, inflammatory mediators and undigested/absorbed nutrients large intestine

89
Q

Extra-intestinal features of IBD

A

Skin rashes, arthritis, inflammation of eyes

90
Q

Treatment of IBD

A

Dietary manipulation, maintainance of fluid, parenteral nutrition

91
Q

Give examples of aminosalicylates for UC

A

Mesalazine, sulphasalazine, Olsalazine, balsalazide

92
Q

What corticosteroids can treat UC

A

Prednisolone, hydrocortisone, budenoside, beclomethasone

93
Q

Which immunosupressives are used to treat UC

A

Azathioprine, mercaptopurine, methotrexate, mycopenolate mofetil, acrolimus and ciclosporin

94
Q

Which biologics can be used to treat UC

A

Infliximab and Adalimumab

95
Q

Which drugs can be given in UC to stop diarrhoea

A

Codeine, loperamide, diphenoxylate

96
Q

Which laxatives are used in UC

A

Movicol and lactulose

97
Q

What is diphenoxylate used for

A

stops diarrhoea in UC

98
Q

What bulking agents are used in UC

A

Fybogel

99
Q

Which Aminosalicylates can be used in CD

A

Mesalazine, Sulphasalazine and Balsalazide

100
Q

Steroids in CD

A

Not beclomethasone like you do in UC

Budesonide, Hydrocortisone and prednisolone

101
Q

Which immunosupressive drugs are recommended in CD

A

Azathioprine, mercaptopurine, methotrexate and tacrolimus

102
Q

Which antibiotics can be used in Chrons

A

Metronidazole and Ciprofloxacin

103
Q

Who does IBS affect more

A

Young women

104
Q

What is IBS aggravated by

A

food and mood

105
Q

What are the main symptoms of IBS

A

abdo pain, bloating, flatulence, colic in stomach, alt in constipation + diarrhoea

106
Q

How does constipation occur in pregnant women

A

Increase in progesterone, relaxes smooth muscle of bowel and baby weight in uterus causes constipation

107
Q

Explain the mechanism of bulk forming laxatives

A

Retains water in large bowel increasing stool bulk

Ispagula husk is the main one, also methylcellulose

108
Q

How do stimulant laxatives work in IBS

A

Used when bulk are ineffective, increase peristalsis e.g. bisacodyl suppositries or senna

109
Q

How are osmotic and bulk laxatives different

A

Osmotic are more powerful than bulk, they retain fluid and stimulate peristalsis e.g. lactylose, Mg salts

110
Q

How do stool softners work

A

Reduce surface tension of hard faeces in bowel allowing water to pentrate e.g. docusate sodium

111
Q

How many days does it take for the onset of osmotic and bulking agents

A

2-3 days

112
Q

How long until relief of symptoms for stimulant

A

8-12 hrs

113
Q

How long can a laxative be used for

A

4 days, any longer refer to GP

114
Q

Which is the first line laxative for children

A

Polyethene Glycol

115
Q

How do antimotility drugs work for diarrhoea

A

loperamide

Reduce bowel motiltiy by working on the opioid receptors in the gut, increasing transit time to absoprbing more fluids

116
Q

Give an example of an antispamodic

A

Mebeverine

peppermint oil

117
Q

How do antimuscarinics wokr in IBS

A

Intestinal spam e.g. buscopan

118
Q

How does Bismuth salicylate work in IBS

A

Reduces intestinal motility allowing absorption of fluids

also works to treat heartburn

119
Q

HOw long should you take probiotics before you see an improvement of symptoms

A

4 weeks min

120
Q

What is Diverticular disease

A

diverticula (pockets) protrude out of digestive tract

121
Q

Causes of DD

A

Low fibre, drier stools so needs more pressure which pushes a small lining of the guy

122
Q

Difference in symptoms between DD and IBS

A

None- but DD occurs in older people and IBS in younger

123
Q

Treatment of Diverticular D

A

Increase fibre- 18g a day

124
Q

Which drugs can cause diarrhoea

A

Opioids,laxatives, antacids with Mg, AB, PPI, NSAIDs

125
Q

Describe Grade 1 hemorrhoids

A

Small swellings on the inside of the anal canal- can’t be seen or felt

126
Q

Describe Grade 2 hemorrhoids

A

PARTLY PUSHED OUT SWELLINGS, GO BACK IN WHEN U GO TOILET

127
Q

Describe Grade 3 hemorrhoids

A

Pemanently hang out the anus, can push them back in with finger

128
Q

What is a classic alarm symptom for haemorrhoids

A

Blood in stool

129
Q

Treatments for haemorrhoids

A

Contain, bismuth salts, local aneathetics, antiseptics, antipruitic, zinc
Most eggective is hydroocortisone

130
Q

What is threadworm

A

Parasite that lies for 5-6 weeks, females lay tiny eggs around back passage when youre in bed

131
Q

How long can a threadworm survive out the body

A

2 weeks

132
Q

Symptoms of threadworm

A

Itching around the anus

Mild abdo pain

133
Q

Drugs for threadworm

A

Mebendazole- over 2 yrs

take second dose 2 weeks after first

134
Q

What are the 3 main symptoms of colon caner

A

Abdo pain, blood in stool, change in bowel

135
Q

Who is at risk for colon caner

A

Over 60, diet high in red meats and low fiber, weight, lac of exercise, smoking + alcohol and family history

136
Q

How often are stool testing kits sent out

A

Every 2 yrs in 6-75 yrs olds

137
Q

What are the different types of cancers

A

Squamous cell carnomas
Adenocarcinoma- start in glandular epithelium of colorectal mucosa
Sarcomas- cancer of bone/muscle
Lymphomas
Carcinoid- slow growing formed in neuroendocrine cells

138
Q

What is stage T2

A

Tumour grown insdie he muscle layer

139
Q

N2

A

1-3 lymph nodes cose tot he bowel congtain cancer cells

140
Q

M1

A

Cancer has spread to the other organs

141
Q

What are the treatment options for colorectal caner

A

Chemotherapy
radiotherapy
surgery
Bioloical therapy

142
Q

Which drugs are used to colorectal cancer

A

Flourouracil with folinic acid
Capecitabine
Oxaliplatin
Irinotecan

143
Q

What is the definition of heartburn

A

Pain in epigastric region after meals

144
Q

What are the common symptoms associated with haemorrhoids

A

Itch
Fresh blood in stools
Discomfort when defecating
Constipation

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