Chapter 1 BNF (Constipation and Bowel Cleansing) Flashcards

1
Q

Stimulant laxative?

A
Bisacodyl
glycerol 
senna
docusate 
danthramer 
sodium picosulfate
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2
Q

stool softeners?

A

liquid paraffin

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3
Q

bulk forming?

A

sterculia
isphagula
methylcellulose

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4
Q

osmotic laxatives?

A

lactulose
macrogol
magnesium

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5
Q

Other laxatives?

A

Prucalopride
lubiprostone
methylnaltrexone
naloxegol

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6
Q

whats best for small hard stools in fibre-deficient diets?

A

bulk forming

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7
Q

BULK FORMING: onset and counselling points?

A

onset: 24hrs but 2/3 days for full effect
points: plenty of fluid to avoid obstruction

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8
Q

OSMOTIC: onset and advuce ?

A

2/3 days, 48hours for lactulose

drink plenty fluid

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9
Q

whats best for soft stools difficult to pass and incomplete emptying?

A

stimulant

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10
Q

STIMULANT: onset and advice?

A

glycerol suppositories: 15-30 minutes. rest; 6-12 hours

advice: senna urine yellow
1 week use, abuse
take at night to pass stool in morning

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11
Q

which laxative is reserved for terminally ill patients and why?

A

dantron due to its genotoxic and carcinogenic effects

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12
Q

which two laxatives are used when two laxatives have been trialed at their highest dose for 6 months?

A

prucalopride (women only )

Lubiprostone

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13
Q

Opioid induced constipation treatment

A

osmotic or docusate

+

stimulant

or methylnaltrexone/naloxegol

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14
Q

which osmotic laxative is preferred in long term constipation?

A

macrogol

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15
Q

whats first line for constipation in children?

A

macrogol

add stimulant
add lactulose or faecal softeners

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16
Q

whats first line in constipation in pregnancy and breastfeeding?

A

bulk forming

add or switch to lactulose

avoid senna at term

17
Q

Whats the dose of loperamide?

A

initially 4mg then 2mg after each lose stool for up to 5 days, max 16mg a day

18
Q

whats the MHRA on loperamide?

A

serious cardiac side effects

QT

19
Q

whats the antidote for loperamide?

A

naloxone

20
Q

Whats first and second line in uninvestigated dyspepsia?

A

antiacids
PPI for 4 weeks
if no response H pylori test

21
Q

How should antiacids be separated with other drugs?

A

2 hours before or after

22
Q

Which PPI should be taken 30 60 minutes before food

A

Lansoprazole

23
Q

which ppi is safe in pregnancy?

A

omeprazole

24
Q

What are the side effects of PPIs

A

osteoporosis
hypomagnesaemia
increased risk of c difficile
abdominal pain, constipation, diarrhoea, nausea

25
Q

what is the MHRA on PPIs?

A

Subacute Cutaneous Lupus

26
Q

what are the interactions with PPIs?

A

digoxin (hypomagnesemia)
clopidogrel (omeprazole)
methotrexate (reduced clearance)

27
Q

which h2 receptor antagonist is safe in pregnancy?

A

ranitidine

28
Q

what are the side effects of h2 receptor antagonists?

A

headache, rashes, dizziness and diarrhoea

psychiatric reactions

29
Q

Other drugs for gastric ulcers?

A

Misoprostol: teratogenic

sucralfate: 1hr before meals

30
Q

What are the 4 drugs used in H pylori?

A

PPI BD
Amoxicillin
Clarithromycin
Metronidazole

31
Q

Which combination should be used when in H pylori infections?

A

Penicillin allergic - PMC
recently treated with macrolide - PAM
If recently treated with metronidazole - PAC

32
Q

What can be used to diagnose H pylori what are the conditions for the test?

A

c urea breath test kit
cant have had antibiotic in last 4 weeks
cant have had antisecretory drug (ppi) in last 2 weeks