Chapter 1 BNF (Constipation and Bowel Cleansing)

Question 1

Stimulant laxative?

Answer 1

Bisacodyl
glycerol 
senna
docusate 
danthramer 
sodium picosulfate

Question 2

stool softeners?

Answer 2

liquid paraffin

Question 3

bulk forming?

Answer 3

sterculia
isphagula
methylcellulose

Question 4

osmotic laxatives?

Answer 4

lactulose
macrogol
magnesium

Question 5

Other laxatives?

Answer 5

Prucalopride
lubiprostone
methylnaltrexone
naloxegol

Question 6

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

Answer 6

bulk forming

Question 7

BULK FORMING: onset and counselling points?

Answer 7

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

Question 8

OSMOTIC: onset and advuce ?

Answer 8

2/3 days, 48hours for lactulose

drink plenty fluid

Question 9

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

Answer 9

stimulant

Question 10

STIMULANT: onset and advice?

Answer 10

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

Question 11

which laxative is reserved for terminally ill patients and why?

Answer 11

dantron due to its genotoxic and carcinogenic effects

Question 12

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

Answer 12

prucalopride (women only )

Lubiprostone

Question 13

Opioid induced constipation treatment

Answer 13

osmotic or docusate

+

stimulant

or methylnaltrexone/naloxegol

Question 14

which osmotic laxative is preferred in long term constipation?

Answer 14

macrogol

Question 15

whats first line for constipation in children?

Answer 15

macrogol

add stimulant
add lactulose or faecal softeners

Question 16

whats first line in constipation in pregnancy and breastfeeding?

Answer 16

bulk forming

add or switch to lactulose

avoid senna at term

Question 17

Whats the dose of loperamide?

Answer 17

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

Question 18

whats the MHRA on loperamide?

Answer 18

serious cardiac side effects

QT

Question 19

whats the antidote for loperamide?

Answer 19

naloxone

Question 20

Whats first and second line in uninvestigated dyspepsia?

Answer 20

antiacids
PPI for 4 weeks
if no response H pylori test

Question 21

How should antiacids be separated with other drugs?

Answer 21

2 hours before or after

Question 22

Which PPI should be taken 30 60 minutes before food

Answer 22

Lansoprazole

Question 23

which ppi is safe in pregnancy?

Answer 23

omeprazole

Question 24

What are the side effects of PPIs

Answer 24

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

Question 25

what is the MHRA on PPIs?

Answer 25

Subacute Cutaneous Lupus

Question 26

what are the interactions with PPIs?

Answer 26

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

Question 27

which h2 receptor antagonist is safe in pregnancy?

Answer 27

ranitidine

Question 28

what are the side effects of h2 receptor antagonists?

Answer 28

headache, rashes, dizziness and diarrhoea psychiatric reactions

Question 29

Other drugs for gastric ulcers?

Answer 29

Misoprostol: teratogenic sucralfate: 1hr before meals

Question 30

What are the 4 drugs used in H pylori?

Answer 30

PPI BD Amoxicillin Clarithromycin Metronidazole

Question 31

Which combination should be used when in H pylori infections?

Answer 31

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

Question 32

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

Answer 32

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