Gastro-Intestinal

Question 1

Which two conditions are labelled under the umbrella term of IBD?

Answer 1

Chron’s Disease and Ulcerative Collitis

Question 2

What is the difference between Chron’s and UC?

Answer 2

Chron’s can affect anywhere along the GIT whilst UC occurs only at the colonic area

Question 3

What are common symptoms of IBD that a patient may display in the pharmacy?

Answer 3

Pain or swelling in the abdomen
Unexplained significant weight loss
Extreme tiredness
Bloody Diarrhoea

Question 4

What symptoms would warrant an emergency hospital admission?

Answer 4

Bloody diarrhoea
Fever
Tachycardia
Hypotension

Question 5

Why is loperamide not suitable for sale in a patient with an uncertain diagnosis of IBD?

Answer 5

May precipitate toxic megacolon in patients with UC

Question 6

Stop smoking- reduce relapse risk

Increase calcium intake to reduce risk of osteoporosis

Answer 6

Stop smoking- reduce relapse risk

Increase calcium intake to reduce risk of osteoporosis

Question 7

Which levels would need to be monitored in a patient with Chron’s?

Answer 7

Iron, B12, folate

Vit D

Question 8

What would be a suitable medication to induce remission?

Answer 8

Predinsolone- but cannot be used to maintain remission!

Question 9

When would prednisolone not be appropriate for inducing remission?

Answer 9

If the patient was suffering from an active infection.

Question 10

If a patient on prednisolone to induce remission had 2+ exacerbations of Chron’s in 12 months, what drug class could possibly be added?

Answer 10

Thiopurines are first line whilst methotrexate is second line.

Question 11

When would thiopurines not be suitable?

Answer 11

The patient has absent or low TPMT activity as this will lead to myelosuppression.
In pregnancy- teratogenic

Question 12

What advice would you give to a breastfeeding patient on a thiopurine?

Answer 12

Discontinue breast feeding

Question 13

What possible side effects may a patient experience on thiopurines?

Answer 13

Hepatotoxicity
Pancreatitis
Bone marrow and WBC depression
Photosensitivity reaction

Question 14

What thiopurine side effect is attributed to only males?

Answer 14

Oligozoospermia- low sperm count

Question 15

What monitoring requirements are required for thiopurines?

Answer 15

Liver Function- this is related to the hepatotoxic side effect

Question 16

For patients initiated on prednisolone, what MHRA alert was released?

Answer 16

Risk of chorioretinopathy

Question 17

What is the name for the side effect of prednisolone that is related to significant weight gain, stretch marks at the abdomen and moon face?

Answer 17

Moon Face- this is due to too much cortisol in the body

Question 18

What groups of side effects for prednisolone can you name?

Answer 18

Neuropsychiatric- anxiety, sleep disorders, psychosis, mood altered
Renal- electrolyte disturbance, fluid retention
Increased risk of infection
Cardiac- Hypertension, diabetic control impaired, hypotension, thromboembolism.
Eye- osteonecrois, osteoporosis
Growth retardation

Question 19

What monitoring may be required in pregnant women on prednisolone?

Answer 19

Fluid Retention

Question 20

What monitoring is required for children on prednisolone?

Answer 20

Height and weight due to growth retardation side side effect

Question 21

When would gradual withdrawal of systemic corticosteroids be required?

Answer 21

Received more than 40mg for more than one week
Repeat evening doses
More than 3 weeks treatment

Question 22

Which drug class could be considered for the treatment of Chron’s where prednisolone is contra-indicated?

Answer 22

Aminosalicylates- mesalazine and sulfasalazine

Question 23

When would aminosalicylates be C/I?

Answer 23

Blood clotting abnormalities- patients may be on wafarin or DOACs.
Salicylate hypersensitivity.

Question 24

What side effects would a patient possibly experience on aminosalicylates?

Answer 24

WBC suppression- flu-like symtpoms, neutropenia, thrombocytopenia, agranulocytosis
GI effects- vomitting, diarrhoea

Question 25

What aminosalicylate side effect would males only have?

Answer 25

Oligozoospermia- low sperm count

Question 26

What monitoring is required for patients on mesalazine?

Answer 26

Renal function- avoid if eGFR is less than 20. Annual monitoring

Question 27

What should patients on sulfasalazine be advised to report?

Answer 27

Blood disorders- unexplained bleeding, bruising, sore throat, fever

Question 28

When may methotrexate not be appropriate for use?

Answer 28

Active infection
Immunodeficiency syndromes
Pleural Effusion

Question 29

What toxicities are associated with methotrexate?

Answer 29

Blood Count- drop in WBC count and platelet count
GI toxicity- stop if diarrhoa develops
Liver toxicity- if liver transaminases are increase
Pulmonary toxicity- report dyspnoea, cough or fever

Question 30

What side effects are associated with methotrexate?

Answer 30

Immunodeficiency- thrombocytopenia
GI symtpoms e.g. diarrohoea, vomitting
Skin reactions- SCARS
Bleeding disorders
Bone disorders
Cough
Neurotoxic problems with intrathecal and parental use

Question 31

What is given alongside methotrexate to prevent hepatotoxicity?

Answer 31

Folic acid

Question 32

When may methotrexate not be appropriate?

Answer 32

Pregnancy and breast feeding

Question 33

What monitoring is required for methotrexate?

Answer 33

FBC
Renal
LFTs

Question 34

What counselling may be given for patients started on methotrexate?

Answer 34

Sore throat, bruising and mouth ulcers could indicate blood disorders
Liver toxicity- vomiting, dark urine, abdominal pain.
Respiratory- SOB