g a s t r o p h a r m

Question 1

what are PPI’s name 3 and their indication

Answer 1

omeprazole
lansoprazole
pantoprazole

proton pump inhibitors

activated in acidic pH, irreversibily inhibit proton, potassium ATPase of the parietal cell

Question 2

what are the SE associated with PPI’s

Answer 2

GI disturbance

headache

Question 3

describe interactions of PPI’s

Answer 3

PPI’s = P450 inhibitor

Question 4

what caution is to be taken for PPI’s

Answer 4

1. can mask sx of gastric Ca

2. stop 2 weeks before endoscopy

Question 5

what are the adverse effects associated with PPI’s

Answer 5

1. hyponatraemia
2. hypomagnasaemia
3. osteoporosis → increased risk of fractures
4. microscopic colitis
5. increased risk of Clostridium difficile infections

Question 6

what drug type is Al hydroxide and describe the MOA

Answer 6

anti-acid

neutralised gastric acid

Question 7

side effect of AlOH

Answer 7

constipation

Question 8

what are the interactions for AlOH and caution

Answer 8

interferes with drug absorption so take separately

take when sx expected and when sx occur

Question 9

what is Mg trisilicate

Answer 9

antacid
same as Al hydroxide
side effect = diarrhoea instead of constipation
same caution as Al hydroxide

Question 10

what type of drug is ranitidine and what is its MOA

Answer 10

H2 receptor antagonist

reduced gastric parietal cell proton secretion

Question 11

what are side effects and interactions of H2RA

Answer 11

cimetidine = P450 inhibitor 
SE = GI disturbance esp in cimetidine

Question 12

what are the 4 groups of laxatives

Answer 12

1. bulk laxatives
2. stimulant
3. osmotic
4. stool softener

Question 13

what is the contraindication to use of laxatives

Answer 13

bowel obstruction

Question 14

give example of bulk laxative and MOA

Answer 14

ispaghula

increase faecal mass = increase peristalsis by triggering stretch receptors

Question 15

give example of stimulant laxative and mode of action

Answer 15

docusate
senna
glycerin PR

increases intestinal motility

Question 16

what drug type is gaviscon and MOA

Answer 16

alginate = reduces reflux by increasing viscosity of stomach contents, form raft on top of stomach contents

Question 17

give examine and MOA of osmotic laxatives

Answer 17

lactulose
macrogol
phosphates pr
Mg salts

increase stool water content

Question 18

example of stool softener and SE

Answer 18

liquid paraffin

SE = reduced ADEK vitamins
can have granulomatous reactions

Question 19

what drug type is mesalazine, give another example

Answer 19

5-ASA = 5-aminosalicylate

another example = sulfalazine

Question 20

what are the side effects of 5-ASA

Answer 20

sulfalazine has more SE

hepatitis
rash, urticaria
pulmonary fibrosis

Question 21

contraindications of use of 5-ASA’s

Answer 21

caution in renal or hepatic impairment

Question 22

other key points for 5 ASA’s

Answer 22

monitor FBC

topical use in distal disease

Question 23

what is budesonide, when is it used

Answer 23

steroid

used to induce remission in ileal Crohn’s

Question 24

what are the key points about budesonide

Answer 24

high first pass metabolism so reduced systemic effects

more potent than pred

Question 25

give examples of anti TNF drugs

and SE

Answer 25

infliximab
etanercept

severe infections, TB, CNS demyelination

Question 26

contraindications for anti TNF drugs

and key points

Answer 26

TB

screen for TB before parental use and give hydrocortisone to reduce SE

Question 27

describe how GORD is managed, review sx, lx, rx

Answer 27

refer to pharm notes

remember rx factors, sx, lx

Question 28

how is PUD managed

Answer 28

same as GORD

Question 29

describe H pylori eradication therapy

Answer 29

PAC 500
 PPI: lansoprazole 30mg BD
 Amoxicillin 1g BD
 Clarithromycin 500mg BD

PMC 250
 PPI: lansoprazole 30mg BD
 Metronidazole 400mg BD
 Clarithromycin 250mg BD

Question 29

describe H pylori eradication therapy

Answer 29

PAC 500
 PPI: lansoprazole 30mg BD
 Amoxicillin 1g BD
 Clarithromycin 500mg BD

PMC 250
 PPI: lansoprazole 30mg BD
 Metronidazole 400mg BD
 Clarithromycin 250mg BD

Question 30

describe the pathophysiology of H. pylori. how the organism is suited to survive

Answer 30

flagella = motility via chemotaxis to colonise under mucosa

exotoxins = cause gastric mucosal injury

urease = neutralise gastric acid and ammonia causes gastric mucosa injury

lipopolysaccharides = adhere to host cells and cause inflammation

outer proteins that allow it to adhere to host cell

Question 31

h. pylori how does it cause ulcer

Answer 31

leads to atrophy of gastric mucosa via inflammation

Question 32

which drugs should be stopped before H pylori testing

Answer 32

PPIs and cimetidine → false –ve C13 breath tests

and antigen tests  stop >2wks before.

Question 33

failure in H. pylori is due to? how can this be reduced

Answer 33

95% success
 Mostly due to poor compliance
 Add bismuth
 Stools become tarry black

Question 34

in crohn’s disease what is the acute management

Answer 34

Resus: Admit, NBM, IV hydration Hydrocortisone: IV + PR if rectal disease Abx: metronidazole PO or IV Thromboprophylaxis: LMWH
Dietician Review
 Elemental diet
 Consider parenteral nutrition Monitoring
 Vitals + stool chart  Daily examination

Question 35

if improving vs not improving after acute severe crohn’s attack what should be done

Answer 35

Improvement → oral therapy
 Switch to oral pred (40mg/d)

No Improvement → rescue therapy
 Discussion between pt, physician and surgeon
 Medical: methotrexate ± infliximab
 Surgical

Question 36

what supportive and drugs are used to induce remission in crohns

Answer 36

Supportive
 High fibre diet
 Vitamin supplements

Oral Therapy
 1st line
 Ileocaecal: budesonide
 Colitis: sulfasalazine
 2nd line: prednisolone (tapering)
 3rd line: methotrexate
 4th line: infliximab or adalimumab

Question 37

management of perianal disease in crohn’s

Answer 37

Occurs in ~50%

Ix: MRI + EUA Rx
 Oral Abx: metronidazole
 Immunosuppression ± infliximab  Local surgery ± seton insertion

Question 38

what drugs are used to maintain remission in crohns

Answer 38

1st line: azathioprine or mercaptopurine  2nd line: methotrexate
 3rd line: Infliximab / adalimumab

Question 39

indications for surgery in crohn’s

Answer 39

indications
 Abscess or fistula
 Perianal disease
 Chronic ill health
 Carcinoma

Question 40

no improvement after acute severe UC attack

Answer 40

Discussion between pt, physician and surgeon
 Medical: ciclosporin, infliximab or visilizumab
 Surgical

Question 41

what drugs are used to induce remission in UC

Answer 41

Oral Therapy
 1st line: 5-ASAs
 2nd line: prednisolone
 3rd line: ciclosporin or infliximab

Topical Therapy: mainly left-sided disease
 Proctitis: suppositories
 More proximal disease: enemas or foams
 5-ASAs ± steroids (prednisolone or budesonide)

Additional Therapy: steroid sparing  Azathioprine
 Infliximab: steroid-dependent pts

Question 42

drugs used to maintain remission in UC

Answer 42

1. 5-ASA PO sulfalazine or mesalazine
2. azathioprine
3. infliximab

Question 43

indications for surgery in UC

Answer 43

Chronic symptoms despite medical therapy

 Carcinoma or high-grade dysplasia

Question 44

what abx increase risk of c.diff

Answer 44

cephalosporins
clindamycin
as well as PPI’s

Question 45

what is the treatment for c.diff

Answer 45

10 days oral vancomycin if not severe - check WCC = first line first episode

second line = oral fidoxomicin

oral vancomycin with IV metronidazole if life threatening = third line

recurrent within 12 weeks = oral fidaxomicin