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Pre-reg exam 2019 > 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

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2
Q

What are coeliac patients at increased risk of?

A

Malabsorption

Vitamin and mineral deficiency - could increase the risk of osteoporosis

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3
Q

What is diverticular disease?

A

Diverticula (sac-like protrusions of mucosa through the muscular colonic wall) cause intermittent lower abdominal pain in the absence of inflammation or infection.

Can cause large rectal bleeds

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4
Q

What is the treatment for diverticular disease

A

Constipation= high fibre diet or bulking forming laxatives paracetamol for pain and antispasmodics

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5
Q

What is not recommended in uncomplicated diverticular disease?

A

Antibiotics unless the patient presents with signs of infection/immunocompromised
Nsaids or opioids

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6
Q

What is the treatment for complicated diverticular disease?

A

Hospital admission, IV antibacterials covering gram negative and anaerobes

Bowel rest

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7
Q

True or false:

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

A

True

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8
Q

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

A

Avoids the sulfonamide-related side effects of sulfasalazine

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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

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10
Q

What compound is mesalazine?

A

5-ASA

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11
Q

Balsalazide is a pro drug of what?

A

5-ASA

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12
Q

What are extraintestinal manifestations?

A

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

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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)
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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

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15
Q

Is mercaptopurine licensed in severe UC and CD?

A

No

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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
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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

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18
Q

What monoclonal antibodies are licensed for Crohn’s?

A

Adalimumab
Infliximab-can also be used for active fistulating CD
Vedolizumab

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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

Mercaptopurine (unlicensed)

  1. Methotrexate if the patient required it to induce remission, or if azathioprine/mercaptopurine is unsuitable
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20
Q

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

A

No- only to induce remission

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21
Q

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

A

Loperamide, codeine phosphate, colestyramine

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22
Q

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

A

Metronidazole and ciprofloxacin (unlicensed)

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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

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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

At least 1 year

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25
Q

Can you use loperamide and codeine phosphate in acute UC?

A

No- contraindicated as it increases the risk of toxic megacolon

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26
Q

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

A

Macrogol containing osmotic laxative

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27
Q

UC

  1. What is first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctitis and proctosigmoiditis?
  2. What would be second line?
A
  1. Rectal aminosalicylates. Oral prednisolone should be considered for the treatment of patients with subacute proctitis or proctosigmoiditis.
  2. Rectal corticosteroid or oral prednisolone
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28
Q

What aminosalicylates have rectal preparations?

A

Mesalazine or sulfasalazine

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29
Q

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

A

High induction dose of an oral aminosalicylate, with addition of a rectal aminosalicylate or oral beclometasone dipropionate if necessary.

Oral prednisolone alone is recommended for patients who cannot tolerate or who decline aminosalicylates, in whom aminosalicylates are contra-indicated or in patients with subacute left-sided or extensive ulcerative colitis.

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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

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31
Q

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

A

It exerts its action topically in the colon

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32
Q

True or false:

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

A

True

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33
Q

Are corticosteroids suitable for maintenance treatment of UC?

A

No because of their side effects

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34
Q

What should be given in acute severe UC?

A

IV corticosteroids
IV ciclosporin is an alternative (unlicensed)
Infliximab

Assess for surgery

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35
Q

What monoclonal antibodies are used for acute UC?

A

Adalimumab, golimumab, infliximab, vedolizumab

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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

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37
Q

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

A

Low dose oral aminosalicylate

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

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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

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39
Q

What are the red flag side effects of aminosalicylates?

A 
Agranulocytosis
Bone marrow disorders
Neutropenia
Cardiac inflammation
Renal impairment - nephrotoxicity
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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)

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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

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42
Q

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

A

May stain the lenses yellow/orange

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43
Q

What should a patient be screened for if starting vedolizumab?

A

TB

Contraindicated in those with TB

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44
Q

What is alverine citrate used for?

A

GI spasms

Dysmenorrhoea

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45
Q

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

A

Causes bloating

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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

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47
Q

What is 1st line for diarrhoea in IBS?

A

Loperamide

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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

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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

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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.

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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.

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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.

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53
Q

Bran is a type of what laxative?

A

Bulk forming

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54
Q

Isphaghula husk is a type of what laxative?

A

Bulk forming

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55
Q

Methylcellulose is a type of what laxative?

A

Bulk forming (also acts as a faecal softener)

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56
Q

Sterculia is a type of what laxative?

A

Bulk forming

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57
Q

When is onset of action for bulk forming laxatives?

A

Within 72 hours

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58
Q

Bisacodyl is what type of laxative?

A

Stimulant

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59
Q

Sodium picosulfate is what type of laxative?

A

Stimulant

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60
Q

Senna is what type of laxative?

A

Stimulant

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61
Q

Docusate sodium is what type of laxative?

A

Stimulant laxative and faecal softener

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62
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

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63
Q

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

A

Peanuts

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64
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

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65
Q

Lactulose is what type of laxative?

A

Osmotic

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66
Q

Macrogol is what type of laxative?

A

Osmotic

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67
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

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68
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.

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69
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

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70
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
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71
Q

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

A

Bulk forming

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72
Q

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

A

Bulk forming laxative

Or lactulose

Docusate sodium and glycerol suppositories can also be used

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73
Q

True or false:

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

A

True

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74
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

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75
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
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76
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

77
Q

How many days classifies acute diarrhoea?

A

Less than 14 days

78
Q

What is the maximum daily licensed dose for loperamide?

A

16mg

79
Q

What is the MHRA advice regarding loperamide?

A

Reports of serious cardiac adverse reactions with high doses associated with abuse
QT prolongation, torsades de points, cardiac arrest

80
Q

Is kaolin recommended for acute diarrhoea?

A

No

81
Q

What role do antacids play in dyspepsia?

A

Symptomatic relief

82
Q

What is a side effect of magnesium?

A

Laxative effect

83
Q

What is a side effect of aluminium?

A

Constipation

84
Q

Why is bismuth containing antacids not recommended ?

A

Neurotoxic, causing encephalopathy, tends to be constipating

85
Q

What are the side effects associated with calcium containing antacids?

A

Can induce rebound acid secretion
Hypercalcaemia
Alkalosis
Constipation

86
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

87
Q

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

A

7 day course

PPI, choice of two: amoxicillin and clarithromycin or metronidazole

88
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

89
Q

H.Pylori treatment:

What antibiotics are prone to resistance during the course?

A

Clarithromycin and metronidazole

90
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

91
Q

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

A

Tinidazole

92
Q

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

What would be an alternative?

A

300mg BD

Misoprostol

93
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

94
Q

What is sucralfate used for?

A

Gastric/duodenal ulceration
Gastritis
Prophylaxis of stress ulceration

95
Q

What is the main caution with sucralfate?

A

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

96
Q

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

A

PPIs as they are more effective

97
Q

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

A

Ranitidine

98
Q

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

A

PPI

99
Q

What is the MHRA warning associated with PPIs?

A

Risk of subacute lupus erythematosus
Patients may present with skin lesions, especially in sun-exposed areas of the skin along with athralgia (pain in joint).

If they develop lesions - Should counsel them to avoid exposing the skin to sunlight and consider discontinuing (as symptoms resolve after withdrawing medicine)

100
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

101
Q

What 2 electrolytes can drop if on PPIs?

A

Sodium and magnesium

102
Q

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

A

PPIs

103
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

104
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

105
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
106
Q

When would you give a pregnant lady omeprazole for GORD?

A

Severe or complicated reflux disease.

107
Q

How should a child with oesophagitis be treated?

A

H2 receptor antagonist

If this does not work, omeprazole

108
Q

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

A

Sodium cromoglicate

109
Q

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

A

Chlorphenamine

110
Q

Buscopan contains what active ingredient?

A

Hyoscine butylbromide

111
Q

Kwells contains what active ingredient?

A

Hyoscine hydrobromide

112
Q

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

A

Can cause serious side effects such as tachycardia, hypotension, anaphylaxis (which is likely to be fatal in patients with CHD)

It is therefore contraindicated in patients with tachycardia and should be used in caution in those with cardiac disease

113
Q

What is cholestasis?

A

An impairment of bile formation and/or bile flow

114
Q

What is the drug of choice for cholestatic pruritus?

A

Colestyramine

115
Q

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

A

Ursodeoxycholic acid

116
Q

Can you give NSAIDs in patients with symptomatic gallstones?

A

Yes

117
Q

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

(progressive destruction of bile ducts within the liver)

A

Ursodeoxycholic acid

118
Q

What is the MHRA alert associated with obeticholic acid?

A

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

119
Q

What is used for oesophageal varice bleeding?

A

Terlipressin

Vasopressin

120
Q

Orlistat is licensed in patients with what BMI?

A

BMI of 30

or BMI of 28 in the presence of other risk factors

121
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

122
Q

How does Orlistat work?

A

Lipase inhibitor so reduces absorption of dietary fat

123
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

124
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

125
Q

When would an anal fissure be classed as chronic?

A

6 weeks or longer

126
Q

What topical preparation can be used in acute anal fissures?

A

Local anaesthetic e.g. lidocaine

127
Q

What topical preparation can be used in chronic anal fissures?

A 
GTN rectal ointment 
Diltiazem ointment
Nifedipine ointment
(Unlicensed)
128
Q

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

A

Bulk forming

129
Q

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

A

Opioids as they cause constipation

130
Q

What pain relief class of medicines should be avoided in patients with rectal bleeding?

A

NSAIDs

131
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

132
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

133
Q

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

A

Bulk forming

134
Q

Are topical haemorrhoidal preparations licensed in pregnancy?

A

No

135
Q

How do you manage exocrine pancreatic insufficiency?

A

Pancreatin - contains lipase, amylase and protease

136
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

137
Q

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

A

Laxative effects

138
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.

139
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

140
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.

141
Q

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

A

To avoid osmotic diarrhoea

142
Q

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

A

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

143
Q

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

A

10-14 days

144
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.

145
Q

What colour does your urine turn if on sulfasalazine?

A

Yellow/orange

146
Q

What age is Mintec peppermint capsules licensed for?

A

> 18 years

147
Q

What age is Colpermin peppermint capsules licensed for?

A

> 15 years

148
Q

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

A

Lipoid pneumonia

Granuloma

149
Q

What is the MHRA advice surrounding PPIs?

A

Very low risk of subacute cutaneous lupus erythematosus
Drug-induced SCLE can occur weeks, months or even 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

150
Q

What antiplatelet interacts with omeprazole?

A

Clopidogrel

151
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.

152
Q

What are some counselling points for taking antacids?

A

They are best taken when symptoms occur or are expected, usually
between meals or at bedtime.

They should 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 hypertension.

153
Q

What is the advice given to patients around taking Pancreatin?

A

It is important to ensure adequate hydration at all times in patients receiving higher-strength pancreatin preparations.

Pancreatin is inactivated by gastric acid therefore manufacturer advises pancreatin preparations are best taken with food (or immediately before or after food).

Enteric-coated preparations deliver a higher enzyme concentration in the duodenum- Manufacturer advises gastro-resistant granules should be mixed with slightly acidic soft food or liquid such as apple juice, and then swallowed immediately without chewing

154
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

155
Q

What are long term complications of ulcerative colitis?

A

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

156
Q

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

A

Toxic megacolon

157
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

158
Q

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

A

Yes

159
Q

What is the patient counselling with aminosalicylates?

A

Report any unexplained bleeding, bruising

Salicylate hypersensitivity e.g. itching, hives

Yellow/orange bodily fluids - may stain contact lenses

160
Q

What is the interaction between lactulose and mesalazine?

A

The manufacturers of some mesalazine gastro-resistant and modified-release medicines suggest that preparations that lower stool pH (e.g. lactulose) might prevent the release of mesalazine.

161
Q

What are the red flag symptoms of constipation?

A

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

162
Q

True or false:

Excessive use of stimulant laxatives causes hyperkalaemia

A

False- causes hypokalaemia

163
Q

What kind of laxative is co-danthramer?

A

Stimulant

164
Q

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

A

Bulk forming

165
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)

166
Q

What is a side effect of calcium salt antacids?

A

Can induce rebound acid secretion and constipation

167
Q

What classes of drugs do antacids interact with?

A

Tetracyclines
Quinolones
Bisphosphonates

168
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

169
Q

What PPI is safe in pregnancy?

A

Omeprazole

170
Q

Is Cimetidine an enzyme inducer or inhibitor?

A

Enzyme inhibitor

171
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.

172
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

173
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
174
Q

Do antimuscarinics cause dry eyes?

A

No

175
Q

When should pancreatin be given and why?

A

Immediately before meals as pancreatin is inactivated by gastric acid

176
Q

True or false:

Enteric coated pancreatin delivers higher pancreatin levels

A

True

177
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

178
Q

How often is the PPI dosing in H Pylori treatment?

A

BD

179
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

180
Q

What is coeliac disease?

A

It is a autoimmune condition= chronic inflammation of the small intestine

181
Q

What is coeliac disease caused by?

A

Gluten= rye, wheat and barley

182
Q

What are symptoms of coeliac disease?

A

Diarrhoea, bloating and abdominal pain

183
Q

Treatment of coeliac disease

A

Avoid gluten

Prednisolone in refractory coeliac disease

184
Q

What is diverculosis and treatment?

A

Asymptomatic
Forms diverticula= small pouches protruding from large intestine

Treatment
Bulking forming laxatives if they have constipation

185
Q

What is acute diverticulitis

A

Sudden inflammation of diverticula

Can be infected = pain, fever, rectal bleeding

186
Q

What is complicated acute diverticulitis

A

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

187
Q

What is treatment for acute diverticulitis

A

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

188
Q

What is treatment for complicated acute diverticulitis

A

Hospital

189
Q

What is not recommended in complicated acute diverticulitis

A

Aminosalicylates and propylactic antibacterials

Pre-reg exam 2019 (21 decks)

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