Drugs for abdominal pain 2

Question 1

List the SE, DI for Metoclopramide

Answer 1

Metoclopramide
* IBS: Off label use
* SE: CNS; drowsiness, fatigue, dizziness, weakness, abdominal cramps & diarrhoea !!
Extrapyrimidal effects in elderly and children
* DI: antipsychotics, CNS depressants, alcohol

Question 2

What is inflammatory bowel disease

Answer 2

A chronic inflammatory disorder of the gastrointestinal tract that includes both Crohn’s disease (CD) and ulcerative colitis

Question 3

Name the signs and symptoms for Inflammatory disease

Answer 3

S&S: Abdominal pain, rectal bleeding, diarrhoea and weight loss characterise both CD and ulcerative colitis.

Question 4

When to refer the patient with Inflammatory bowel disease

Answer 4

REFERRAL
All patients with a potential diagnosis of Crohn’s disease or ulcerative colitis, should be discussed with a specialist

Question 5

Mainstay of therapy in mild to moderate cases of ulcerative colitis (more effective if the colon is involved for Chron’s disease)
Acute attacks and relapses prevented by which drugs?

Answer 5

Sulfasalazine
Mesalazine

Question 6

Sulfasalazine is split by what?

Answer 6

Split by colonic bacteria into sulfapyridine and 5-aminosalicylic acid (5- ASA, mesalazine). 5-ASA believed to be responsible for beneficial effect.

Question 7

PKS for sulfapyridine and 5-ASA

Answer 7

Sulfapyridine absorbed, metabolised in the liver and excreted via the urine.
* Most of 5-ASA eliminated unchanged in the faeces

Question 8

Contraindications for Sulfasalazine

Answer 8

Contraindications:
sulfa or salicylate allergy, existing gastric / duodenal ulcers

Question 9

Prescriber’s point for sulfasalazine

Answer 9

Prescriber’s points:
* Monitor blood counts, hepatic function, urea and electrolytes with chronic therapy
* GI adverse effects can be alleviated by a drug holiday and starting at a lower dose
* Gastric irritation may be minimised by taking after meals, full glass of water, enteric coated tablets
* Report sore throat, fever or easy bruising – indicated heamotologic abnormalities (thrombocytopenia, granulocytopenia, red cell haemolysis