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Pre-reg Exam 2021 > Disorders Of Gastric Acid Amd Ulceration > Flashcards

Disorders Of Gastric Acid Amd Ulceration Flashcards

1
Q

What are the symptoms of dyspepsia?

A 
Upper abdominal pain
Fullness
Early satiety
Bloating
Belching
Nausea
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2
Q

What causes dyspepsia?

A

Indigestion
GORD
Gastritis
Gastric or duodenal ulcers

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3
Q

What symptoms need urgent endoscopic referral?

A

Anaemia
Loss of weight
Anorexia
Recently changed, unexplained new dyspepsia in 55+ unresponsive to treat,met
Malaena, dysphagia, haematemesis, recurrent vomiting

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4
Q

What do you use to treat uninvestigated dyspepsia?

A

Antacids
PPI for 4 weeks if symptoms persist

H. Pylori test if unresponsive to PPI

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5
Q

What do you use for investigates functional dyspepsia?

A

H. Pylori test

PPI or H2 antagonist for 4 weeks

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6
Q

How do antacids work?

A

Neutralises stomach acid

Provides immediate symptom relief in 15-30 mins

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7
Q

How do the alginates work?

A

Forms viscous gel raft on top of stomach contents to prevent reflux

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8
Q

What are the antacids?

A 
Aluminium salt - constipating 
Calcium salt
Magnesium salt - laxatimg
Potassium salt
Sodium salt
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9
Q

Which antacids have low sodium?

A

Maalox
Mucogel

Altacite plus

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10
Q

What are the alginates?

A

Albinos acid

Sodium alginate

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11
Q

How do you take antacids?

A

After each main meal and at bedtime when required

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12
Q

What are the antacid interactions that impair the absorption of drugs?

A

Tetracyclines
Quinolones
Bisphosphonates

Leave a 2 hour gap

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13
Q

What are the antacid interactions?

A

Damage enteric coatings by increasing gastric pH

High sodium content - fluid retention, avoid in hypertension, heart, liver or kidney failure

Avoid in sodium restricted diet e.g. lithium

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14
Q

How do PPIs work?

A

Inhibits gastric acid secretion by blocking hydrogen-potassium ATPase of the gastric parietal cell

It is the most effective antisecretory drug

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15
Q

What are the PPIs?

A 
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
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16
Q

Which PPI needs to be taken 30-60 mins before food?

A

Lansoprazole

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17
Q

What PPI is safe in pregnancy?

A

Omeprazole

18
Q

How do you take PPIs?

A

Swallow whole

Do not crush

Do not take indigestion remedies 2 hours before or after you take this medicine

19
Q

What is the dose for PPIs?

A

Lowest effective dose for shortest period

20
Q

What are the side effects of PPIs?

A

GI upset

Hypomagnesaemia
Fractures
Rebound acid secretion, protracted dyspepsia

21
Q

What is the MHRA advice for PPIs?

A

Very low risk of subacute cutaneous lupus erythematosus

Avoid sun exposure

22
Q

What are the interactions with omeprazole?

A

Clopidogrel- reduced antiplatelet effect

Methotrexate- decreased clearance of methotrexate

23
Q

How do H2 receptor antagonists work?

A

Reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell

Antisecretory drug

24
Q

What are the H2 receptor antagonists?

A

Cimetidine - enzyme inhibitor
Famotidine
Nizatidine
Ranitidine

25
Q

What are the side effects of the H2 antagonists?

A 
Headaches
Rashes
Dizziness
Diarrhoea 
Psychiatric reactions
26
Q

What are the cautions in H2 receptor antagonists?

A

Masks symptoms of gastric cancer

27
Q

Can misoprostol be used in pregnancy?

A

No. Teratogenic

28
Q

Can misoprostol be used in duodenal ulceration?

A

Yes

29
Q

What are the side effects of misoprostol?

A

Colic and diarrhoea are dose limiting side effects

Diarrhoea is common and can occasionally be severe and require withdrawal

30
Q

Can sucralfate be used in duodenal ulcers?

A

Yes

31
Q

What are the side effects of sucralfate?

A

Bezoar formation

1 hour before meals / 1 hour gap between enteral feeds

32
Q

What is used to treat H. Pylori ulcers?

A

1 week triple therapy

PPI BD + Clarithromycin + amoxicillin or metronidazole

33
Q

If a patient is penicillin allergic how do you treat H. Pylori?

A

PMC

PPI
Metronidazole
Clarithromycin

34
Q

If a patient has recently been treated with a macrolide how do you treat H. Pylori?

A

PPI
Amoxicillin
Metronidazole

35
Q

If a patient has recently been treated with metronidazole how do you treat H. Pylori?

A

PPI
Amoxicillin
Clarithromycin

36
Q

How do you treat NSAID induced ulcers?

A

Withdraw NSAID

PPI or H2 antagonist/misoprostol

37
Q

What do you use for prophylaxis of NSAID induced ulcers?

A

PPI if at risk

PPI with cox-2 selective NSAID

38
Q

How do you treat mild GORD symptoms?

A

Antacid + alginate

H2 receptor antagonists/PPI

39
Q

How do you treat severe symptoms of GORD?

A

PPI for 4-6 weeks

40
Q

How do you treat GORD in pregnancy ?

A

Antacids or alginates

Omeprazole for complicated GORD

41
Q

How do you treat GORD in children?

A

Common in infant and resolves after age 12-18 months

Mild-moderate GORD thickened feeds or alginates

42
Q

How do you diagnose H. Pylori?

A

C-urea breath test kits

Do not perform test within 4 weeks of antibacterial
Or 2 weeks treatment with antisecretory drug

Pre-reg Exam 2021 (79 decks)

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