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PRPS Block 2 > CCC - GI - Dyspepsia, GORD, Colic, Constip. > Flashcards

CCC - GI - Dyspepsia, GORD, Colic, Constip. Flashcards

1
Q

What are the symptoms of dyspepsia?

A 
Upper abdominal discomfort/pain
heartburn
reflux
nausea
vomiting related to eating
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2
Q

List 5 ALARM symptoms for dyspepsia?

A

GI bleeding
Dysphagia
Progressive unintentional weightloss
Persistent vomiting

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3
Q

What is the most common differential diagnosis which should be considered?

A

Cardiac pain - angina

Sweating/clammy/ pale pallor/ breathing problems.

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4
Q

Which medicines should be ruled out as they increased risk of dyspepsia/GI bleed?

A

Bisphosphonates
NSAIDs
Iron
Corticosteroids

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5
Q

When are antacids best taken for dyspepsia?

A

After meals + bedtime

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6
Q

What side effects can be common with antacid ingredients?

A

Magnesium - diarrhoea

Aluminium - constipation

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7
Q

Can other meds be taken alongside antacids?

A

No - will impair absorption

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8
Q

What is the max licensed dose of ranitidine for OTC sale?

A

75mg

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9
Q

What are 3 practical tips for reducing dyspepsia?

A

Weightloss if overweight
Smoking cessation if a smoker
Avoid trigger foods

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10
Q

Who can orlistat be sold to?

A

Overweight adults >18 and with BMI >28kg/m2

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11
Q

What are the main symptoms of GORD?

A

Burning feeling behind breastbone

sour/bitter taste in throat

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12
Q

What would you see on an endoscope of someone with frequent GORD and what can this progress to?

A

Oesophagitis - inflammation of oesophageal lining.

Barretts oesophagus or oesophageal stricture.

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13
Q

List 6 trigger factors for GORD?

A 
Foods - fatty, citrus, onions, coffee. 
Drugs which relax LOS - CCBs, theophylline, nitrates. 
Smoking
Alcohol
Obesity 
Genetic factors.
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14
Q

List 4 ALARM symptoms for GORD?

A

GI bleeding
Dysphagia
Progressive unintentional weightloss
Persistent vomiting

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15
Q

What differential diagnosis should be considered and how should it be ruled out?

A

Cardian pain

  • will not be relieved by antacid
  • brought on by exercise/exertion
  • relieved by GTN
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16
Q

MoA PPIs?

A

Inhibit H/K-ATPase - proton pump - of the gastric parietal cell to reduce H+ ion secretion and reduce acid production.

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17
Q

Can PPIs be used as symptomatic relief PRN or must they be taken regularly?

A

NICE (2014) evidence says they can be used PRN.

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18
Q

Do PPIs have any efficacy in healing ulcers?

A

Yes their effectiveness is related to healing ulcers rather than improving GORD.

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19
Q

What are 3 most common S/E with PPIs?

A

diarrhoea
headaches
dizziness

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20
Q

What 3 characteristics would make someone unsuitable for a PPI?

A

Electrolyte problems - hypoMg
Osteoporosis
Elderly - increased risk of fractures

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21
Q

What are conditions on omeprazole sale OTC?

A

10mg tabs
>18y
max 4 weeks treatment

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22
Q

What are conditions on eomeprazole sale OTC?

A

> 18y

max Tx 14 days

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23
Q

3 practical tips for GORD?

A
  • smaller meals
  • raising head of bed
  • lying flat when sleeping.
24
Q

Can Gaviscon sachets be used in pre-term infants?

A

Not recommended due to high sodium content.

25
Q

Important question to ask if anyone is buying PPIs OTC?

A

Do they have a referral for endoscopy?

PPI will mask symptoms - avoid for 2 weeks before.

26
Q

What is typical age of colic?

A

few weeks - 4/5 months.

27
Q

What are the symptoms of colic?

A

excessive crying for >3 hours a day for 3 days per weeks for 3 weeks.

28
Q

What is the rule of 3 for colic?

A

> 3hours/day
3 days/week
3 weeks.

29
Q

List 5 signs a baby might have colic?

A
  • crying at same time each day.
  • draw legs up when they cry
  • flace flushes
  • clench hands
  • crying often relaxes when baby exhausted or passes stool.
30
Q

What are 2 danger symptoms of colic?

A
  • failure to thrive in baby

- post-natal depression in mum

31
Q

List some points of advice to give parents?

A
  • hold baby upright to allow wind to pass.
  • if breastfeeding avoid products in diet which may upset baby - caffeine, alcohol, spicy foods, chocolate, dairy.
  • bottle feeding - ensure teat hole is correct size - too large - gulp air.
  • relax baby - relaxed parents, baby massage.
32
Q

What treatments are available for colic?

A

Simeticone - dentinox, infacol

Gripe water

33
Q

what treatment for colic can be given on pharmacy service?

A

Infacol - simeticone - helps coalesce gas bubbles - easier to pass.

34
Q

What are some symptoms of post-natal depression?

A
  • low mood/enjoyment
  • anxiety
  • disturbed sleep/eating
  • poor concentration
  • low energy/self-esteem
35
Q

Symptoms of constipation?

A
  • reduced frequency of defaecation
  • straining and passing small hard stools
  • abdominal discomfort, cramps or feeling incomplete emptying.
36
Q

Is constipation more common in women or men?

A

women

37
Q

Is constipation a problem during pregnancy?

A

Yes - changes in hormones.

38
Q

What are the 3 main contributing factors to constipation?

A
  • dietary lack of fibre
  • dehydration
  • sedentary lifestyle.
39
Q

What are some danger symptoms for constipation?

A
  • new/worsening constipation
  • blood in stool
  • weightloss
  • nausea/vomiting
40
Q

When does the BNF recommend laxatives are used?

A
  • when straining should be avoided - angina

- when rectal bleeding needs to be avoided - haemorrhoids.

41
Q

What are 1st line treatments for constipation?

A
  • increase fluid intake
  • increase exercise
  • increase fibre in diet.
42
Q

What are the 4 main types of laxatives?

A

Osmotic
Stimulant
Stool softener
Bulk-forming

43
Q

Give 2 examples of bulk-forming laxatives and how long they take to work?

A
  • ispaghula husk, stericula

- few days.

44
Q

How do bulk-forming laxatives work?

A

Increase faecal mass and draw water into the stool - stimulates persitalsis.

45
Q

Give 2 examples of osmotic laxatives and how long they take to work?

A
  • lactulose, macrogol

- 8-12 hours.

46
Q

How to osmotic laxatives work?

A

Draw water into the large bowel - lubricate and help move things along.

47
Q

Give 2 examples of stimulant laxatives and how long they take to work?

A
  • senna, bisacodyl, sodium picosulfate

- 8-12 hours - take nocte.

48
Q

How do stimulant laxatives work?

A

Stimulate colonic nerves to increase intestinal motility and reduce transit time.

49
Q

Give an example of a stool softener laxative and how does it work?

A

docusate sodium

Reduce surface tension and increase fluid in faeces - also has stimulant properties.

50
Q

What is the best advice for constipation on children?

A

Ensure fibre in diet, hydration and physical activity.
Avoid toilet phobias and use encouragement at all times.
Apple, pear or prune juice is good for relieving constipation - natural laxative.

51
Q

What symptoms of constipation in a child should be referred to GP?

A
  • weak, dizzy.
  • marked anal pain
  • blood in the stool
  • constipation becomes regular.
52
Q

What are the best laxatives for use in pregnancy?

A

Bulk-forming and osmotic - not absorbed by the body.

53
Q

Can senna be used in pregnancy?

A

Not ideal

Can induce contractions in 3rd trimester
Can enter breastmilk - cause colic/diarrhoea in infant.

54
Q

Which electrolyte disturbance is common in laxative abuse?

A

hypokalaemia

55
Q

List some common drugs which can cause constipation?

A
  • antimuscarinics
  • iron
  • antispasmodics
  • opioids
  • verapamil
  • antipsychotics/antiepileptics
  • aluminium/calcium salts.

PRPS Block 2 (7 decks)

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