Chapter 1- GI System Flashcards
Name 7 antibiotics that can cause C Diff infection
Ampicillin Amoxicillin Co-amoxiclav 2nd gen cephalosporins 3rd gen cephalosporins Clindamycin Quinolones
Name three treatment options for C Diff
Metronidazole
Vancomycin
Fidaxomicin
Name two chronic inflammatory bowel diseases
Ulcerative colitis
Crohn’s disease
Name three classes of drug used to treat inflammatory bowel diseases
Aminosalicylates
Corticosteroids
Immune response drugs
Name four aminosalicylates used in IBS
Balsalazide
Mesalazine
Olsalazine
Sulfasalazine
Name four corticosteroids used in IBS
Hydrocortisone
Beclometasone
Budesonide
Prednisone
Name four drugs used in IBS that effect the immune system
Ciclosporin
Azathioprine
Mercaptopurine
Methotrexate
Name four monoclonal antibodies used in IBS
Infliximab
Adalimumab
Golimumab
Vedolizumab
MOA of colestyramine and why is it used in IBS
Binds bile salts- can get loss of bile salt absorption in IBS
Abuse of laxatives can lead to what?
Hypokalaemia
Name 5 classes of laxatives
Bulk forming Stimulants Faecal softeners Osmotic laxatives Other
Stimulant laxatives can cause what?
Abdominal cramps
Which antacids are constipating
Aluminium containing
Which antacids are laxatives
Magnesium containing
How do you treat H.pylori
One week triple therapy:
PPI
Clarithromycin
Amoxicillin or metronidazole
What’s the MHRA warning for PPIs?
Low risk of subacute cutaneous lupus erythematosus
Why can antimuscarinics/anticholinergics be used in IBS?
They reduce intestinal motility
What is diverticular disease?
Where the diverticula (sac like protrusions of mucosa through the muscular colonic wall) cause intermittent lower abdominal pain in absence of inflammation/infection
What is diverticulitis?
When the diverticula become inflamed and infected
True or false: peppermint oil can irritate the mouth or oesophagus
TRUE so don’t chew or break the capsules
When are bulk forming laxatives appropriate?
When the diet is deficient in fibre
When are stimulant laxatives appropriate
To increase intestinal motility
How does linaclotide work
Increases intestinal fluid secretion and transit, and decreases visceral pain
How do antimotility drugs work
Bind to opioid receptors in the GI tract and therefore prolong the duration of intestinal transit
Name two potentially carcinogenic stimulant laxatives
Co-danthramer
Co-danthrusate
What laxative can be used to treat hepatic encephalopathy and why
Lactulose- it discourages the proliferation of ammonia-producing organisms
Which laxative should be swallowed with plenty of water and should not be taken before bedtime
Ispaghula husk
Why are bismuth containing antacid products (unless chelates) not recommended
Absorbed bismuth can be neurotoxic, causing encephalopathy; they can be constipating
Calcium containing antacids can induce what?
Rebound acid secretion
Prolonged high doses of calcium containing antacids can cause what
Hypercalcaemia and alkalosis and can precipitate the milk-alkali syndrome
What is simeticone
Activated dimeticone is added to an antacid as an antifoaming agent to relieve flatulence
What preparation may be useful for the relief of hiccup in palliative care
Simeticone
What gastroprotective complex/chelator has been associated with bezoar formation?
Sucralfate
List indications for antimuscarinic drugs
Arrhythmias Asthma and airway disease Motion sickness Parkinsonism Urinary incontinence Mydriasis & cycloplegia Premedication Antidote to organophosphorous poisoning
What’s the predominant primary bile acid in humans?
Cholic acid
What is linaclotide
Guanylate Cyclase-C receptor agonist laxative used in moderate to severe IBS with constipation
How do bulk forming laxatives work
Relieve constipation by increasing faecal mass which stimulates peristalsis
Which type of laxative needs adequate fluid intake to avoid intestinal obstruction
Ispaghula husk
True or false: ispaghula husk should be taken just before going to bed
FALSE
How does lubiprostone work
Is a chloride channel activator that acts locally in the gut to increase intestinal fluid secretion and intestinal motility (=laxative effect)
MOA of prucalopride
A selective serotonin 5HT4 receptor agonist with prokinetic properties
True or false: bisacodyl is an osmotic laxative
False it’s a stimulant
Co-danthramer stimulant laxative can make your urine blue: true or false?
False- can make it red
What component of the metabolised sennisides from senna stimulates peristalsis?
The anthrone component
What type of laxative is sodium picosulfate
Stimulant
True or false: loperamide acts on opioid receptors in the GI tract and does not readily cross the BBB
True
Name an enkephalinase inhibitor used in the treatment of diarrhoea
Racecadotril
True or false: antacids can damage enteric coatings designed to prevent dissolution in the stomach
True!
Tripotassium dicitratobismuthate is a gastroprotective complex/chelate that can cause what two things?
Darkened tongue and blackened faeces
True or false: PPIs can increase the risk of fractures but do not increase the risk of GI infections
False they increase the risk of both fractures and GI infections
PPIs can cause hypomagnesaemia true or false?
True
Symptoms of dyspepsia
Upper abdominal pain Fullness Early satiety Bloating Nausea
Alarm features with dyspepsia?
Bleeding Dysphagia Recurrent vomiting Weight loss >55 yrs with unexplained recent onset dyspepsia
Symptoms of gastro-oesophageal reflux disease (GORD)
Heartburn Acid regurgitation Dysphasia Oesophagitis Ulceration
Treatment for GORD in pregnancy
1) lifestyle
2) antacids
3) Ranitidine
4) PPI
Treatment of GORD in normal patients (I.e not pregs)
1) lifestyle
2) antacids
3) PPI
4) H2 receptor antagonist
Treatment of GORD in children
1) feed thickener or alteration in feed frequency
2) alginate
3) specialist
Gaviscon and peptic contain what three ingredients
Sodium alginate
Sodium bicarbonate
Calcium carbonate
What makes gaviscon advance?
Also contains potassium bicarbonate
Main aim of treating diarrhoea
Prevent or reverse electrolyte and fluid depletion
Three main categories of medication to treat ulcerative colitis and crohns
Aminosalicylates (meslazine, sulfasalazine)
Azathiopurine/mercaptopurine
Corticosteroids
Side effects of long term corticosteroids include what three things?
Osteoporosis
Hypertension
Diabetes
Counselling for aminosalicylates
Report any: bruising, bleeding, fever, sore throat, malaise
Orange/yellow staining of body fluids
Which type of fibre is better in IBS and give an example
Soluble fibre such as oats rather than insoluble such as bran
How long does senna take to work?
8-12 hrs
How long does bisacodyl take to work
10-12 hrs
How long does docusate take to work
24-48 hrs
How long does lactulose take to work
48 hrs
How long does ispaghula husk take to work
Few days
What is arachais oil
Faecal softener- peanut oil
First line treatment of rectal problems e.g haemorrhoids
Soothing - zinc oxide
Pain relief - lidocaine
Combination preps - corticosteroids + anaesthetic
What diuretic would you give if someone has a stoma
Potassium sparing due to risk of losing electrolytes
Is colestyramine absorbed in the GI tract?
No
Counselling points for pancreatin
Inactivated by gastric acid so take with or just after fluid
Take with plenty of fluid
Fat soluble vitamins include:
D
E
A
K
