3+4 Flashcards
5 Advantages of the oral mucosal drug delivery system
Accessible self-administer Highly hydrated environment to dissolve Reduces chance of systemic side effects Oral mucosa repairs rapidly
5 disadvantages of oral mucosal drug delivery system
Saliva washes away drug mastication/speech can dislodge it Can choke it small surface area Highly enzymatic environment
What is oral thrush
Its a fungal infection by candidas albicans of the oropharynx
Who in oral thrush common in
Patients with dentures, xerostyomia, DM, Taking immunosupressant drugs, anaemias
What does oral thrush look like
Creamy white patches in mouth
Can be scraped off tongue leaving a red tongue
Unpleasant taste in mouth
burning sensation
How do you treat oral thrush
Nystatin or miconazole- topcial application
Systemically give fluconazole
How long does it take for a mouth ulcer to go
10-14 days
List the local causes of mouth uclers
Mechanical trauma, chemical/thermal injury
What are apthous ulcer
Most common type of mouth ulcer
Causes of aphthous ulcers
May have a genetic component or due to
Oral trauma,
changes in hormone levels, ex smokers, lack of B12 and folate
Which medications can cause mouth ulcers
Nicorandil, NSAID like ibuprofen and oral NRT
Describe appearance of minor aphthous ulcer
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
Describe appearance of MAJOR aphthous ulcer
larger than 10mm 1/2 at a time 2 weeks-months leaves a scar v painful and difficulty eating
Describe appearance of herpetiform ulcer
1-2mm
multiple at the same time- can join together
1 week-2 months
Management advice of aphthous uclers
Self-limiting avoid spicy, hot, acidic foods Use a straw very soft toothbrush Change form of medication
OTC meds for aphthous ulcer
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
Rx meds for aphthous ulcers
Doxycycline/ strong steroid mouthwashes
Which 4 meds cause dry mouth
Antimuscarinics, TCAs. antipsychotic, antihistamines,
Which drugs can cause stomatitis
NSAIDs cause aphthous like ulcers
Methotrexate, doxorubicin- chemotherapy assocuated mucostitis
What is gingival hyperlasia
Overgrown of gum tissue
What drugs cause gingival hyperplasia
Phenytoin, CCB, sodium valproate, cyclosporine
What drugs angiodema
ACEI
Describe the pain of dyspepsia(indigestion)
epigastric pain, above umbilicus and located centrally, pain behind breast bone
What is a sharp burning sensation in the epigastric region and behind breast bone called
Heartburn/acid reflux
What is the pain like in colic
waves of severe pain on top of a constant diuller main- occurs when organ is spasm
What are the symptoms of a peptic ulcer
Pain related to meals signifies a lesion on the stomach
What is a duodenal ulcer
pain 1-2hrs after food- worse at night
What is a gastric ulcer
Epigastric or central pain few mins after food
Pain immediately on eating
Reflux or oesphagitis
Which type of ulcer is relieved by food
Duodenal ulcer
When do you need referral in over 55s
Hx of gastric ulcer Hx of gastric surgery Family history of Gatric cancer Pernicious anaemia NSAID use
What are the alarm symptoms
Epigastric mass Iron deficiency anaemia Persistent vomiting progressive dysphagia Significant GI bleeding
Management of dyspepsia and acid reflux
Small frequent meals avoid bending don't eat before bed reduce weight, alcohol, caffeine, chocolate and fat Stop smoking
Why are antacids used in dyspepsia
Fast act in supressing symptoms
Used for isolated episodes
What are the side effects of magnesium salts
Can cause diarrhoea
Can increase sodium which can cause HF/hypertension
How are aluminium salts different to Mg
Al are longer acting
can lead to constipation
Side effects of calcium salts
Fast acting, lead to constipation
Can cause acid rebound which causes the release of gastrin causing more acid
Name a side effect and an give an example of a Bismuth salts
Constipation
Pepto-bismol
How long does it take before relief of symptoms using a PPI
2 days
When are alginates used
Relief in GORD
How do alginates work
Form a floating viscous gel, on top of stomach contents protecting the mucous membrane of the oesophagus
What is domperidone
stimualtes GI peristalsis
OTC max 1 week for nausea, hearburn and dyspepsia
Simeticone
Small bubbles in stomach coalese allowing gas to be eliminated
Treatment for uninvestigated dyspepsia
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
Risk factors of GORD
Pregnancy, smoking, alcohol, obesity, large meals
What happens in GORD
The lower eosophageal sphincter relaxes transiently causing heartburn
Management of mild symptoms of GORD
Use antacids and alginates
Drug management for Severe cases of GORD
PPI/surgery
How does the surface of the esophageal mucousal act as defense mechanism
Mucous and unstirred water trap bicarbonate which acts as a weak buffer
What are the cardiac features of pain of GORD
Gripping/crushing pain
Radiates to neck or left arm
Worse with exercise
Accompanied by dysponea
How does esophageal damage occur
When drug remains on esophagus for too long
Which common drugs cause oesphageal injury
Doxycycline, tetracycline, clindamycin, aspirin, KCL, ferrous sulphate, quinidine NSAIDs
Which drugs can worsen GORD
Smooth muscle relaxants
nitroglycerins, antimuscarins, beta agonsits, aminophyllines, benzo’s
Which 3 biphosphonates need to be taken in caution in those with oespahgeal problems
Ibandronate, risedronate, alendronate
What is a peptic ulcer
Lesion in the mucosa of the digestive tract
Describe a H. pylori associated ulcer
Spiral-shaped, gram negative bacterium found in gastric antrum of the human stomach
What are the risk factors for H. Pylori associated ulcer
Low social class, overcrowding and bed sharing
How does a NSAID associated ulcer occur
prostaglandins produce protective mucous layer for the stomach, nsaids reduce PG, increasing risk of gastric irritation and ulceration
Which NSAIDs have the highest risk of uclers
Piroxicam, keoprofen and ketorolac
When are you most at risk of developing NSAID associated ulcer
1st month highest risk
within the first 3 months also high risk
What are the 6 alarm symptoms for Ulcers/GI bleeding
Unexplained weight loss Epigastric pain Significant GI bleeding Progressive dysphagia Iron deficiency anaemia Persistent vomiting
How does misoprostal prevent ulcers
Stimulates protective mechanisms and reduces acid secretion
Treatment of NSAID associated ulcer
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
Test for H pylori
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
Highest risk of NSAID associated ulcer
Over 65 Hx of peptic ulcer taking other meds with GI effects Serious co-morbidities e.g. Diabetes, CVD, ADD IN PPI FOR THESE
Explain the mechanism of H2 receptor antagonist
Competitive inhibitors at Histamine at parietal cell
Mechanism of Misoprostal
Inhibits gastric acid secretion by direct action on parietal cells through binding to PG receptor
Increases bicarbonate,
reduces pepsin
What are the 2 main symptoms of gastroenteritis
Vomitting and diarrhoea
What is the name of the virus that causes gastroenteritis in
children and older children
Children: noravirus
Older children: rotavirus
Which is the common type of bacteria causing gastroenteritis
Campylobacter
Which parasites cause gastroenteritis
Cryptosporidium, entamoeba histolytiva, giardia
What bacteria is found in reheated rice
Bacilius cereus
Where is staphylococcus aureus found in
Cooked meat and cream products
What is found in reheated meat dishes
Clostridium perfringens
Risk factors for gastroenteritis
OVER 65S, BABIES, CHILDREN, IMMUNOCOMPROMISED
What is the most common and serious complication with gastroenteritis
Dehydration and electrolyte disturbances
What are common symptoms of UC and Crohns
Diarrhoea, abdominal pain, rectal bleeding, malnutrition an wieght loss
Where is the inflammation in Chrons
Affects any par of the intestine, and extends into the submucosa and deeper layers
Where is the inflammation in UC
Localized to the colonic mucosa
What is the peak age for IBD
20-40 and then again at middle age
In CD, which gene has a mutation
Mutation in NOD2 gene
which disease is more prevalent in smoker
CD is more common in smokers
Which part of the intestine does UC affect
Large intestine
What happens in UC to the mucosa
Mucosa is ulcerated, reduced goblet cells and increased paneth cells
What happens to the colonic crypts in UC
Become distorted and branched rather than short and straight
In which part of the tissue if there an increase in inflammatory cells
Lamina propia
in CD is the inflammation continuous
No it’s interspersed
What is the mechanism for diarrhoea in IBD
Lack of bile salt absorption, inflammatory mediators and undigested/absorbed nutrients large intestine
Extra-intestinal features of IBD
Skin rashes, arthritis, inflammation of eyes
Treatment of IBD
Dietary manipulation, maintainance of fluid, parenteral nutrition
Give examples of aminosalicylates for UC
Mesalazine, sulphasalazine, Olsalazine, balsalazide
What corticosteroids can treat UC
Prednisolone, hydrocortisone, budenoside, beclomethasone
Which immunosupressives are used to treat UC
Azathioprine, mercaptopurine, methotrexate, mycopenolate mofetil, acrolimus and ciclosporin
Which biologics can be used to treat UC
Infliximab and Adalimumab
Which drugs can be given in UC to stop diarrhoea
Codeine, loperamide, diphenoxylate
Which laxatives are used in UC
Movicol and lactulose
What is diphenoxylate used for
stops diarrhoea in UC
What bulking agents are used in UC
Fybogel
Which Aminosalicylates can be used in CD
Mesalazine, Sulphasalazine and Balsalazide
Steroids in CD
Not beclomethasone like you do in UC
Budesonide, Hydrocortisone and prednisolone
Which immunosupressive drugs are recommended in CD
Azathioprine, mercaptopurine, methotrexate and tacrolimus
Which antibiotics can be used in Chrons
Metronidazole and Ciprofloxacin
Who does IBS affect more
Young women
What is IBS aggravated by
food and mood
What are the main symptoms of IBS
abdo pain, bloating, flatulence, colic in stomach, alt in constipation + diarrhoea
How does constipation occur in pregnant women
Increase in progesterone, relaxes smooth muscle of bowel and baby weight in uterus causes constipation
Explain the mechanism of bulk forming laxatives
Retains water in large bowel increasing stool bulk
Ispagula husk is the main one, also methylcellulose
How do stimulant laxatives work in IBS
Used when bulk are ineffective, increase peristalsis e.g. bisacodyl suppositries or senna
How are osmotic and bulk laxatives different
Osmotic are more powerful than bulk, they retain fluid and stimulate peristalsis e.g. lactylose, Mg salts
How do stool softners work
Reduce surface tension of hard faeces in bowel allowing water to pentrate e.g. docusate sodium
How many days does it take for the onset of osmotic and bulking agents
2-3 days
How long until relief of symptoms for stimulant
8-12 hrs
How long can a laxative be used for
4 days, any longer refer to GP
Which is the first line laxative for children
Polyethene Glycol
How do antimotility drugs work for diarrhoea
loperamide
Reduce bowel motiltiy by working on the opioid receptors in the gut, increasing transit time to absoprbing more fluids
Give an example of an antispamodic
Mebeverine
peppermint oil
How do antimuscarinics wokr in IBS
Intestinal spam e.g. buscopan
How does Bismuth salicylate work in IBS
Reduces intestinal motility allowing absorption of fluids
also works to treat heartburn
HOw long should you take probiotics before you see an improvement of symptoms
4 weeks min
What is Diverticular disease
diverticula (pockets) protrude out of digestive tract
Causes of DD
Low fibre, drier stools so needs more pressure which pushes a small lining of the guy
Difference in symptoms between DD and IBS
None- but DD occurs in older people and IBS in younger
Treatment of Diverticular D
Increase fibre- 18g a day
Which drugs can cause diarrhoea
Opioids,laxatives, antacids with Mg, AB, PPI, NSAIDs
Describe Grade 1 hemorrhoids
Small swellings on the inside of the anal canal- can’t be seen or felt
Describe Grade 2 hemorrhoids
PARTLY PUSHED OUT SWELLINGS, GO BACK IN WHEN U GO TOILET
Describe Grade 3 hemorrhoids
Pemanently hang out the anus, can push them back in with finger
What is a classic alarm symptom for haemorrhoids
Blood in stool
Treatments for haemorrhoids
Contain, bismuth salts, local aneathetics, antiseptics, antipruitic, zinc
Most eggective is hydroocortisone
What is threadworm
Parasite that lies for 5-6 weeks, females lay tiny eggs around back passage when youre in bed
How long can a threadworm survive out the body
2 weeks
Symptoms of threadworm
Itching around the anus
Mild abdo pain
Drugs for threadworm
Mebendazole- over 2 yrs
take second dose 2 weeks after first
What are the 3 main symptoms of colon caner
Abdo pain, blood in stool, change in bowel
Who is at risk for colon caner
Over 60, diet high in red meats and low fiber, weight, lac of exercise, smoking + alcohol and family history
How often are stool testing kits sent out
Every 2 yrs in 6-75 yrs olds
What are the different types of cancers
Squamous cell carnomas
Adenocarcinoma- start in glandular epithelium of colorectal mucosa
Sarcomas- cancer of bone/muscle
Lymphomas
Carcinoid- slow growing formed in neuroendocrine cells
What is stage T2
Tumour grown insdie he muscle layer
N2
1-3 lymph nodes cose tot he bowel congtain cancer cells
M1
Cancer has spread to the other organs
What are the treatment options for colorectal caner
Chemotherapy
radiotherapy
surgery
Bioloical therapy
Which drugs are used to colorectal cancer
Flourouracil with folinic acid
Capecitabine
Oxaliplatin
Irinotecan
What is the definition of heartburn
Pain in epigastric region after meals
What are the common symptoms associated with haemorrhoids
Itch
Fresh blood in stools
Discomfort when defecating
Constipation
