Bowel Flashcards
what antibiotics cause c diff (5)
quinilones clindamycin cephlasporins (second and third gen) ampicillin/ amoxicillin co-amox
antispasmodics which slow gut transit e.g. codeine are contrainditcated in diverticular disease because
they can exacerbate symptoms
what sort of fiber should people with IBS use
soluble - e.g. ispagula husk
not insoluble like bran
what sort of laxative is preffered in IBS
osmotic such as macrogol
but lactulose may cause bloating
in IBS patients who have not responded to antispasmodic drugs for abdo pain what can be tried
TCA
or later SSRI
what type of drug is mesalazine
aminosalicylate
is cuclosporin used for crohns or UC
UC
what is the connection between smoking and chrons
smoking cessation reduces the risk of relapse
What two antibiotics are used for fistulating crohns disease
metronidazole and cirpofloxacin
what is the risk of metronidazole use in fistulating crohns
what duration do we limit it to
peripheral neuropathy
usually 1 month, at most 3 months
do we use antispasmodic or antimotility drugs in IBD
no - may percipitate mega colon (includes loperamide, codeine etc) treatment of the inflamation is more logical
what is colestyramine used for in IBD
diarrhoea resulting from loss of bile salt absorption (as cholestytamine binds bile salts)
which aminosalicylate is older, activates further up the bowel and therefore has more sulfonamide like side-effects
sulfasalazine
as opposed to new ones: mesalazine, besalazine, osalazine
what significant 2 side-effectds are common to all aminosalycilates
blood disorders and lupus like syndrome
what are the sulfonamide like sideeffects of aminosalycilates
Diarrhea. dizziness. loss of appetite. nausea or vomiting. tiredness
what should always be given with methotrexate in IBD
folic acid on a differenty day
patients taking aminosalicylates should be councelled to report signs of blood disorders such as
sore throat fever malaise bruising bleeding
how often should renal function be monitored for aminosalicylates
at 3 month and then annually
what is the caution with using lactulose with mesalazine
preparations that lower ph may prevent the release of drug
which aminosalycilate has high monitoring requirements
LFTs, renal and FBC
sulfasalazine
what drugs should be withheld on the day of bowel prep (3)
ACEi/ARB
NSAIDs
duiretics
what class of drug is mebevarine
antimuscarinic
when should mebevarine be taken
20 mins before meals
what is ursodexycholic acid used for ?
dissolution/prophylaxis of galls stones and billary cirhosis
how lond can orlistat be used for
12 months
what is methycellulose used for but there is little evidence of benifit
increase satiety in obesity
What are phentermine and diethylpropion
what are the risks
central stimulants NOT recommended for obesity
phentermine - pulmonary hypertension
what would be the local aneasthetic of choice for anal fissure
what are two associated risks
lidocaine - others are more irritant
- caution excessive use as absorbed through anal mucosa
- local sensitisation after more than a few days use
what are zinc oxide, bismuth subgallate, hamamelis used for in haemerroids
soothing ans astringent
when should you use oily phenol for haemoerroids and what is the mode of administration
injection
mainly for unprolapsed haemerrhoids
if you are mixing your pancreatic enzymes with food what should you do to avoid them breaking down
admin within the hour
avoid excessive heat
what should you mix gastro resistant pancreatic enzymes with
milk, slightly acidic soft food
swallow imediately without chewing
when should pancreatic enzymes be taken in relation to food and why
what else could you use for this effect (2 drugs)
with or just after as inactivated by acid
you can also give cemetidine and ranitidine with them
why are EC and MR preps not suitable in stoma
not sufficient release of active ingrediant
why should you not give enemas and washouts to patient with a stoma
severe loss of electrolytes and water
if constipated what laxatives would be ok in stoma patient
bulk forming (can also use this to treat diahorrea weirdly) senna
what is the caution with antacids in stoma patients
tendancy increased for
Mg - diahorreah
Aluminium - constipation
diuretics should usually be avoided in stoma but if you had to use one what would you choice
K sparing
what is the risk of digoxin in stoma
particularly suceptable to hypokalaemia
