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Pharm 409A Primary Care Modules > Gastro-intestinal Disorders > Flashcards

Gastro-intestinal Disorders Flashcards

1
Q

What are the symptoms of gastric reflux? (5 points)

A
  • heart burn
  • acid taste in mouth
  • flatulence
  • nausea, biliousness
  • gastric pain
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2
Q

What are the possible causes of gastric reflux? (8 points)

A
  • hiatus hernia- requires radiological diagnosis
  • obesity or pregnancy
  • foods and drugs
  • bacteria e,g, H. Pylori
  • bending over
  • stress and anxiety
  • tight clothes
  • old age
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3
Q

What are the general advice for lifestyle management of gastric reflux? (10 points)

A
  • normal weight for age and height
  • control caffeine alcohol, fat and spice in diet
  • have small regular meals slowly - relax
  • no meals less than 4H before bedtime
  • exercise regularly, go for short walk after meal
  • stop smoking
  • raise head of bed
  • avoid right clothes around waist/abdomen
  • avoid bending over, slumping or stooping
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4
Q

What are the different types of medication used to manage gastric reflux? (6 points)

A
  • antacids
  • alginates
  • dimethicone
  • peppermint oil
  • H2 antagonists
  • PPIs
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5
Q

What are antacids? (4 points)

A
  • metal salts which neutralise acid in stomach
  • should be taken 1 hour after meals where gastric emptying has slowed so the effect can last up to 3 hours
  • affects the absorption of EC tablets, drugs like warfarin, digoxin, tetracycline.
  • liquids are more effective than tablets, tablets need to be chewed well
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6
Q

Why shouldn’t antacids be taken before meals?

A

-gastric emptying is fast during the meal so the effect may only last 30 min

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7
Q

What are the different metal salts used in antacids? (4 points)

A
  • sodium bicarbonate
  • aluminium salts
  • magnesium slats
  • calcium carbonate
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8
Q

What are the properties of sodium bicarbonate used as an antacid? (3 points)

A
  • water soluble quick but short acting neutraliser
  • avoid in sodium restrictive diets
  • long term use may cause systemic alkalosis and renal damage
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9
Q

What are the properties of aluminium salts in antacids? (3 points)

A
  • e.g. aluminium hydroxide
  • can cause constipation
  • avoid if concerned about dementia due to assoc. between Al in drinking water and senile dementia
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10
Q

What are the characteristics of magnesium salts used in antacids? (4 points)

A
  • e.g. Trisilicate
  • can cause osmotic diarrhoea
  • Mg hydroxide is a potent acid neutraliser but trisilicate has poor buffering capacity
  • caution in renal damage as hyper Mg can occur in high doses
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11
Q

What are the characteristics of calcium carbonate used in antacids? (3 points)

A
  • potent long acting acid neutraliser
  • long term use may cause acid rebounds hypercalcaemia
  • may cause milk-alkali syndrome if taken with too much milk
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12
Q

What are alginates? (5 points)

A
  • e.g. Gaviscon, mylanta plus.
  • forms protective coat on top of acids
  • take after meals and chew tablets thoroughly.
  • medicines taken after the alginate may sit on foam layer and not be absorbed
  • bicarbonate components in some alginate preparations does not provide an antacid effect, it is there to release CO2 so the foam can float on top of gastric fluid.
  • alginates are approved in pregnancy
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13
Q

What is diemethicone or simethicone? (2 points)

A
  • e.g. degas

- surfactant which reduces surface tension causing gas bubbles to coalesce and burst causing belching

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14
Q

What is peppermint oil? (2 points)

A
  • carminative antispasmodic which inhibits GI smooth muscle

- menthol is the main constituent of peppermint oil and may act as a CCB and be useful in IBS

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15
Q

What are the H2 antagonists? (3 points)

A
  • e.g. Ranitidine
  • these antagonise acid production
  • tablets are taken over a 2 week period to prevent over medication or failure to seek help with recurrent symptoms
  • dose is low for dyspepsia and does not treat ulcers
  • max 2 tablets in 24 hours
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16
Q

What are PPIs? (9 points)

A
  • e.g. Omeprazole
  • systemically blocks the enzyme causing acid release
  • helpful for short term relief of elude symptoms
  • only recommend in symptomatic patients, not to be used for prevention
  • suitable for patients with symptoms 2 or more x a week but less than once daily
  • start at lowest effective dose 30 min before meal preferably mane
  • if symptoms do not improve in 14 days or worsen. Refer
  • patients over 50 years with first time/longstanding and frequent symptoms should be referred
  • interactions with ketonconazole, itraconazole, warfarin, phenytoin, diazepam, clapping real due to P450 interaction
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17
Q

When should gastric reflux be referred? (9 points)

A
  • acute so tach pain or changed pain
  • 45Y + weight loss, vomiting (carcinoma?)
  • difficulty or pain on swallowing, regurgitation (oesophageal carcinoma?)
  • blood in stool, vomiting, coffee ground poo
  • jaundice
  • anaemia
  • pain radiating to arms (heart attack, angina?)
  • OTC failure (e.g. >7 days)
  • children
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18
Q

What are the symptoms of gastric reflux in infants? (3 points)

A
  • regurgitation of milk after feeds (via mouth or nose or both)
  • effortless vomiting or projectile
  • may occur with or without crying and distress
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19
Q

How is infantile gastric reflux managed?

A
  • refer for investigation

- dr may prescribe alginate to thicken feeds, antacids, medications to enhance stomach emptying and peristaltic movement

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20
Q

What is gastric reflux?

A

-when gastric contents like acid, reflux into the oseiohagus and irritate the sensitive mucosa

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21
Q

What are the symptoms of peptic ulcer? (6 points)

A
  • dull, gnawing, mild to severe pain which may radiate towards back
  • pain relieved by food, vomiting, rest, Antacids, milk
  • hunger pain occurs 1-3 hours after food, may wake px up early in the morning
  • exacerbations and remissions of pain
  • weight loss, nausea, vomiting
  • blood in vomit (coffee grounds) and stools (not common)
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22
Q

How are peptic ulcers managed? (9 points)

A
  • refer for investigation
  • aim for normal weight for age and height
  • reduce caffeine, alcohol, fat, and spice in diet
  • don’t skip meals, have 3 balanced and regular meals a day
  • manage stress
  • exercise regularly
  • stop smoking
  • avoid drugs that can aggravate symptoms like NSAIDs, corticosteroids
  • adhere to medical management
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23
Q

What are the symptoms of gastritis or dyspepsia? (6 points)

A
  • sudden onset
  • brief duration
  • malaise, loss of appetite
  • feeling of fullness
  • vertigo
  • nausea, vomiting
24
Q

What causes gastritis or dyspepsia? (2 points)

A
  • over-indulgence of food, alcohol

- irritants like spicy food, caffeine, alcohol, smoking, allergenic foods, NSAIDs

25
Q

How is gastritis or dyspepsia managed? (2 points)

A
  • antacids and simethicone

- h2 antagonists or PPIs

26
Q

What is constipation? (2 points)

A
  • reduced frequency of defecation

- passage of hard dry stools

27
Q

What are the pharmacist roles in diagnosing constipation?

A

-determine what is normal for the patient and then determine if a significant change in bowel habit has occurred

28
Q

What are some common questions relating to the diagnosis of constipation? (5 points)

A
  • bowel habits: normal, changes, frequency, hard/dry, straining, heeds call to toilet
  • associated symptoms e.g, abdo discomfort, blood in stools
  • diet, (fluid and fibre)
  • exercise
  • medication
29
Q

What components of the diet might cause constipation? (3 points)

A
  • inadequate fluid e,g, tea has tannins, caffeine can dehydrate
  • inadequate fibre. Dry fibre must have plenty of fluid
  • too much ingestion of cheese, calcium and iron
30
Q

How can medications cause constipation? (2 points)

A
  • laxative abuse causing lazy colon

- prescription medicines have constipation as a side effect

31
Q

What are examples of medicines that cause constipation as a side effect? (15 points)

A
  • opiates
  • anticholinergics
  • antidepressants
  • sedating antihistamines
  • NSAIDs
  • SSRIs
  • lipid lowering agents
  • antacids (Al and Ca)
  • diuretics
  • psychotropics
  • levodopa
  • clozapine
  • anti hypertensives (especially CCBs like verapamil)
32
Q

When should constipation be referred? (6 points)

A
  • change in bowel habit more than 2 weeks
  • abdo pain, vomiting, bloating (faecal impaction? Cancer?
  • blood in stools
  • laxative abuse
  • OTC failure
  • if prescribed meds are the issue
33
Q

What lifestyle advice can be given to patients suffering from constipation? (4 points)

A
  • exercise regularly
  • drink adequate fluids (6-8 glasses of water or juice per day)
  • adequate fibre in diet
  • heed call to toilet
34
Q

What are the different types of laxative medication? (5 points)

A
  • stimulant
  • surfactants/softeners
  • bulk laxatives
  • osmotic laxatives
  • other
35
Q

What are examples of stimulant laxatives? (3 points)

A
  • anthraquinone laxatives e,g, senna, aloe, cascara, rhubarb, frangula, danthron
  • bisacodyl
  • castor oil
36
Q

What are the general treatment principles with stimulant laxatives? (7 points)

A
  • increase peristalsis
  • assoc with griping pain in abdomen
  • work within 6-12 hours
  • should not be used for more than 1 week
  • suitable for when frequency is a problem, but stools are still soft
  • senna first line, bisacodyl second line
  • not suitable for general sales due to risk of misuse
37
Q

What are the anthraquinone laxatives? (4 points)

A
  • e.g. Senna:
  • the main active compounds are sennosides A and B which are products and metabolised by gut micro flora to produce the active compound rheinanthrone
  • reduces fluid absorption in colon forming softer stools
  • accelerates colonic transport
38
Q

What is different about danthron? (2 points)

A
  • synthetic anthraquinone laxative (the others are natural)

- associated with carcinogenicity in rats and not available without a rx

39
Q

What is bisacodyl? (5 points)

A
  • dephenylmethane derivative
  • inhibits Na+/K+ ATPase pump allowing water to accumulate in colon
  • oral bisacodyl works in 6-10 hours
  • suppository works in 15-69 minutes
  • not suitable for general sale due to risk of misuse
40
Q

What is caster oil? (4 points)

A
  • prodrug of ricinoleic acid: alters fluid and electrolyte movement
  • inhibits Na+/K+ ATPase and stimulates Adenyl cyclase to allow water to accumulate in colon
  • increases colonic activity and mucosal permeability
  • drastic purgative and tastes vile
41
Q

What are surfactant laxatives? (3 points)

A
  • aka stool softeners such as docusate sodium and poloxamer 188
  • lubricates faeces and makes them more water permeable
  • possible cAMP action to enhance water transport into the colon
42
Q

What are the general principles regarding bulk laxative treatment? (8 points)

A
  • choice laxative for long term regular use
  • swells in gut increasing faecal mass and stimulates peristalsis
  • efficacy depends on water holding capacity and use as substrate for colonic bacteria which hold water to create soft, soggy and heavy stools
  • takes several days to work
  • take with plenty of water, usually in the morning
  • granules and powder can be mixed with juice or water
  • take care to avoid mineral deficiencies
  • flatulence may occur initially
43
Q

What is dietary fibre?

A

The non absorbable portion of plants including celluloses, pectin, gums, mucilages and liginin

44
Q

What are the different types of bulk laxatives? (4 points)

A
  • bran fibre
  • isphagula husk fibre, psyllium
  • sterculia
  • methyl cellulose
45
Q

What is bran fibre? (4 points)

A
  • produces soft, bulky stools and normalises transit
  • raw bran is better than cooked meal however intestinal obstruction has occurred when unprocessed bran has been ingested
  • the phytate in the bran can chelate zinc
  • avoid in patients with gluten intolerance
46
Q

What is isphagula husk fibre, psyllium ? (2 points)

A
  • derived from outside of plantango seeds

- psyllium can cause allergies following inhaltional and dermal exposure

47
Q

What is sterculia?

A

Bulk laxative from the karaya gum of sterculia shrub

48
Q

What is methyl cellulose? (2 points)

A
  • semisynthetic bulk laxative which forms viscous solution with water
  • can increase faecal excretion of copper and magnesium
49
Q

What are the two main types of osmotic laxatives?

A
  • sorbitol

- lactulose

50
Q

What is sorbitol? (4 points)

A
  • hyperosmolar effect which softens stools
  • acts in a few hours, but regular use may cause dehydration
  • salts are not palatable
  • used as sweetener in many liquid medicines and can cause diarrhoea and flatulence
51
Q

What is lactulose? (4 points)

A
  • metabolised by bacteria into lactic and other acids
  • results in osmotic effect which softens stools
  • lower pH contracts colonic muscle
  • often used to manage chronic constipation especially in those taking opiates.
52
Q

What are examples of other laxatives? (4 points)

A
  • liquid paraffin or mineral oil
  • Epsom salts
  • Glauber’s salts
  • Glycerin
53
Q

What is liquid paraffin? (10 points)

A
  • coats and softens faces and prevents water absorption out of colon
  • Associated with many adverse effects
  • long term use impairs absorption of vitamins,
  • may cause anal leakage and irritation
  • may be aspirated into airways and cause lipid penumonitis
  • accumulation in lymph nodes my spleen, liver and adipose tissues
  • has caused granulatomas in rectal tissue
  • traces of polycyclic hydrocarbons have mutagenic potential
  • banned for use in food
  • MOH no longer recommends
54
Q

How is constipation managed in infants?

A

-on midwife or GP advice, may use extra fluid particularly breast milk or water if infant is less than 12 weeks of age

55
Q

How is constipation managed in children? (4 points)

A
  • often increasing diet fibre will work
  • can use half a glycerine suppository (only available in adult strength so use half.)
  • only use glycerine suppository if constipation is recent with no other symptoms
  • would normally refer to doctor
56
Q

How is constipation managed in pregnancy? (3 points)

A
  • may be caused by hormones or iron supplementation
  • ensure adequate fibre and fluid intake
  • avoid stimulants. Bulk laxatives are preferred but may be uncomfortable
57
Q

How is constipation managed in the elderly? (3 points)

A
  • common due to decreased exercise, inadequate fibre and fluid in diet, medications,
  • false teeth can make fibrous foods hard to chew as granules can get caught in dentures
  • manage with bulk laxatives and plenty of fluids (preferred) but lactulose may be an option

Pharm 409A Primary Care Modules (2 decks)

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