Chapter 1: Gastro-intestinal system Flashcards
What are the three treatment options for C.diff?
Metronidazole, vancomycin and fidaomicin
What is coeliac disease?
Coeliac disease is an autoimmune condition which is associated with chronic inflammation of the small intestine. Dietary proteins known as gluten activate an abnormal immune response.
What is the recommended treatment for symptomatic diverticular disease?
A high-fibre diet is recommended for the treatment of symptomatic diverticular disease, although evidence support this is inconsistent and of low quality. Bulk-forming drugs have also been used.
In a patient who is thiopurine methyl transferase (TPMT) deficient, which of the following can be given: azathioprine, mercaptopurine or methotrexate?
Methotrexate
Why is loperamide and other anti-dirrahoeal drugs controlled-indicated in acute ulcerative colitis?
Increased risk of toxic megacolon
Two important monitoring points for aminosalicylates
A blood count should be performed and drug stopped immediately If there is suspicion of a blood dyscrasia. Renal function should be monitored before treatment, at 3 months and then annually.
Which laxative should be avoided in IBS?
Lactulose - as may cause bloating
Patients with IBS who have not responded to laxatives from the different classes and who have had constipation for at least 12 months, can be treated with what?
Linaclotide
What is the first line choice of anti-motility drug for the relief of diarrhoea in patients with IBS?
Loperamide
What is the second line treatment option in patients with IBS who do not respond to antispasmodics?
A low-dose tricyclic antidepressant such as amitriptyline can be used for abdominal pain or discomfort
Why is loperamide preferred to codeine in reducing intestinal motility in patients with short bowel syndrome?
Loperamide is preferred as it is not sedative and does not cause dependence or fat malabsorption.
Why are high doses of loperamide often required in patients with short bowel?
Disrupted enterohepatic circulation and rapid gastrointestinal transit time.
Co-phenotrope has traditionally been used to help decrease faecal output, why is its use limited?
Crosses the blood brain barrier and can produce central nervous system side effects, potential for dependence and anticholinergic effects.
What type of laxative is macrogol?
Osmotic
Laxative abuse can lead to what? (hint: electrolyte disturbance)
Hypokalaemia
What type of laxative is isphaghula husk?
Bulk forming
What is the time till onset of action for bulk forming laxatives?
Onset of action is up to 72 hours.
Why must adequate fluid intake be maintained with bulk forming laxatives?
Important to avoid intestinal obstruction
What type of laxative is Senna?
Stimulant
What type of laxative is bisacodyl?
Stimulant
Why is the use of co-danthramer and co-danthrusate limited to constipation in terminally ill patients?
potential carcinogenicity and evidence of genotoxicity
What type of laxative is lactulose?
Osmotic
How would you manage opioid induced constipation?
In patients with opioid induced constipation, an osmotic laxative and a stimulant laxative is recommended. Bulk-forming laxatives should be avoided.
What is the first line laxative in pregnancy?
Bulk forming
Magnesium containing antacids tend be to X whereas aluminium containing antacids may be X
Magnesium = laxative Aluminium = constipating
What are the indications for simeticone?
Simeticone is added to an antacid as an antifoaming agent to relieve flactulence. These preparations may be useful for the relief of hiccup in palliative care.
what is the MHRA advice concerning PPIs and risk of subacute cutaneous lupus erythematous (SLE)?
Very infrequent cases of SCLE have been reported in patients taking PPIs. Drug-induced SCLE can occur weeks, months or even years after exposure to the drug. If a patient treated with a PPI develops lesions then consider SCLE as a possible diagnosis and consider discontinuing PPI treatment.
what was the recent MHRA alert about hyoscine butyl bromide injections (Feb2017) concerted with?
The MHRA advises that hysocine butyl bromide injection can cause serious adverse effects including tachycardia, hypotension and anaphylaxis - several reports have noted this is more likely to be fatal in patients with underlying coronary heart disease. It is contraindicated in patients with tachycardia and should be used with caution in patients with cardiac disease.
What is cholestasis? How might it clinically present?
An impairment of bile formation and/or bile flow, which may clinically present with fatigue, pruritus, dark urine, pale stools and jaundice.
What is the drug of choice in relieving cholstatic pruritus?
Colestyramine - not absorbed by the GI tract so forms an insoluble complex in the intestine with bile acids and reduces excess deposition in the dermal tissues.
What are inborn errors of primary bile acid synthesis?
Group of diseases in which the liver does not produce enough primary bile acids due to enzyme deficiencies.
