Drugs used in Gastro-intestinal tract

Question 1

Aminosalicylates, anti-inflammatory drugs used in ulcerative colitis, eg sulfasalazine, mesalazine

Answer 1

REPORTING: Blood dyscrasias- sore throat, fever, rash, ulcers, bleeding

Mesalazine: switching brands- advise to report any changes in symptoms

Sulfasalazine: colours body fluids orange/yellow

Question 2

Liquid paraffin- used as a lubricant for constipation

Answer 2

Not really recommended any more

Anal irritation, seepage of paraffin after prolonged use

Question 3

Sucralfate- used for gastric ulcers and gastritis

Answer 3

BEZOAR formation- stone like mass found in GI system

Caution especially in critically ill patients in intensive care or with enteral feeds

Question 4

Pancreatin- mixtures of enzymes used to aid digestion- CREON

Answer 4

Advise patients to maintain adequate hydration at high doses
Also advise that the capsules should be swallowed whole and not chewed due to an enteric coating.
Used in Cystic fibrosis

Question 5

Magnesium containing antacids can have opposite side effects to those containing aluminium

Answer 5

Magnesium containing = laxative effects (diarrhoea)

Aluminium containing= constipation effects

Question 6

Antimuscarinics e.g. atropine, hyoscine butylbromide (buscopan) used to reduce gastric motility

Answer 6

Caution- use in DOWNS SYNDROME

Antimuscarinc side effects: (same as anticholinergic): 
Constipation
Dry mouth 
Urinary retention 
Dry skin 
Transient bradycardia

Question 7

Proton pump inhibitors can cause electrolyte disturbance

Answer 7

Hyponatreamia (reduced sodium)

Question 8

Side effects of the antidiarrhoeal drug loperamide

Answer 8

Flatulence!
Nausea
Headache

Question 9

Side effects of bulk forming laxatives? Eg isoaghula husk (fybogel)

Answer 9

Flatulence
Abdominal distension (bloating)
These swell in contact with liquid and therefore advise to take with plenty of water and not to take immediately before bed

Question 10

Stimulant laxatives side effects
Eg. Senna
Docusate sodium
Bisacodyl

Answer 10

Abdominal cramps
Diarrhoea if used in excess
Often abused to lose weight

Question 11

Osmotic laxative e.g. lactulose, macrogols (movicol)

Increases water in the large bowel

Answer 11

Need patient to drink adequate amount of water for them to work
Can take 3 days to work
Nausea, vomitting, cramps, bloating, flatulence all side effects

Question 12

What do the words “low Na+” on antacid preparations indicate?

Answer 12

Sodium content of less than 1mmol per tablet or 10ml dose. This is written on for people with hypertension

Question 13

Should antacids be taken at the same time as other drugs?

Answer 13

No as this may impair absorption

They can also damage the enteric coating on tablets

Question 14

When should PPIs be taken?

Answer 14

At least 30 mins before food for optimal absorption

Question 15

What drug, used for GI ulcers, should be avoided in all trimesters of pregnancy and in women of a child bearing age unless absolutely necessary?

Answer 15

Misoprostol

Used for NSAID induced ulcers

Teratogenic

Question 16

Safest PPI in pregnant women?

Answer 16

Omeprazole- only one not known to be harmful

H2 antagonists should be avoided

Question 17

Diarrhoea advice in a pregnant woman?

Answer 17

Cannot give loperamide

ORT can be used

Question 18

Safest laxative in pregnant women?

Answer 18

Bulk forming laxatives most appropriate- ispaghula husk I.e. Fybogel
Lactulose probably not harmful
Avoid stimulants and macrogols

Question 19

Haemorrhoids in pregnant woman

Answer 19

Avoid steroid based preparations- e.g. Preparation H containing hydrocortisone

Local therapies may be used: germaloids cream or ointment or suppositories but NOT the spray

Question 20

Which antiemetic drug can be purchased over the counter?

Answer 20

Cyclizine (antihistamine)

Metoclopramide and Domperidone no longer OTC: Metoclopromide risk in Parkinsons, Domperidone with QT prolongation effects so cardiac risks.

Can recommend Peptobismol to settle stomach but not very nice, and travel sickness tablets available.

Question 21

What laxative and what anti-emetic are recommended for use in terminally ill patients?

Answer 21

Laxative- co-danthromer/ co-danthrusate (can colour urine red)

It is locally irritant- avoid contact with skin

Anti-emetic: Ondansetron, Haloperidol- these are good for opioid induce N&V.
(Haloperidol also used first line for delirium in palliative care- this is very common)

Question 22

Which laxative should be used where there is faecal impaction?

Answer 22

impacted colon, your feces become dry and won’t budge, making it impossible to excrete them from your body

Should therefore use the OSMOTIC laxative to get water into the stool: MACROGOL (movicol) is used

Question 23

What is the most common side effect of VERAPAMIL (rate limiting CCB)?

Answer 23

Constipation!
Does not appear to be an issue with any of the other CCB’s just Verapamil

Verapamil has a more profound effect on gut smooth muscle than the other calcium channel antagonists. It reduces gut motility and causes constipation.

Question 24

When is metoclopromide contraindicated for treating sickness?

Answer 24

3 - 4 days after Gastrointestinal surgery
GI heamorrhage
GI obstruction
Under 18 years due to neurological effects

Question 25

Which laxatives do we use in opioid induced constipation/ immobility (e.g. due to hospital stay)?

Answer 25

Regular LACTULOSE

PLUS SENNA PRN/ REGULAR!!

Question 26

What is Colestipol? When should other medications be taken in relation to this drug?

Answer 26

A bile acid sequestrant used to lower cholesterol (LDL specifically)

Take other medication 1 hour before or 4 hours after this medication as it can effect absorption

Question 27

Abdominal pain
Vomiting
Bloating
Constipation 
Diarrhoa

Which one is not a typical symptom of IBS?

Answer 27

Vomiting