BILE ACIDS/GALLSTONES

Question 1

GALLSTONES:

How are they treated first line?

Answer 1

Analgesia

ursodeoxcholic acid

Question 2

what are indications for ursodeoxycholic acid?

Answer 2

primary billiard cirrhosis

Dissolution of gallstones

Question 3

PANCREATIC;

What is exocrine pancreatic deficiency?

Answer 3

reduced secretion of pancreatic enzymes into intestines

Leads to maldigestion, malnutrition and associated with low levels of micronutrients

GI symptoms

Question 4

How is exocrine pancreatic insufficient treated?

Answer 4

pancreatic enzymes

must be taken with meals and snacks

Question 5

STOMA CARE;

What is a stoma?

Answer 5

An artificial opening on the abdomen to divert flow of faeces or urine to an external pouch outside body; colestomy and ileostomy are most common forms.

Question 6

STOMA;

What formulations medications are NOT suitable for stoma patients?

Answer 6

enteric coated and modified release

Question 7

STOMA;

What medications CAN be given and why?

Answer 7

Paracetamol- NSAIDs cause ulcerations and bleeding
Opioids can cause constipation

PPIs due to increased gastric acid secretion increasing stoma output

Bulk forming laxatives should be used, if ineffective low dose stimulant laxative.

Question 8

STOMA;

What medications CANNOT be given?

Answer 8

Potassium lowering drugs due to increased risk of hypokalaemia if taking digoxin therefore potassium sparing diuretics should be given

Diuretics used in caution due to risk of dehydration and potassium depletion

Laxative should not be offered due to risk if rapid loss of electrolytes and water

Question 9

ANAL FISSURE;

What is it?

Answer 9

A tear in the lining of the anal canal

bleeding and pain on defeaction

Question 10

ANAL FISSURE:

What is treatment?

Answer 10

bulk-forming laxatives
osmotic laxatives

Pain relief lidocaine or an analgesic may be considered

Question 11

HAEMORRHOIDS;

What is it?

Answer 11

abnormal swellings around anus, women more likely to experience

Question 12

HAEMORRHOIDS;

what is treatment?

Answer 12

increased fluid and fibre

bulk-forming laxative

Analgesic -non opioid due to constipation and not NSAID if bleeding

Topical preparations;

local anaesthetic and corticosteroid (Anusol HC)
(not for pregnant women)

Question 13

OBESITY:

What medications cause obesity?

Answer 13

atypical antipsychotics,
beta-adrenoceptor blocking drugs, insulin (when used in the treatment of type 2 diabetes),
lithium carbonate, lithium citrate, sodium valproate,
sulphonylureas,
thiazolidinediones, and tricyclic antidepressants.

Question 14

Obesity:

What conditions can cause obesity?

Answer 14

hypothyroidism
type 2 diabetes,
hypertension,
cardiovascular disease, dyslipidaemia,
osteoarthritis
sleep apnoea

Question 15

OBESITY;
What medications are used to treat obesity?

Answer 15

Orlistat
semaglutide

Question 16

ORLISTAT;
How does it work?

Answer 16

anti-obesity drug, acts by reversibly inhibiting gastric and pancreatic lipases.

Question 17

ORLISTAT;
How should it be used?

Answer 17

BMI 30 or more if lifestyle changes are not effective

BMI 28 or more, if patient has risk factors

Question 18

ORLISTAT;
What are doses and when should they be given?

Answer 18

120mg up to TDS

dose to be taken immediately before, during, or up to 1 hour after each main meal, continue treatment beyond 12 weeks only if weight loss since start of treatment exceeds 5% (target for initial weight loss may be lower in patients with type 2 diabetes), if a meal is missed or contains no fat, the dose of orlistat should be omitted.

Question 19

ORLISTAT;

What are contraindications?

Cautions?

Answer 19

cholestasis
chronic malabsorption

Caution;
CKD

Question 20

ORLISTAT;
What are side effects?

Answer 20

abdominal pain
anxiety
diarrhoea
GI disorders

Question 21

DIVERTICULAR DISEASE;
What is it?

What is treatment?

Answer 21

Condition that causes bulges to form in the colon

Bulk forming drugs such as isphagula husk and methycellulose are useful in controlling diarrhoea

Question 22

COLESTYRAMINE ;
What are indications?

Answer 22

Partial Biliary obstruction
Primary billiard cirhosis
Diarrhoea associated with crohns
Treatement of leflunomide or teriflunomide overdose
Dyslipidaemia