Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Full Pre Registration Exam Notes > Chapter 1: GI system > Flashcards

Chapter 1: GI system Flashcards

1
Q

Are patients with coeliac disease recommended to self medicate with OTC vitamin and mineral supplements?

A

No. Although recommended daily intake of Calcium is 1000mg and Vit D 10ug if this is not achieved through diet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are coeliac patients at increased risk of?

A

Malabsorption
Vitamin and mineral deficiency - could increase the risk of osteoporosis
Risk of OS causes need for active treatment of bone disease and should be part of ongoing treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is diverticular disease?

What conditions might its symptoms overlap with?

A

Diverticula (sac-like protrusions of mucosa through the muscular colonic wall) cause intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds. in the absence of inflammation or infection.

Diff D: IBS, colitis, and malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for diverticular disease

  • symptomatic diverticular disease
  • uncomplicated diverticulitis
  • complicated severe D
A
  • Symp DD: Constipation= high fibre diet or bulking forming laxatives paracetamol for pain and antispasmodics
  • Uncomp D: low residue diet and bowel rest. Antibacterials only if pt has infection, inflammation or is immunocompromised.
  • Complicated severe ppt: hospital IV antibacterials for anaerobes and G-ve bacteria as well as bowel rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is not recommended in uncomplicated diverticular disease?

A

Antibiotics
unless the patient presents with signs of infection/immunocompromised

Nsaids or opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment for complicated diverticular disease?

A

Hospital admission, IV antibacterials covering gram negative and anaerobes

Bowel rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

True or false: There is sufficient evidence to justify the role of fibre, rifaximin, antispasmodics, mesalazine, and probiotics in the prevention or treatment of diverticulitis.

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the advantage of the newer aminosalicylates (mesalazine, balsalazide, olsalazine) over sulfasalazine?

A

Avoids the sulfonamide-related side effects of sulfasalazine; NOT DOSE RELATED: male infertility (reversible), haemolytic anaemia, hypersensitivity, bone marrow suppression, hepatitis and DRUG DOSE RELATED: n+v, dyspepsia, malaise, headache

5-ASA however still causes same SE as sulfasalazine such as blood dyscrasias and lupus like syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sulfasalazine is a combination of what two compounds?

A

5-ASA and sulfapyridine

Sulfapyridine acts only as a carrier to the colonic site of action but still causes side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What compound is mesalazine?
What is Balsalazide?
What is olsalazine?

A

5-ASA
prodrug of 5-ASA
dimer of 5-ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non operative management of acute Diverticulitis FAILS or diffuse peritonitis requires ..

A

URGENT sigmoid colectomy is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are extraintestinal manifestations? Crohns

A

When people with IBD develop conditions affecting the joints, eyes or skin. e.g. arthritis, osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. In a patient with a first presentation or single inflammatory Crohn’s exacerbation in a 12 month period, what is used?
  2. If this is not suitable, or if the patient has right-sided colonic disease, what could be used? When would these not be appropriate and why?
A
  1. Corticosteroid - prednisolone, methylprednisolone or IV hydrocortisone
  2. Budesonide or aminosalicylates. Not appropriate if severe presentation as they are less effective (even though they have fewer side effects)
    Budesonide less effective but fewer SE than corticosteroids as systemic effect limited. ASA less effective than corticosteroid or budesonide but preferable due to fewer SE.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you add in additional treatment (on top of steroid monotherapy) in a Crohn’s disease exacerbation?

What would you add?

A

2 or more inflammatory exacerbations in 12 months, or if the steroid dose cannot be reduced

Azathioprine or mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is mercaptopurine licensed in severe UC and CD?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. What can be added to a steroid to induce remission in a Crohn’s patient?
  2. If these are not suitable, what could be used?
A
  1. Azathioprine

Mercaptopurine can be added but unlicensed

  1. Methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What test do you need to do before starting someone on azathioprine or mercaptopurine?

A

TPMT levels

If activity is deficient, it may not be suitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What monoclonal antibodies are licensed for Crohn’s?

A

Adalimumab
Infliximab- active fistulating CD
Vedolizumab - rec for mod-sev active crohns disease when other two unsuitable/CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. What is used for maintenance of remission for Crohn’s?

2. What would be second line and when would you use this?

A
  1. Azathioprine or Mercaptopurine (unlicensed)

2. Methotrexate if the patient required it to induce remission, or if azathioprine/mercaptopurine is unsuitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Should steroids be used for the maintenance of remission for Crohn’s?

A

No- only to induce remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can be used to manage Crohn’s associated diarrhoea?

A

Loperamide, codeine phosphate, colestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What antibiotics can be used (alone or in combination) to improve symptoms of fistulating Crohn’s?

A

Metronidazole and ciprofloxacin (unlicensed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If metronidazole is given for fistulating Crohn’s, how long for and what are the associated risks?

A

1 month (no longer than 3) due to risk of peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is used to control the inflammation in fistulating Crohn’s disease (and continued for maintenance)? How long should they be on this for?

A

Azathioprine or mercaptopurine (unlicensed) or infliximab. Infliximab should be used after ensuring that all sepsis is actively draining.

At least 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Can you use loperamide and codeine phosphate in acute UC?

A

No- contraindicated as it increases the risk of toxic megacolon but can be used in non acute UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What type of laxative may be useful for proximal faecal loading in proctitis?

A

Macrogol containing osmotic laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute treatment to induce UC remission generally consists of ?
In acute mild-mod extensive UC can oral and rectal ASA be given 1st line?

A

ASA +/- corticosteroid

YES. Oral and rectal ASA in combo can be used 1st line in pt with acute mild-mod extensive UC - this is assoc with higher rates of improvement in disease activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What ASA have rectal preparations?

A

Mesalazine or sulfasalazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is first line treatment for patients with acute exacerbation mild-moderate left-sided or extensive UC?

A

BNF: High induction dose of an oral ASA, with additional rectal ASA/oral Beclometasone if necessary.
Online BnF: topical ASA 1st line. If no remission in 4 weeks add ^dose oral ASA or switch to ^dose oral ASA and 4-8 weeks of topical corticosteroid. If response inadequate stop topical treatment and offer oral ASA and 4-8 weeks of oral corticosteroid.

Oral pred. alone is rec for pts who cannot tolerate/decline/CI ASA or in pts with subacute left-sided or extensive ulcerative colitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Mild to moderate UC:

In patients being treated with aminosalicylates for UC, when would you add in oral prednisolone?

A

No improvements within 4 weeks of initial therapy

If patient is on beclometasone, discontinue this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why does oral budesonide have fewer systemic side effects than corticosteroids? (UC)

A

It exerts its action topically in the colon

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

True or false:

Budesonide is licensed for inducing remission in mild to moderate UC if aminosalicylates are not suitable

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Are corticosteroids suitable for maintenance treatment of UC?

A 
No because of their side effects
G - Glaucoma (topical)
L - Limb muscle atrophy/myopathy
U - Peptic Ulcer
C - Cataract (systemic)
O - OS (dose/duration dep)
C - Cushings (moon face, fat, striae)
O - Osteonecrosis 
R - Retardation of growth in children + ^BP (^mineralocorticoid => salt and water retention. and ^vascular reactivity)
T - Thinning skin = easy bruising
I - Infections <= immunosuppression
C - changes in mood/psyche
O - oedema (mineralocorticoid action salt water retention)
I - impaired healing of wounds
D - Diabetes Mellitus (^hyperglycaemia)
S - Suppression of HPA (long term use; acute adrenal insufficiency if steroids withdrawn)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What should be given in acute severe UC?

A

IV corticosteroids
IV ciclosporin is an alternative (unlicensed)
Infliximab

Assess for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What monoclonal antibodies are used for acute UC?

A

Adalimumab, golimumab, infliximab, vedolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can be used to maintain remission after an acute exacerbation of proctitis/proctosigmoiditis?

A

Rectal aminosalicylate can be started alone or in combination with oral aminisalicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What can be used to maintain remission after an acute exacerbation of left-sided or extensive UC?

A

Low dose oral ASA

Oral azathioprine or mercaptopurine [unlicensed indications] can be considered to maintain remission, if there has been 2 or more inflammatory exacerbations in 12-months that required tx with systemic corticosteroids, or if remission is not maintained by ASAs, or following a single acute severe episode.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

True or false:

When used to maintain remission, single daily doses of oral aminosalicylates can be more effective than multiple daily dosing, but may result in more side-effects.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the red flag side effects of aminosalicylates?

A 
Agranulocytosis
Bone marrow disorders
Neutropenia
Cardiac inflammation
Renal impairment - nephrotoxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the monitoring requirements for aminosalicylates?

A

Renal function should be monitored before starting treatment, at 3 months, and then annually

Patients should report any unexplained bleeding/bruising/fever/malaise during treatment

FBC - drug should be stopped immediately if any indication of blood dyscrasia (disease/disorder of the blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Within what time period during starting sulfasalazine treatment do haematological abnormalities often occur?

A

Within the first 3-6 months of starting treatment

Discontinue if these occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What should patients on sulfasalazine be aware of if they wear contact lenses?

A

May stain the lenses yellow/orange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What should a patient be screened for if starting vedolizumab?

A

TB

Contraindicated in those with TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is alverine citrate used for?

A

GI spasms

Dysmenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why would lactulose not be suitable in a patient with IBS?

A

Causes bloating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

In IBS patients who have had constipation the last 12 months but have not responded to laxatives, what can be used?

A

Linaclotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is 1st line for diarrhoea in IBS?

A

Loperamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is co-phenotrope used for and what is a main side effect of it?

A

Decreases faecal output

Opioid that crosses BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Patients on colestyramine long term may need supplements of vitamins A, D, K, and folic acid. Why?

A

Can intefere with absorption of fat soluble vitamins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the advice around taking colestyramine with other drugs?

A

Manufacturer advises take other drugs at least 1 hour before, or 4–6 hours after, colestyramine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What role does teduglutide have in short bowel syndrome?

A

Teduglutide is an analogue of human glucagon-like peptide-2 (GLP-2), which preserves mucosal integrity by promoting growth and repair of the intestine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

In patients with short bowel syndrome/stoma, what kinds of preparations would be unsuitable and why? (hint- types of release)

A

Enteric-coated and modified-release preparations are unsuitable for use in patients with short bowel syndrome, particularly in patients with an ileostomy, as there may not be sufficient release of the active ingredient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Methylcellulose is a type of what laxative?

A

Bulk forming (also acts as a faecal softener)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Sterculia is a type of what laxative?

A

Bulk forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When is onset of action for bulk forming laxatives?

___________ has onset of action of 8 to 12 hours. Note that ___________ has an onset of action of 10-12 hours

A

Within 72 hours

Senna has onset of action of 8 to 12 hours. Note that bisacodyl has an onset of action of 10-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Bisacodyl is what type of laxative?

A

Stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Sodium picosulfate is what type of laxative?

A

Stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Senna is what type of laxative?

A

Stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Docusate sodium is what type of laxative?

A

Stimulant laxative and faecal softener

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is co-danthramer and co-danthrusate used for and what patient group is it limited to? Why?

A

Constipation in palliative care

Carcinogenicity and genotoxicity risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Arachis oil enema would be contraindicated in patients with what allergy?

A

Peanuts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the warnings associated with liquid paraffin as a lubricant?

A

Anal seepage and the risks of granulomatous disease of the gastro-intestinal tract or of lipoid pneumonia on aspiration.

Should not be taken immediately before going to bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is lubiprostone used for?

A

Licensed for the treatment of chronic idiopathic constipation in adults whose condition has not responded adequately to lifestyle changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is prucalopride used for?

A

It is licensed for the treatment of chronic constipation in adults, when other laxatives have failed to provide an adequate response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is 1st line for short duration constipation where dietary measures have not helped?

If stools are soft but difficult to pass, what would be more appropriate?

A
  1. Bulk forming

2. Stimulant laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q
  1. In patients with opioid induced consitipation, what would be appropriate?
  2. If these do not work, what can then be used?
A
  1. Osmotic laxative and stimulant laxative
    Docusate sodium can be used to soften the stools
  2. Naloxegol
    Methylnaltrexone bromide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What type of laxative should be avoided in opioid induced constipation?

A

Bulk forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is 1st line medication for constipation in pregnancy after dietary measures?

A

Bulk forming laxative
Or lactulose [osmotic)
Stimulant effect: bisacodyl/senna but do not use senna near term or if history of unstable pregnancy. Stimulants more effective than bulk but SE diarrhoea/abdo discomfort reduce acceptability.

Docusate sodium and glycerol suppositories can also be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

True or false:

Stimulant laxatives are more effective than bulk-forming laxatives but more likely to cause side-effects

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is 1st choice for constipation in breast feeding after dietary requirements?

A

Bulk forming laxative

Lactulose or macrogol can be used if stools remain hard. alternative, a short course of a stimulant laxative such as bisacodyl or senna can be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q
  1. What is 1st line for constipation in children after dietary measures?
  2. If response is inadequate, what can be tried?
  3. If stools remain hard, what can be used?
A
  1. Macrogol 3350 with KCL, sodium bicarbonate and NaCl
  2. Add or change to a stimulant laxative
  3. Lactulose or docusate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

In children with chronic constipation, should laxatives be continued after regular bowel patterns has been established?

How should laxatives be stopped?

A

Yes- for several weeks after and then tapered gradually according to response over months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How many days classifies acute diarrhoea? How long do symptoms last? What could be the causes?

A

Less than 14 days but symptoms usually improve in 2-4 days. Can result from infection, drug SE or acute symptom of chronic GI disorder, accumulation of non absorbed osmotically active solutes in GI lumen (eg lactase deficiency) or GI effects of secretory stimuli or when intestinal motility/morphology is altered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the maximum daily licensed dose for loperamide?

A

16mg

Adult dose 4mg initially followed by 2mg up to 5 days. dose taken after each loose stool. usually 6-8mg daily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the MHRA advice regarding loperamide?

What can be given in event of an overdose?

A

Serious cardiac ADR with high doses associated with abuse.
QT prolongation, torsades de points, cardiac arrest.
Overdose: naloxone antidote. loperamide duration is longer than naloxone (1-3) hours so repeated treatment may be indicated. Monitor for 48 hrs for possible CNS depression.
Pharmacists should advise pts not to take more than recommended dose on label

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Is kaolin recommended for acute diarrhoea?

A

No - insufficient evidence to recommend adsorbent preparations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What role do antacids play in dyspepsia?

A

Symptomatic relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is a side effect of magnesium?

A

Laxative effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is a side effect of aluminium?

A

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Why is bismuth containing antacids not recommended ?

A

Neurotoxic, causing encephalopathy, tends to be constipating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the side effects associated with calcium containing antacids?

A

Can induce rebound acid secretion
Hypercalcaemia
Alkalosis
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What role do alginates play with an antacid?

A

Can protect mucosa from acid reflux

Some form a viscous gel raft that floats to surface of stomach contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What would be a standard treatment for a H.Pylori patient who is not penicillin allergic?

A

7 day course
1. PPI + Amox AND choice of: clarithromycin or metronidazole (exclude amox if pen allergy, keep clarithromycin and metronidazole)
2. (switch latter for 2nd treatment of ongoing symptoms)
2. for pt who received prev treatment with clarithromycin and metronidazole
PPI + Amox + tetracycline [unlicenced] OR levofloxacin [unlicenced]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Would you continue with PPI cover after treatment of H.Pylori?
What is the exception to this?

A

No

However if the ulcer is large or complicated by haemorrhage or perforation, then it is continued for a further 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

H.Pylori treatment:

What antibiotics are prone to resistance during the course?

A

Clarithromycin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the disadvantage over 2 week triple therapy for H.Pylori over 1 week?

A

Even though the eradication rate is higher, adverse effects and poor compliance are common problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What could be used as an alternative to metronidazole in H.Pylori treatment?

A

Tinidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What would be the dose of ranitidine in prophylaxis against NSAID related ulcers?

What would be an alternative?

A

300mg BD

Misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

In patients with NSAID related ulcer where the NSAID can be discontinued, which of the following promotes the most rapid healing:
H2 receptor antagonists
Misoprostol
PPI

A

PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is sucralfate used for?

A

Gastric/duodenal ulceration
Gastritis
Prophylaxis of stress ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the main caution with sucralfate?

A

Bezoar formation- solid mass of indigestible material that accumulates and can cause a blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

In Zollinger-Ellison syndrome, should a PPI or a H2 receptor antagonist be used?

A

PPIs as they are more effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the only H2 receptor antagonist that can be given IV?

A

Ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What can be used to reduce the degradation of pancreatic enzyme supplements in CF patients?

A

PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What can PPIs increase the risk of?

A

Increases risk of fractures and osteoporosis so consider preventative therapy if appropriate
Increases risk of GI infections e.g. C Diff
May mask the symptoms of gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What 2 electrolytes can drop if on PPIs?

A

Sodium and magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Do PPIs or H2 receptor antagonists provide more relief of GORD symptoms?

A

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

For mild symptoms of GORD, what can be used?

A

Antacids

May need PPI or H2 receptor antagonist but should be titrated down to a level which maintains remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

For severe symptoms of GORD, what should be used?

A

PPI - re-assess if still symptomatic after 4-6 weeks

Should be titrated down to a level which maintains remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q
  1. How do you manage GORD in pregnancy?

2. If this is ineffective, what can be tried?

A
  1. Diet and lifestyle changes
    Antacid/alginate
  2. Ranitidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

When would you give a pregnant lady omeprazole for GORD?

A

Severe or complicated reflux disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

How should a child with oesophagitis be treated?

A

H2 receptor antagonist

If this does not work, omeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is licensed as an adjunct to dietary avoidance in patients with food allergy?
(hint- not an epi-pen)

A

Sodium cromoglicate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What antihistamine is licensed for the symptomatic control of food allergy?

A

Chlorphenamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Buscopan contains what active ingredient?

A

Hyoscine butylbromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Kwells contains what active ingredient?

A

Hyoscine hydrobromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the MHRA alert associated with hyoscine butylbromide injection (IM, IV, SC)?

A

Serious SE such as tachycardia, hypotension, anaphylaxis (which is likely to be fatal in patients with CHD)
CI patients with tachycardia and should be used in caution in those with cardiac disease

108
Q

What is cholestasis?

A

An impairment of bile formation and/or bile flow

109
Q

What is the drug of choice for cholestatic pruritus?

A

Colestyramine

110
Q

What is the drug of choice for intrahepatic cholestatic pruritus in pregnancy?

A

Ursodeoxycholic acid

111
Q

Can you give NSAIDs in patients with symptomatic gallstones?

A

Yes

112
Q

What is the recommended medicine to use for primary biliary cholangitis?

(progressive destruction of bile ducts within the liver)

A

Ursodeoxycholic acid

113
Q

What is the MHRA alert associated with obeticholic acid?

A

Serious liver injuries in patients with mod-severe hepatic impairment
Need to be adequately dose adjusted according to LFTs

114
Q

What is used for oesophageal varice bleeding?

A

Terlipressin

Vasopressin

115
Q

Orlistat is licensed in patients with what BMI?

A

BMI of 30

or BMI of 28 in the presence of other risk factors

116
Q

When should discontinuation of Orlistat be considered? (when do you know it is not effective)

A

After 12 weeks if weight loss has not exceeded 5% since starting the treatment

117
Q

How does Orlistat work?

A

Lipase inhibitor so reduces absorption of dietary fat

118
Q

What vitamin may you need to be on if taking Orlistat and why?

A

D as orlistat may reduce absorption of fat soluble vitamins

119
Q

What laxatives should be used in acute anal fissures and why?

A

Bulk forming
Osmotic can be an alternative
To make sure stools are soft and easily passed

120
Q

When would an anal fissure be classed as chronic?

A

6 weeks or longer

121
Q

What topical preparation can be used in acute anal fissures?

A

Local anaesthetic e.g. lidocaine

122
Q

What topical preparation can be used in chronic anal fissures?

A 
GTN rectal ointment 
Diltiazem ointment
Nifedipine ointment
(Unlicensed)
123
Q

If a patient with haemorrhoids is suffering from constipation, what type of laxative should be used?

A

Bulk forming

124
Q

What type of analgesics should not be used in haemorrhoid patients and why?

A

Opioids as they cause constipation

125
Q

Topical rectal preparations containing local anaesthetics such as lidocaine should only be used for a few days- why?

A

May cause sensitisation of the anal skin

126
Q

Topical corticosteroids are suitable for short term use in haemorrhoid patients- what is the max number of days this should be used for?

A

No more than 7 days

127
Q

If a pregnant lady with haemorrhoids is suffering from constipation, what type of laxative should be used?

A

Bulk forming

128
Q

Are topical haemorrhoidal preparations licensed in pregnancy?

A

No

129
Q

How do you manage exocrine pancreatic insufficiency?

A

Pancreatin - contains lipase, amylase and protease

130
Q

What is the risk of CF patients taking high dose pancreatic enzymes?

What is therefore the guidelines of how many units of lipase to have a day?

A

Fibrosing colonopathy (presents with abdominal pain, vomiting etc)

No more than 10,000 units/kg/day of lipase

131
Q

In stoma patients, why should medicine preparations containing sorbitol be avoided?

A

Laxative effects

132
Q

What would be the most appropriate diuretic to use in stoma patients and why?

A

Potassium sparing
Diuretics should be used with caution in patients with an ileostomy or with urostomy as they may become excessively dehydrated and potassium depletion may easily occur.

133
Q

What is the danger with using laxatives in a stoma patient?

If they do need a laxative after increasing fluid intake and dietary fibre, what can be used?

A

May cause rapid and severe loss of water and electrolytes.

Bulk forming laxatives
If this does not work, a small dose of stimulant e.g. senna with caution

134
Q

What is the danger with stoma patients taking digoxin?

A

Patients with a stoma are particularly susceptible to hypokalaemia if taking digoxin, due to fluid and sodium depletion. Potassium supplements or a potassium-sparing diuretic may be advisable with monitoring for early signs of toxicity.

135
Q

Why should daily doses of liquid formulations be split in stoma patients?

A

To avoid osmotic diarrhoea

136
Q

What 3 antibiotics can you use for C.Diff infection?

A

1st line: Metronidazole
2nd line: Vancomycin
3rd line: Fidaxomicin

137
Q

What is the suggested duration of antibiotic treatment for C.Diff?

A

10-14 days

138
Q

If a patient has an aspirin sensitivity, would aminosalicylates be appropriate for them?

A

No - sulfasalazine and mesalazine are derivatives of salicylates, like aspirin.

139
Q

What colour does your urine turn if on sulfasalazine?

A

Yellow/orange

140
Q

What age is Mintec peppermint capsules licensed for?

A

> 18 years

141
Q

What age is Colpermin peppermint capsules licensed for?

A

> 15 years

142
Q

Liquid paraffin is indicated for constipation, but what is its main side effects?

A

Lipoid pneumonia on aspiration
Anal seepage
Granulomatous disease risk of GI tract

143
Q

What is the MHRA advice surrounding PPIs?

A

Very low risk of subacute cutaneous lupus erythematosus. Drug-induced SCLE can occur weeks to years after exposure to the drug.
If a patient on PPIs develops lesions in sun-exposed areas accompanied with arthralgia;
- Advise them to avoid sun exposure
- Consider SCLE as a possible diagnosis

144
Q

What antiplatelet interacts with omeprazole?

A

Clopidogrel

145
Q

What is the administration counselling points for isphaghula?

A

Preparations that swell in contact with liquid should always be carefully swallowed with water and should not be taken immediately before going to bed.

146
Q

What are some counselling points for taking antacids?

A
  • best taken when symptoms occur usually between meals or at bedtime.
  • preferably not be taken at the same time as other drugs since they may impair absorption.
  • Antacids can damage enteric coatings on tablets.
  • The words ‘low Na+’ added after some preparations
    indicates a sodium content of less than 1mmol per tablet or 10ml dose. This is directed for people with HTN.
147
Q

What is the advice given to patients around taking Pancreatin?

A

=> Ensure adequate hydration receiving higher-strength pancreatin preparations.
=> Pancreatin is inactivated by gastric acid: therefore best taken with food (or immediately before/after food).
=> Enteric-coated preparations deliver a higher enzyme conc in the duodenum-
=> Manufacturer advises GR granules should be mixed with slightly acidic soft food / liquid such as apple juice, and then swallowed immediately without chewing

148
Q

True or false:

Coeliacs are at a higher risk of malabsorption of key nutrients such as calcium and Vitamin D

A

True - important to assess for osteoporosis

149
Q

What are long term complications of ulcerative colitis?

A

Colorectal cancer
Osteoporosis - from dietary change, corticosteroid medication
VTE
Toxic megacolon

150
Q

The use of loperamide or codeine in an acute flare up of UC increases the risk of what?

A

Toxic megacolon

151
Q

What are the complications of Crohn’s Disease?

A

Intestinal strictures, abscesses, fistulae
Malnutrition
Anaemia
Colorectal and small bowel cancers
Growth failure and delayed puberty in children
Arthritis
Secondary osteoporosis - from steroid meds

152
Q

Can you use loperamide and codeine for diarrhoea in Crohn’s?

A

Yes

153
Q

What is the patient counselling with ASA?

A

Report any unexplained bleeding, bruising
Salicylate hypersensitivity e.g. itching, hives
Yellow/orange bodily fluids - may stain contact lenses

154
Q

What is the interaction between lactulose and mesalazine?

A

The manufacturers of some mesalazine GR and MR suggest that preparations that lower stool pH (e.g. lactulose) might prevent the release of mesalazine.

155
Q

What are the red flag symptoms of constipation?

A

New onset in > 50 years
Anaemia
Abdominal pain
Unexplained weight loss

156
Q

True or false:

Excessive use of stimulant laxatives causes hyperkalaemia

A

False- causes hypokalaemia

157
Q

What kind of laxative is co-danthramer?

A

Stimulant

158
Q

What kind of laxative should you avoid in opioid-induced constipation?

A

Bulk forming

159
Q

What are the red flag symptoms of dyspesia?

A

Anaemia
Loss of weight
Recent/unexplained dyspepsia in 55+ unresponsive to treatment
Malaena (blood in stool)

160
Q

What is a side effect of calcium salt antacids?

A

Can induce rebound acid secretion and constipation

161
Q

What classes of drugs do antacids interact with?

A

Tetracyclines - CNS SE
Quinolones - convulsions
Bisphosphonates - increased risk GI ulcers

162
Q

What groups of patients are antacids cautioned in?

A

Fluid retention can occur due to high sodium content so cautioned in hypertension, heart, liver or kidney failure
Avoid in sodium restricted diet e.g. lithium

163
Q

What PPI is safe in pregnancy?

A

Omeprazole

164
Q

What is the advice with enteral feeds and food when taking sucralfate?

A

Administration of sucralfate and enteral feeds should be separated by 1 hour and for administration by mouth, sucralfate should be given 1 hour before meals.

165
Q

What is the advice surrounding when to do a 13C urea breath test in terms of if the patient has had antibacterial therapy/antisecretory drug?

A

Do not perform test within 4 weeks of antibacterial

Do not perform test within 2 weeks of antisecretory drug

166
Q

What are the side effects of antimuscarinics?

A 
Blurred vision
Arrhythmias
Pupil dilation (mydriasis)
Urinary retention
Constipation
Dry mouth 
Angle-closure glaucoma 
Drowsiness, confusion
167
Q

Do antimuscarinics cause dry eyes?

A

No

168
Q

When should pancreatin be given and why?

A

Immediately before meals as pancreatin is inactivated by gastric acid

169
Q

True or false:

Enteric coated pancreatin delivers higher pancreatin levels

A

True

170
Q

What is the advice with pancreatin and mixing with food and drink?

A

Pancreatin is inactivated by heat

If mixed with foods or liquids, do not keep for more than 1 hour

171
Q

All the antibiotic and PPI triple therapies are BD dosing. What combination is the exception to this?

A

Omeprazole 20mg BD
Amoxicillin 500mg TDS
Metronidazole 400mg TDS

172
Q

Treatment of coeliac disease

A

Avoid gluten

Prednisolone in refractory coeliac disease

173
Q

What is diverculosis and treatment?

A

Asymptomatic
Forms diverticula= small pouches protruding from large intestine

Treatment
Bulking forming laxatives if they have constipation

174
Q

What is acute diverticulitis

A

Sudden inflammation of diverticula

Can be infected = pain, fever, rectal bleeding

175
Q

What is complicated acute diverticulitis

A

Abscess, bowel perforation, fistula, intestinal obstruction, haemorrhage, sepsis

176
Q

What is treatment for acute diverticulitis

A

Paracetamol if no systemic symptoms, antibacterials if needed and low fibre diet generally in diverticulitis

177
Q

What is not recommended in complicated acute diverticulitis

A

Aminosalicylates and propylactic antibacterials

178
Q

What are symptoms of Coeliac disease? What is the best non drug treatment?

A

Diarrhoea, bloating, abdominal pain.

Best no drug treatment is life long strict diet of GF food avoiding wheat, barley and rye ingredients

179
Q

Corticosteroid side effects

A

Adrenal suppression, hypothyroidism, striae, acne, moon face, glaucoma, OS, DB

180
Q

Dose of prednisolone for inducing remission in acute phase of IBD?

A

40mg once daily oral prednisolone used to induce remission in the acute phase of UC and Crohn’s - reasonable compromise between efficacy and toxic effects. This dose should be reduced gradually by 5mg every 7 days over a period of 8 weeks to prevent early relapse.

181
Q

Diverticulosis BNF definition

A

asymptomatic condition characterised by presence of diverticula. Prevalence difficult to determine but age dependent with majority of patients >40yrs

182
Q

NSAIDs and opioid analgesics are not recommended in Diverticular disease - why?

A

because their use may increase risk of diverticular perforation

183
Q

Difference between Crohns vs UC

A

Crohns: chronic IBD transmural granulamatous inflammation can affect any part of GI tract. ‘skip’ lesions. Stricture. feeling of abdominal mass. ^risk in smokers. Recurrent attacks and periods of remission. Symptom: abdominal pain, diarrhoea, fever, weight loss and rectal bleeding.

UC: diffuse mucosal inflammation in relapsing-remitting pattern. Presents in 15-25yo with continuous extending pattern from rectum upwards to varying degree. Symptoms: bloody diarrhoea, urgent need to defecate, and abdominal pain.

184
Q

What are the complications of Crohns disease

A

intestinal strictures, abscesses in intestine/adjacent structures, fistulae, anaemia, malnutrition, colorectal and small bowel cancers, growth failure and delayed growth in children. Extra intestinal manifestations of arthritis and abnormalities in joints, eyes, liver and cause of secondary OS. Those at greater risk should be monitored for osteopenia and assessed for risk of fractures.

185
Q

What is Fistulating Crohn’s disease

A

Complication involving fistula between intestine and adjacent structures eg perinala skin, bladder and vagina. occur in 1 in 4 pateints mostly when disease involves ileoclonic area.

186
Q

Crohns non drug treatment?

A

Smoking cessation, attention to nutrition, surgery consider in pts with early disease limited to distal ileum or severre/chronic acitve disease

187
Q

Crohns maintianing remission following surgery

A

Azathiprine or mercaptopurine (unlicensed) can be used ASA can also be considered but budesonide or enteral nutrition should not be used.

188
Q

UC complications

A

^ risk of colorectal cancer, secondary OS, Venous thromboembolism and toxic megacolon

189
Q

UC severity measured

A

Truelove and Witts Severity Index to asseess bowel movments, heart rate, ESR and pyrexia, melaena or anaemia.

190
Q

UC: If the inflammation is distal, a __________ preparation is adequate but if the inflammation is extended, ___________ medication is required

A

Rectal - Either suppositories or enemas can be offered, taking into account the patient’s preferences. Rectal foam preparations and suppositories can be used when patients have difficulty retaining liquid enemas.

Systemic

191
Q

When used to maintain remission, single daily doses of oral aminosalicylates can be _________effective than multiple daily dosing

A

When used to maintain remission, single daily doses of oral aminosalicylates can be more effective than multiple daily dosing but may result in more side effects

192
Q

IN UC use of corticosteroids how long would course generally be?

A

The duration of corticosteroid course (usually 4 to 8 weeks) depends on the corticosteroid chosen

193
Q

UC - What is 1st-line treatment for patients with a mild-to-mod initial ppt or inflammatory exacerbation of proctitis ?
What would be 2nd line?

A
  1. ASA 1st line. Rectal ASA alone more effective for proctitis and proctosigmoiditis. Ifremission notachieved in 4 weeks add oral ASA. Monotherapy oral ASA for those who do not prefer enemas/suppositories (tho less effective).If response remains inadequate, consider addition of a topical or an oral corticosteroid for 4 to 8 weeks.
  2. Rectal corticosteroid or oral prednisolone can be considered in pt intolerant/decline/CI to ASA.Oral prednis. should be considered for the treatment of pts with subacute proctitis or proctosigmoiditis.
194
Q

SE ASA pt advised to report any

A

Blood disorders - report unexplained bleeding, bruising, purpura, sore throat, fever, malaise during treatment. Blood count done and drug stopped if suspected blood dyscrasias

195
Q

Is any one preparation of mesalazine better than the other?

A

No evidence to show that any one oral preparation of mesalazine is more effective than the other. If switched pt should report any changes in symptoms.

196
Q

IBS describe

A

chronic condition in 20-30yo mostly women. Symptoms abdominal pain/discomfort, disordered, passage of mucus and bloating

197
Q

IBS self management

A

high fibre diet, exercise.

198
Q

What antispasmodics are used as intestinal smooth muscle relaxants in IBS

A

alverine, mebeverine, peppermint oil

199
Q

What drug classes are used in IBS

A

antispasmodics (alverine, mebeverine, peppermint oil) and antimuscarinics (dicycloverine, hyosciene and propantheline)

200
Q

All antispasmodics should be avoided in

A

PARALYTIC ILEUS - condition where the gut (intestinal) muscles are paralysed.

201
Q

Colonisation of C Diff in colon often follows antibiotic therapy - which drugs are hazardous?

A 
Ampicillin, Amoxicillin
Coamoxiclav
2nd gen & 3rd gen cephalosporins
clindamycin
quinolones
202
Q

misconceptions about bowel habits have led to excessive laxative use. abuse may lead to

A

hypokalaemia. Before prescribing laxatives it is important to be sure that the patient is constipated and that the constipation is not secondary to an underlying undiagnosed complaint.

203
Q

If dietary and lifestyle changes do not control constipation in PREGNANCY which class of drugs can be used?

A

1st line bulk laxative
2nd line osmotic (lactulose)
3rd line stimulant (bisacodyl/senna)
use of senna should be avoided near term or if there is a history of unstable pregnancy.
Docusate sodium and glycerol suppositories can also be used.
Stimulant laxatives are more effective than bulk-forming laxatives but are more likely to cause SE (diarrhoea and abdominal discomfort), reducing their acceptability to patients

204
Q

Light liquid paraffin

A

less suitable for prescribing. SE: anal seepage of paraffin and consequent anal irritation after prolonged use;lipoid pneumonia

205
Q

What is constipation

A

is defaecation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete defaecation. It can occur at any age and is commonly seen in women, the elderly, and during pregnancy.

206
Q

non drug advice for constipation

A
  • ^ in dietary fibre, adequate fluid intake and exercise.
  • Balanced Diet contain whole grains, fruits and veg.
  • Fibre intake should be ^ gradually (to minimise flatulence and bloating).
  • Effects of high-fibre diet seen in a few days - 4 weeks.
  • Adequate fluid intake is important (particularly with a high-fibre diet or fibre supplements), but can be difficult for some people (frail or elderly).
  • Fruits high in fibre and sorbitol, and fruit juices high in sorbitol, can help prevent and treat constipation.
207
Q

bulk forming laxatives; examples, onset of action, symptoms

A

bran, ispaghula husk, methylcellulose and sterculia.
USEFUL FOR adults with small hard stools if fibre cannot be increased in the diet.
Onset up to 72 hours.
Symptoms of flatulence, bloating, and cramping may be exacerbated.
Adequate fluid intake must be maintained to avoid intestinal obstruction.

Methylcellulose, ispaghula husk and sterculia may be used in pts who cannot tolerate bran. Methylcellulose also acts as a faecal softener.

208
Q

stimulant laxatvie

A

bisacodyl, sodium picosulfate, and members of the anthraquinone group (senna, co-danthramer and co-danthrusate).
Increase intestinal motility and often cause abdo cramp; avoid in intestinal obstruction

209
Q 
Which class has onset of action up to 72 hours? 
A. Stimulant laxative
B. Bulkforming laxative
C. Osmotic laxative
D. Faecal softener
A

B. Bulk forming laxative

210
Q

use of co-danthramer and co-danthrusate is limited to constipation in..
What kind of drug is this?

A

terminally ill patients because of potential carcinogenicity (based on animal studies) and evidence of genotoxicity.
- Example of stimulant laxative

211
Q 
Which drug acts both as stimulant laxative and faecal softener?
A. Methylcellulose
B. Co-danthramoer
C. Docusate sodium
D. Sterculia
A

C. Docusate sodium

212
Q

Glycerol suppositories act as a lubricant and as a rectal stimulant by virtue of the mildly irritant action of glycerol. True or False

A

True

213
Q

Methylcellulose also acts as a stimulant laxative.

A

False - it acts as a faecal softener and is a bulk forming laxative

214
Q

Faecal softeners are claimed to act by

A

decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass. Enemas containing arachis oil (ground-nut oil, peanut oil) lubricate and soften impacted faeces and promote a bowel movement. Liquid paraffin has also been used as a lubricant for the passage of stools but manufacturer advises that it should be used with caution because of its adverse effects

215
Q

What drugs have faecal softening properties? but are not actually faecal softeners.

A

Docusate sodium and glycerol suppositories

216
Q

__________ laxatives increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with.
Examples of this drug class?

A

Osmotic
Lactulose is a semi-synthetic disaccharide which is not absorbed from the gastro-intestinal tract.
Macrogols (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride) are inert polymers of ethylene glycol which sequester fluid in the bowel

217
Q

Is lactulose absorbed from the GI tract?

A

no - Lactulose is a semi-synthetic disaccharide which is not absorbed from the gastro-intestinal tract.

218
Q

Which laxative is useful in the treatment of hepatic encephalopathy and why?

A

Lactulose produces an osmotic diarrhoea of low faecal pH, and discourages the proliferation of ammonia-producing organisms. It is therefore useful in the treatment of hepatic encephalopathy.

219
Q

giving fluid with __________ may reduce the dehydrating effect sometimes seen with osmotic laxatives.

A

Macrogols

220
Q

Linaclotide is a

  • indication
  • MOA
A

guanylate cyclase-C receptor agonist licensed for the treatment of mod-sev IBS associated with constipation. It increases intestinal fluid secretion and transit, and decreases visceral pain.

221
Q

Prucalopride is a

A

selective serotonin 5HT4-receptor agonist with prokinetic properties. It is licensed for the treatment of chronic constipation in adults, when other laxatives have failed to provide an adequate response.

222
Q

Bowel cleansing preparations are used

A

before colonic surgery, colonoscopy or radiological examination to ensure the bowel is free of solid contents

223
Q

Examples of bowel cleansing preparations

A

macrogol 3350 with anhydrous sodium sulfate, KCl, Na bicarbonate and NaCl, citric acid with Mg carbonate, Mg citrate with Na picosulfate and Na acid phosphate with Na phosphate.

224
Q

True or false

Bowel cleansing treatments are treatments for constipation.

A

FALSE

225
Q

In the management of short-duration constipation (where dietary measures are ineffective) treatment should be started with

A

bulk-forming laxative, ensuring adequate fluid intake. If stools remain hard, add or switch to an osmotic laxative. If stools are soft but difficult to pass or the person complains of inadequate emptying, a stimulant laxative should be added.

226
Q

[ELDERLY] Constipation is a common cause of distress and is almost invariable after an opioid analgesic. It should be prevented if possible by regular administration of laxatives;

A

faecal softener with a peristaltic stimulant (e.g. co-danthramer) or lactulose solution with a senna preparation should be used. Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation.

227
Q

In patients with opioid-induced constipation what is recommended?

A

osmotic laxative (or docusate sodium to soften the stools) and a stimulant laxative is recommended. Bulk-forming laxatives should be avoided.

228
Q

What kind of constipation should bulk laxatives eg loperamide be avoided in?

A

Opioid induced constipation. Opioids prevent peristalsis of the fibre-increased bulk, which exacerbates abdominal pain and, in some cases, contributes to bowel obstruction.

229
Q

Naloxegol is recommended for..

A

Naloxegol is recommended for the treatment of opioid-induced constipation when response to other laxatives is inadequate.

230
Q

Manufacturer advises that in patients receiving palliative care, methylnaltrexone bromide should be used as

A

an adjunct to existing laxative therapy.

231
Q

The treatment of faecal impaction depends on the stool consistency. In patients with hard stools, a high dose of an

A

oral macrogol (such as macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride) may be considered.

232
Q

Faecal impaction: In those with soft stools, or with hard stools after a few days treatment with a macrogol, an oral __________laxative should be started or added to the previous treatment. what if this is ineffective?

A

STIMULANT.

If the response to oral laxatives is inadequate, for soft stools consider rectal administration of bisacodyl, and for hard stools rectal administration of glycerol alone, or glycerol plus bisacodyl.

233
Q

Faecal impaction: If the response to oral laxatives is inadequate

A

If the response to oral laxatives is inadequate, for soft stools = use rectal bisacodyl.
For hard stools = rectal glycerol, or glycerol + bisacodyl.
Alternatively, a docusate Na or Na citrate enema.
If still insufficient Na acid phosphate with Na phosphate or arachis oil retention enema.
Hard faeces: helpful to give the arachis oil enema overnight before giving a Na acid phosphate with Na phosphate/citrate enema the following day. Enemas may need to be repeated several times to clear hard impacted faeces.

234
Q

In the management of chronic constipation, treatment should be

A
  1. bulk-forming laxative, + good hydration.
  2. Add or change to an osmotic laxative eg macrogol.
  3. Lactulose if macrogols are not effective/tolerated.
  4. Still inadequate, add stimulant laxative.
    Laxative dose should be adjusted gradually to produce one or two soft, formed stools per day.
235
Q

Chornic constipation: If at least two laxatives (from different classes) have been tried at the highest tolerated recommended doses for at least 6 months, the use of

A

prucalopride (in women only) should be considered. If treatment with prucalopride is not effective after 4 weeks, the patient should be re-examined and the benefit of continuing treatment reconsidered.

236
Q

How should laxatives be withdrawn when patient starts to get regular bowel movements?

A

Laxatives can be slowly withdrawn when regular bowel movements occur without difficulty, according to the frequency and consistency of stools.
If a combo of laxatives has been used, reduce + stop one laxative at a time; stimulant laxative should be reduced first.
However, it may be necessary to also adjust the dose of the osmotic laxative to compensate.

237
Q

Constipation in pregnancy non medication

A

If dietary and lifestyle changes fail, fibre supplements in the form of bran or wheat are likely to help women experiencing constipation in pregnancy.

238
Q

The first-line treatment for children with constipation requires

A

use of a laxative in combo with dietary modification or with behavioural interventions. Diet modification alone not recommended as 1st-line.

239
Q

Constipation in children dietary information

A

^in dietary fibre, adequate fluid intake, and exercise. balanced diet contain fruits+veg , high-fibre bread, baked beans, and wholegrain breakfast cereals. Unprocessed bran (bloating and flatulence and reduces the absorption of micronutrients) is not recommended.

240
Q

Treatment of faecal impaction may initially increase symptoms of soiling and abdominal pain in
A. adults
B. children

A

b. Children

241
Q

Main aim of diarrhoea

A

Reverse fluid and electrolyte depletion especially in infants, frail and elderly. Oral rehydration preparations used to replenish lost electrolyes

242
Q

Antimotility drugs such as loperamide are used in uncomplicated diarrhoea but not in children under

A

3 yrs

243
Q

Is routine prophylaxis against traveller’s diarrhoea recommended?

A

No but ciprofloxacin can be used.
loperamide can also be used for mild-mod travellers’ diarrhoea where toilet amenities are limited/unavailable but should be avoided in bloody/suspected inflammatory diarrhoea and cases of significant abdominal pain

244
Q

Diarrhoea is

A

the abnormal passing of loose or liquid stools, with increased frequency, increased volume, or both.

245
Q

Diarrhoea red flag symptoms

A

unexplained weight loss, rectal bleeding, persistent diarrhoea, a systemic illness, has received recent hospital treatment or antibiotic treatment, or following foreign travel (other than to Western Europe, North America, Australia or NZ).

246
Q

Oral rehydration therapy

A

is the mainstay of treatment for acute diarrhoea to prevent or correct diarrhoea dehydration and to maintain the appropriate fluid intake once rehydration is achieved

247
Q

in patients with severe dehydration and in those unable to drink, immediate admission to hospital and

A

urgent replacement treatment with an intravenous rehydration fluid is recommended

248
Q

Loperamide is 1st line in

A

standard treatment when rapid control of symptoms of diarrhoea.
Travellers’ Diarrhoea
Faecal incontinence [unlicenced] after underlying cause of incontinence has been addressed

249
Q

Racecadotril is licensed as an adjunct to rehydration for the symptomatic treatment of

A

uncomplicated acute diarrhoea in adults and children over 3 months.

250
Q

loperamide not recommended for children under

A

12 yrs - acute diarrhoea

18 yrs - acute diarrhoea associated with IBS

251
Q

loperamide SE

A

GI disorders, headache, nausea

beware of serious cardiac adverse rxns in high doses associated with abuse/misuse

252
Q

Dyspepsia describes a range of upper gastro-intestinal symptoms, which are typically present for

A 
4 or more weeks. 
Symptoms: upper abdo pain or discomfort, heartburn, gastric reflux, bloating, n+v. 
Underlying cause (e.g. GORD, Peptic ulcer disease, malignancy, or drug SE), but majority of pts are likely to have functional dyspepsia, no underlying cause.
253
Q

Uninvestigated dyspepsia describes symptoms in patients who

A

have not had an endoscopy.

254
Q

Dyspepsia symptoms in pregnancy are commonly due to

A

gastro-oesophageal reflux disease

255
Q

Dyspepsia lifestyle measures

A

Healthy eating, weight loss (if obese), avoiding trigger foods, eating smaller meals, eating evening meal 3–4 hours before bed, raising the head of the bed, Smoking cessation, reducing alcohol. Assess for stress, anxiety, or depression symptoms.

256
Q

Drugs that may cause dyspepsia

A

a-blockers, antimuscarinics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, CCB, corticosteroids, nitrates, NSAIDs, theophyllines, and tricyclic antidepressants

257
Q

dyspepsia can be treated with antacids?

A

Antacids and/or alginates may be used for short-term symptom control, but long-term, continuous use is not recommended.

258
Q

For uninvestigated dyspepsia

A

proton pump inhibitor should be taken for 4 weeks

investigate H Pylori

259
Q

Functional dyspepsia action

A

test H Pylori => negative =>

PPI or histamine2 rec antagonist could be taken for 4 weeks

260
Q

In patients with uninvestigated dyspepsia taking an NSAID and unable to stop the drug, consider

A

reducing NSAID dose and using long-term gastro-protection with acid suppression therapy, or switching to an alternative to the NSAID: paracetamol or selective COX2 inhibitor or antiplatelet drug

261
Q

COX 2 selective inhbitors

A

celecoxib, rofecoxib

262
Q

An __________review should be performed for patients with dyspepsia to assess their symptoms and treatment.

A

annual. A ‘step down’ approach/stopping treatment, should be encouraged. Return to self-treatment with antacid and/or alginate therapy may be appropriate.

263
Q

Testing for H. pylori is recommended in the following patients in line with Public Health England (PHE) Guidance

A
  1. Uncomplicated dyspepsia + no alarm symptoms, unresponsive to lifestyle changes and antacids, following 1 month PPI course
  2. Pt at high risk of H. pylori infection; elderly, North African ethnicity, living in a high risk area, or in parallel with a course of a PPI
  3. Previously untested pts with a history of peptic ulcers or bleeds
  4. Prior to initiating NSAIDs in pts with history of peptic ulcers or bleeds
  5. Pts with unexplained iron-deficiency anaemia after endoscopic investigation has excluded malignancy, and other causes have been investigated.
264
Q

recommended tests for the diagnosis of gastro-duodenal infection with H. pylori

A

The urea (13C) breath test, Stool Helicobacter Antigen Test (SAT), or laboratory-based serology

PHE advise urea (13C) breath test and SAT should not be performed within 2 weeks of treatment with a PPI or within 4 weeks of antibacterial treatment, as can lead to false negatives.

265
Q

In patients with functional dyspepsia, routine retesting after H. pylori eradication is recommended or not recommended

A

not recommended.

266
Q

Orlistat MOA

A

Orlistat = potent, specific and long-acting inhibitor of GI lipases. Estimated orlistat 60mg TDS blocks the absorption of approximately 25% of dietary fat. acts in lumen of stomach and small intestine by forming a covalent bond with the active serine site of the gastric and pancreatic lipases. The inactivated enzyme is thus unavailable to hydrolyse dietary fat, in the form of TG, into absorbable free fatty acids and monoglycerides.

Full Pre Registration Exam Notes (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions