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BNF gastrointestinal system > Disorders of gastric acid and ulceration > Flashcards

Disorders of gastric acid and ulceration Flashcards

1
Q

Symptoms of dyspepsia

A

upper abdominal pain, reflux, bloating, heartburn, nausea/vommiting

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2
Q

Dyspepsia symptoms in pregnancy are often due to what?

A

GORD

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3
Q

Non drug treatment of dyspepsia

A
  • healthy eating
  • weight loss
  • avoiding trigger food
  • small meals
  • eating 3 to 4 hours before going to bed
  • raising head of bed
  • smoking cessation
  • reducing alcohol
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4
Q

Red flag dyspepsia symtoms

A

GI bleed, unexplained weight loss, >55, Dysphagia

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5
Q

What drugs can cause dypepsia

A

Antimuscarinics, alpha blockers, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCB, corticosteroids, nitrates, NSAIDS, theophyllne, TCA

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6
Q

What should patients with dyspepsia be tested for?

A

H pylori

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7
Q

First line treatment for uninvestigated dyspepsia

A

PPI for 4 weeks

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8
Q

What do magnesium / aluminium containing antacids do to bowel habit?

A 
Magnesium = diarrhoea 
Aluminium = constipating
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9
Q

What is the issue with calcium continaing antacids?

A

can induce rebound acid secretion, hypercalcaemia, alkalosis, preciptiate milk-alkali syndrome

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10
Q

What symptom does simeticone relieve?

A

Flatulence

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11
Q

What is the brand name for sodium alginate + potassium bicarb?

A

Gaviscon advancew

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12
Q

What is the dose of simeticone in children 1 month - 1 year with colic?

A

Dentinox: 2.5mL to be taken with/after feed; max 6 doses a day
Infacol: 0.5-1mL to be taken before feeds

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13
Q

Two brand names of simeticone`

A

Infacol + dentinox

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14
Q

What risk factors contribute to a patient being high risk of developing gastric ulcers?

A
  • NSAIDS (high dose)
  • > 65
  • other drugs that inc. GI risks
  • co morbidities (CVD, HTN, diabetes)
  • heavy smoker
  • excessive alchol
  • prolonged duration of NSAIDS
  • H pylori
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15
Q

If a gastric ulcer develops due to NSAID use, what shiuld be done to treat it?

A
  • PPI for 8 weeks
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16
Q

How long after starting H pylori eradicatin treatment should a patient be reviewed?

A

6 - 8 weeks

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17
Q

What type of NSAID causes the LEAST GI risk

A

COX 2 inhibitors

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18
Q

Why cant bismuth subsalicylate be used in chidren <16

A

reye syndrome risk

19
Q

What is a caution with sucrafalte use?

A

Bezoar formation - caution in those on enteral feeds concomitantly + predisposing conditions e.g. delayed gastric emptying

20
Q

How long should the gap between enteral feed administration + sucralfate be?

A

1 hour

21
Q

Why should’nt H2 receptor antagonists be used for zollinger-ellison syndrome?

A

PPI are more effective

22
Q

What can H2 antagonsits mask the synptoms of?

A

gastric cancers

23
Q

Cimetidine can be sold OTC to patients above what age?

A

16 (provided not more than 2 week supply if sold)

24
Q

Dose of cimetidine (single dose) for nocturnal heartburn

A

100mg

25
Q

Oral preparations of Ranitidine are not licensed for children under what age?

A

3

26
Q

When rantidine is sold OTC what is the max single dose that can be given?

A

75mg (max total daily dose of 300mg)

27
Q

Example of a synthetic prostaglanding analgoue that has antisecretory properties used to help heal gastric ulcers

A

misoprostol

28
Q

what drug class can be used for endoscopic treatment of severe peptic ulcer bleeding?

A

PPI (IV)

29
Q

What condition can PPIs be used for the reduce degradtion of pancreatic enzyme supplements?

A

Cystic fibrosis

30
Q

What is the MHRA warning alert associated with PPIs

A

small risk of SLE

31
Q

What are some cautions of PPI use?

A

1) mask symptoms Gastric cancers
2) risk of osteoporosis
3) Risk of c.diffe

32
Q

Is hypomagnesmia common immediately after starting PPIS?

A

no - usually occurs after 1 year of treatment

33
Q

What electrolyte should be monitored when using PPI therapy

A

magensium ( + sodium(

34
Q

What strength of omeprazole can be sold OTC to adults > 18years

A

10mg caps

35
Q

Pantoprazole 20mg capsules can be sold OTC to what age group

A

> 18

36
Q

complications of GORD

A

ulceration, oesophageal strictures, haemorrhage, aneamia due to chronic blood loss, aspiration pneumonia, barretts oesophageous

37
Q

Sodium alginate wiht calcium carbonate and sodium bicaroate brand names

A

Peptac, Gaviscon, Rennie

38
Q

What patients should be tested for H pylori

A

1) pt with uncomplicated dyspepsia and no alarm sx who are unresponsive to lifestyle change + 1/2 months of PPI
2) Pt at high risk (older, North African)
3) History of peptic bleed/ulcers
4) Prior to initiating NSAIDS in pt with history of ulcer
5) Pt with unexplained iron deficiency anaemia

39
Q

What tests can be used for h pylori

A

Urea C13 breath test, stool H pylori antigen (SAT) or laboratory based serology

40
Q

PHE recomends that C13 breath test / SAT should not be performed in what circumstance?

A

within 2 weeks of treatment wiht PPI or 4 weeks of an antibiotic (leads to false negatives)

41
Q

What drug classes are used for H pylori eradication

A

1 PPI + 2 antibiotics

42
Q

First line oral therapy for treatment of h pylori

A

PPI + amoxicillin and either clarithromycin or metronidazole for 7 days

43
Q

If a patient with h pylori has recently had both clarithromycin and metronidazole, what other antibiotic can be tried?

A

tetracycline

44
Q

If a patient has a penicillin allergy, what regime should be given for H pylori eradication

A

PPI + metro + clari for 7 days

BNF gastrointestinal system (8 decks)

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