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PHAY00010 > Clinical Pharmacy III > Flashcards

Clinical Pharmacy III Flashcards

IBS, IBD, Coeliac Disease

1
Q

ABC of IBS =

A

Abdominal pain or discomfort

Bloating

Change in bowel habit

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2
Q

Characteristic of the change in bowel habit of IBS.

A

Diarrhoea episodes after a constipated period

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3
Q

Symptoms of IBS

A

Abdominal pain or discomfort

Bloating

Diarrhoea episodes after a constipated period

Worse with eating -> can identify causative food

Rectal mucus, no dark blood

Legarthy, nausea (limit vomitting)

Back pain, headahces and baller problems

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4
Q

Blood test result of IBS

A

Normal full blood count

Normal ESR and CRP levels

Negative IgAtTGA

Histology result normal

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5
Q

How is IBS diagnosed?

A

Presence of ABCs for at least 6 months

Blood test and history test

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6
Q

What diet of IBS patients should be monitored?

A

Fibre intake

Avoid eating insoluble fibre, encourage highly soluble fibre

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7
Q

How is IBS treated?

A

Focus on control symptoms rather than treating the cause

Lifestyle advice is important

Pharmacological therapy

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8
Q

What drugs are used to manage the symptoms of IBS?

A

Consider antispasmodic agents

Consider laxatives

Consider loperamide or bulk-forming agents

Adjust dose according to response (stool consistency)

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9
Q

Give examples of some antispasmodic agents used for IBS.

A

Hyoscine

Mebeverine

Alverine

Peppermint oil

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10
Q

What laxatives should be avoided in IBS?

A

Lactulose - exacerbate bloating

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11
Q

Aim of IBS management

A

Well-formed stool - type 4 class in Bristol stool form scale

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12
Q

Risk factors of coeliac disease.

A

Genetics

Autoimmune conditions like T1DM or autoimmune thyroid disease

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13
Q

Causes of coeliac disease

A

Autoimmune conditions

Immune response to gluten

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14
Q

Pathology of coeliac disease

A

Chronic inflammation -> damage to lining of small intestines

Reduced villie surface areas -> reduced absorption of nutrients

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15
Q

Complications associated with coeliac disease

A

Cancer - higher risk of mutations

Anaemia

Osteoporosis - insufficient of Ca and vitD absorbed

Dermatitis herpetiformis

Other autoimmune disorders related to liver and thyroids

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16
Q

What is dermatitis herpetiformis?

A

Skin conditions

Characteristics of symmetrical outburst

Any locations on body

Red raised skin patches and lesions

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17
Q

How can coeliac disease can cause osteoporosis?

A

Malabsorption of vit D and calcium ions

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18
Q

Symptoms of coeliac disease

A

Persistent and unexplained GI symptoms

Steatorrhoea (diarrhoea with fat secretion)

Prolonged fatigue

Unexplained weight loss

Severe or persistent mouth ulcers

T1DM

Autoimmune thyroid disease

First-degree relative with coeliac disease

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19
Q

Explain why mouth ulcers are present in coeliac disease

A

suggested to be due to malnutrition, immyne system activation and inflammation

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20
Q

What results of blood tests and histology that can confirm coeliac disease?

A

Positive results of IgA and IgATGA

Low inflammatory marker

Histology confirm a villous atrophy of intestinal mucosa

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21
Q

What is the distinctive characteristic of coeliac disease?

A

Histology and biopsy confirm villous atrophy of intestinal mucosa

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22
Q

What cautions should be taken during diagnosis of coeliac disease?

A

Patients should maintain normal diet until after diagnosis

MUST NOT exclude gluten during this time

23
Q

Management of coeliac disease.

A

Long-term adherence to a gluten-free diet

24
Q

What food must coeliac patients avoid?

A

Based on wheat, barley and rye - bread, flour, cakes, pastries and biscuit

Contain wheat, barley or rye as fillers of flavouring - sausage, ready meals, soup, some sauces

Can be contaminated with gluten - oats, items fried in the same oil

Dietery itmes that contain malt - beers`

25
Q

Two most common forms of IBD

A

Crohn’s Disease

Ulcerative Colitis

26
Q

Crohn’s disease and ulcerative colitis, which one is more common?

A

Ulcerative colitis are twice more common

27
Q

What are the three types of ulcerative colitis?

A

Extensive colitis - continous infallamtion of whole colon

Distal colitis - inflammation of descending colon and rectum

Procitis - inflammation of rectal lining

28
Q

Inflammation pattern of Crohn’s Disease

A

Not continous, patched through the whole GI tract

29
Q

Differences between inflammatory characteristic of ulcerative colitis and Crohn’s disease

A

Ulcerative colitis: only at mucosal level

Crohn’s disease: inflammation of full thickness of bowel wall

Can be confirmed by histology

30
Q

Stool pattern between ulcerative colitis and Crohn’s disease

A

Ulcerative colitis: Diarrhoea more severe - always have blood, mucus and pus

Crohn’s disease: Steatorrhoea or containing blood or constipated

31
Q

Extraintestinal abdominal features in ulcerative colitis and Crohn’s disease

A

Ulcerative colitis: none

Crohn’s disease: fatty liver, renal stones or adhesion

32
Q

Development of fistulas in ulcerative colitis and crohn’s disease:

A

ulcerative colitis: absence

crohn’s disease: present

33
Q

Onset of symptoms - ulcerative colitis and crohn’s disease

A

ulcerative colitis: sudden, occassionally severe

crohn’s disease: slow and steady, can be acute

34
Q

Pain sensation - ulcerative colitis and crohn’s disease

A

ulcerative colitis: lower abdominal pain + moderate-to-severe, with fever and tachycardia

crohn’s disease: collicky, like appendicitis

35
Q

Mouth ulcers - ulcerative colitis and crohn’s disease

A

ulcerative colitis: rarely

crohn’s disease: common

36
Q

Perianal abscesses - ulcerative colitis and crohn’s disease

A

ulcerative colitis: absence

crohn’s disease: present

37
Q

Complications - ulcerative colitis and crohn’s disease

A

Both have similar complications: affect eyes, joints, skin, spine, fatty liver

Crohn’s disease: gallstones, renal stones and fistula development

38
Q

Risks factors of IBD.

A

Smoking (suggested)

Family history

Appendectomy

Use of NSAIDs and oral contraceptive pills (suggested)

39
Q

Principles of IBD management

A

Induce and maintain remission

Nutrition supply

Pain relief

Symptomatic control of constipation and diarrhoea

Manage fatigue

Surgery for fistula and abscesses

Treat dyspepsia (if present)

40
Q

What drugs are given for pain relief of IBD?

A

1st-line: paracetamol

2nd-line: can add opioids, but required specialist

Must not use NSAIDs

41
Q

What drug that must not be given to control symptom of IBD?

A

Loperamide cannot be used in Crohn’s disease

Risk of developing toxic megacolon (severe inflammation and dilation of colon) - life-threatening

42
Q

Pharmacological treatment of Crohn’s disease (NICE guidelines)

A

To induce remission:
1st-line: Monotherapy of prednisolone, methylprednisolone or IV hydrocortisone

2nd-line: budesonide or 5-ASA agents (sulfazadine, mesalazine)

3rd-line: add azathioprine or mercaptopurine

4th-line: add methotrexate

5th-line: biological therapy like infliximab or adalimumab

To maintain remission:
1st-line: azathioprine or mercaptopurine

2nd-line: methotrexate

43
Q

What tools are used to assess the classification of ulcerative colitis to manage?

A

Truelove and Witt’s severity index

44
Q

What are the four classes of ulcerative colitis used to dictate the management?

A

Mild-moderate proctitis

Mild-moderate protosigmoiditis + left-sded ulcerative colitis

Mild-moderate extensive colitis

Acute severe ulcerative colitis

45
Q

Pharmacological treatment - mild-to-moderate proctitis

A

To induce remission:
1st-line: topical 5-ASA,
(If not achieved within 4 weeks: add oral 5-ASA)

2nd-line: add topical corticosteroid or PO prednisolone

If develop to moderate-to-severe: introduce immunotherapy and biologicals

To maintain remission:
- Topical 5-ASA
- PO 5-ASA + topical 5-ASA
- PO 5-ASA

If not work:
1st-line: oral azathioprine OR oral mercaptopurine

2nd-line: oral 5-ASA

46
Q

Pharmacological treatment - mild-to-moderate proctosigmoiditis.

A

To induce remission:
1st-line: topical 5-ASA,
(If not achieved within 4 weeks: add oral 5-ASA)

2nd-line: add topical corticosteroid or PO prednisolone

If develop to moderate-to-severe: introduce immunotherapy and biologicals

To maintain remission:
- Topical 5-ASA
- PO 5-ASA + topical 5-ASA
- PO 5-ASA

If not work:
1st-line: oral azathioprine OR oral mercaptopurine

2nd-line: oral 5-ASA

47
Q

Pharmacological treatment - mild-to-moderate left-sided ulcerative colitis.

A

To induce remission:
1st-line: topical 5-ASA,
(If not achieved within 4 weeks: add oral 5-ASA)

2nd-line: add topical corticosteroid or PO prednisolone

If develop to moderate-to-severe: introduce immunotherapy and biologicals

To maintain remission:
low maintenance PO 5-ASA

If not work:
1st-line: oral azathioprine OR oral mercaptopurine

2nd-line: oral 5-ASA

48
Q

Pharmacological treatment - mild-to-moderate extensive ulcerative colitis.

A

To induce remission:
1st-line: topical 5-ASA + high dose PO 5-ASA
(If not achieved within 4 weeks, use high dose PO + oral steroid)

2nd-line: oral prednisolone

If develop to moderate-to-severe: introduce immunotherapy and biologicals

To maintain remission:
low maintenance PO 5-ASA

If not work:
1st-line: oral azathioprine OR oral mercaptopurine

2nd-line: oral 5-ASA

49
Q

Pharmacological treatment - mild-to-moderate acute severe ulcerative colitis.

A

Admit to hospital + MDT meetings to see need surgery

To induce remission:
1st step: IV corticosteroids -> if not possible, IV ciclosporin OR surgery

2nd step (after 72 hours): if no improvement -> IV corticosteroid + IV ciclosporin OR surgery

To maintain remission:
1st-line: oral azathioprine OR oral mercaptopurine

2nd-line: oral 5-ASA

50
Q

When will PO azathioprine or PO mercaptopurine be used to maintain remission of ulcerative colitis?

A

5-ASA not effective

2 or more exacerbation within 12 months that require systemic corticosteroid

51
Q

Describe the meaning and factors associated with Truelove and Witt’s severity index for ulcerative colitis

A

Check notes

52
Q

What are the special precautions for the use of azathioprine and mercaptopurine?

A

Assess thiopurine methyltransferase (TPMT) activity before giving

If deficient -> must not give

If low but NOT deficient -> low dose

53
Q

Why is rectal treatment suitable for IBD?

A

Suppository target rectum -> suitable for proctitis

Foam targets sigmoid colon -> suitable for proctosigmoiditis

Enema targets descending colon + distal part of transverse colon -> suitable for left-sided colitis.

PHAY00010 (4 decks)

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