BILE ACIDS/GALLSTONES Flashcards
GALLSTONES:
How are they treated first line?
Analgesia
ursodeoxcholic acid
what are indications for ursodeoxycholic acid?
primary billiard cirrhosis
Dissolution of gallstones
PANCREATIC;
What is exocrine pancreatic deficiency?
reduced secretion of pancreatic enzymes into intestines
Leads to maldigestion, malnutrition and associated with low levels of micronutrients
GI symptoms
How is exocrine pancreatic insufficient treated?
pancreatic enzymes
must be taken with meals and snacks
STOMA CARE;
What is a stoma?
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.
STOMA;
What formulations medications are NOT suitable for stoma patients?
enteric coated and modified release
STOMA;
What medications CAN be given and why?
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.
STOMA;
What medications CANNOT be given?
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
ANAL FISSURE;
What is it?
A tear in the lining of the anal canal
bleeding and pain on defeaction
ANAL FISSURE:
What is treatment?
bulk-forming laxatives
osmotic laxatives
Pain relief lidocaine or an analgesic may be considered
HAEMORRHOIDS;
What is it?
abnormal swellings around anus, women more likely to experience
HAEMORRHOIDS;
what is treatment?
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)
OBESITY:
What medications cause obesity?
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.
Obesity:
What conditions can cause obesity?
hypothyroidism
type 2 diabetes,
hypertension,
cardiovascular disease, dyslipidaemia,
osteoarthritis
sleep apnoea
OBESITY;
What medications are used to treat obesity?
Orlistat
semaglutide
ORLISTAT;
How does it work?
anti-obesity drug, acts by reversibly inhibiting gastric and pancreatic lipases.
ORLISTAT;
How should it be used?
BMI 30 or more if lifestyle changes are not effective
BMI 28 or more, if patient has risk factors
ORLISTAT;
What are doses and when should they be given?
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.
ORLISTAT;
What are contraindications?
Cautions?
cholestasis
chronic malabsorption
Caution;
CKD
ORLISTAT;
What are side effects?
abdominal pain
anxiety
diarrhoea
GI disorders
DIVERTICULAR DISEASE;
What is it?
What is treatment?
Condition that causes bulges to form in the colon
Bulk forming drugs such as isphagula husk and methycellulose are useful in controlling diarrhoea
COLESTYRAMINE ;
What are indications?
Partial Biliary obstruction
Primary billiard cirhosis
Diarrhoea associated with crohns
Treatement of leflunomide or teriflunomide overdose
Dyslipidaemia
