Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GPhC BNF > GASTRO-INTESTINAL SYSTEM > Flashcards

GASTRO-INTESTINAL SYSTEM Flashcards

1
Q

CROHN’S DISEASE- MAINTENANCE OF REMISSION TIPS

STOP SMOKING+NUTRITION KEY

DO NOT USE CORTICOSTEROIDS/BUDESONIDE FOR MAINTENANCE!

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SULFASALAZINE/AMINOSALICYLATES

IMMEDIATE MEDICAL ATTENTION?

A 
BLOOD DISORDERS?
UNEXPLAINED BLEEDING/BRUISING
PURPURA
SORE THROAT
FEVE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SULFALSAZINE/AMINOSALICYLATE SIDE-EFFECTS

A 
Nausea
Headache
Rash
Loss of appetite
Raised temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

STOMA CARE

LIQUID FORMS>MR FORMS, fluid/electrolyte loss

Na+Fluid depletion-> hypokalaemia, what risk?

A

DIGOXIN TOXICITY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

STOMA CARE- ADVERSE EFFECT CAUSES

CAUSE OF DIARRHOEA?

CAUSE OF CONSTIPATION?

CAUSE OF GI irritation+bleed?

CAUSE OF DEHYDRATION->HYPOKALAEMIA?

CAUSE OF RAPID LOSS OF WATER/ELECTROLYTES?

A

DIARRHOEA? Sorbitol/Magnesium antacids/Iron (ileostomy)

CONSTIPATION? Opioids/Calcium antacids/Iron (colostomy)

GI irritation+bleed? Aspirin/NSAIDs

Dehydration->hypokalaemia? Diuretics-> Switch to K+ sparing diuretic

Rapid loss of water/electrolytes? Laxatives-> Switch to bulk-forming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

STOMA CARE

EC/MR capsules unsuitable?

Better form?

A

EC/MR capsules unsuitable? Ineffective

Better form?
Quick action: liquids/uncoated/soluble tablets/capsules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

STOMA CARE

What is it?

A

Artificial opening on abdomen, diverts flow of faeces/urine into external pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

EXOCRINE PANCREATIC INSUFFICIENCY- MONITOR?

A

Levels of fat-soluble vitamins and micronutrients (zinc, selenium, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

EXOCRINE PANCREATIC INSUFFICIENCY

PATIENTS W/ CYSTIC FIBROSIS (CF)
High dose pancreatin issue?
Do not exceed?
Report any new?

A

PATIENTS W/ CYSTIC FIBROSIS (CF)
High dose pancreatin issue? Fibrosing colonopathy
Do not exceed? 10,000units/kg/day of lipase
Report any new? Abdominal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

EXOCRINE PANCREATIC INSUFFICIENCY

WHAT DOES PANCREATIN CONTAIN?

COUNSELLING?

A

LIPASE+AMYLASE+PROTEASE
which digest
FATS+CARBS+PROTEINS
absorbed

COUNSELLING? Take w/ meal/snacks, prevent early breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

EXOCRINE PANCREATIC INSUFFICIENCY- TREATMENT?

A

Pancreatin- pancreatic enzyme replacemenet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PANCREATIC CANCER

What is it?

A

Reduced secretion of pancreatic enzymes into the duodenum due to pancreatitis/CF etc-> maldigestions/malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HAEMORRHOIDS- PREGNANCY?

A

BULK-FORMING LAXATIVE

Topical needed? Give a simple, soothing product

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HAEMORRHOIDS- TREATMENT

PAIN/ITCHING?

A

TOPICAL PREPARATIONS
Lidocaine (anaesthetic)-> a few day use
Corticosteroids-> Max. 7 days use due to S-E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HAEMORRHOIDS

PAIN MANAGEMENT?
AVOID?

A

PAIN MANAGEMENT? PARACETAMOL

AVOID?
OPIOIDS-> constipation
NSAIDs-> exacerbate rectal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HAEMORRHOIDS

Constipated?

A

Bulk-forming laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HAEMORRHOIDS- NON-DRUG TREATMENT?

A

Increase dietary fibre+fluid intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HAEMORRHOIDS

What is it?

Internal?

External?

A

What is it?
Swelling of vascular mucosal anal cushions around anus (high risk during prengnacy)

Internal?
Painless

External?
Itchy/painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ANAL FISSURES- CHRONIC MANAGEMENT(>/6 weeks)

1st LINE?
2nd LINE?
Specialist?

Last resort?

A

1st LINE? Rectal GTN (headache common)
2nd LINE? Topical/oral diltiazem/nifedipine (less s-e w/ topical)
Specialist? botox

Last resort? SURGERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ANAL FISSURES

ACUTE TREATMENT? (easy passage of stools+ease up pain)
-Prolonged burning?

A

ACUTE TREATMENT? (easy passage of stools+ease up pain)
Bulk-forming laxative–> Osmotic laxative

-Prolonged burning? Short-term topical containing
lidocaine (X pregnant women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ANAL FISSURES

What is it?

A

Tear/ulcer in anal canal, causing bleeding+pain on defecation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GALLSTONES PAIN- TREATMENT

MILD-MORATE?

SEVERE?

A

MILD-MORATE? Paracetamol/NSAID

SEVERE? IM Diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GALLSTONES

DEFINITIVE TREATMENT (SYMPTOMATIC)?

A

SURGICAL REMOVAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

GALLSTONES

IRRITATED/BLOCKED GALLBLADDER?

Left untreated?

A

Can cause
pain/infection/inflammation

Left untreated? severe complications-> biliary colic, acute cholecystitis, cholangitis, pancreatitis, and obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

GALLSTONES

What is it?

A

Hard mineral/fatty deposits forming stones in the gallbladder bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CHOLESTASIS- INTRAHEPATIC CHOLESTASIS IN PREGNANCY

When does it occur?

Treatment?

A

When does it occur? Late-> adverse fetal outcomes

Treatment? Ursodeoxycholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CHOLESTASIS- CHOLESTATIC PRURITUS TREATMENT cur

1st LINE?
2nd LINE?
3rd LINE?

A

1st LINE? Cholestyramine
2nd LINE? Ursodeoxycholic Acid
3rd LINE? Rifampicin (unlicensed, careful in LD, hepato?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

LIVER DISORDERS- CHOLESTASIS

What is it?
Symptoms?

A

Impaired bile formation/flow-> fatigue, pruritus, dark urine, pale, jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
H2-RECEPTOR ANTAGONISTS- OTC sale
FAMOTIDINE
Age?
Duration?
Indication?
Dose?
A 
FAMOTIDINE
Age? 16+
Duration? 2 weeks max
Indication? Hearbturn/dyspepsia/prevention, sleep L, etc
Dose? 10mg single, MAX. 20mg OD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

H2-RECEPTOR ANTAGONISTS- INTERACTIONS?

A

Reduced absorption of -azole antifungals

Cimetidine- CYP450 enzyme inhibior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

H2-RECEPTOR ANTAGONISTS- SIDE-EFFECTS?

DHDRT

A 
Diarrhoea
Headache
Dizziness
Rash
Tiredness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

H2-RECEPTOR ANTAGONISTS

Can mask symptoms of..?

A

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

H2-RECEPTOR ANTAGONISTS- EXAMPLES?

A

Famotidine
Ranitidine
Cimetidine
Nizatidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

PPIs- INTERACTIONS?

A

Clopidogrel+Omeprazole (Lansoprazole instead)

Methotrexate+Omeprazole (increased levels of methotrexate)-> PPI acts as enzyme inhibitor?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

PPIs

Increased risk of..?

Can mask symptoms of?

A

Increased risk of..?
Fractures/Osteoporosis (hypomagnesaemia)
C. Difficile

Can mask symptoms of?
Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

PPIs

MHRA Warning?

A

Low risk of subacute cutaneous lupus erythmeatosus, crazy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

PPIs- EXAMPLES?

A

OMEPRAZOLE
ESOMEPRAZOLE
LANSOPRAZOLE
RABEPRAZOLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

ANTACIDS- INTERACTIONS

Increases stomach ph (»alkali) so enteric-coated capsules are…?

Impairs absorption of other drugs..?

High sodium content, don’t take with or in..?

Low-sodium antacid- example?

A

Increases stomach ph (»alkali) so enteric-coated capsules are…? Damaged before reaching intestine

Impairs absorption of other drugs..?
Bisphosphonates (risderonate, alendronate, zolendronic acid),

High sodium content, don’t take with or in..? Lithium/Hypertension

Low-sodium antacid- example? Co-magaldrox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

ANTACIDS EFFECT

MAGNESIUM? (LM)

ALUMINIUM? (AC)

CALCIUM?

SIMETICONE?

ALGINATES+ANTACIDS?

A

MAGNESIUM? LAXATIVE effect

ALUMINIUM? CONSTIPATING effect

CALCIUM? Induces rebound acid secretion

SIMETICONE? relieves flatulence

ALGINATES+ANTACIDS? Increases viscosity of stomach content
-Forms a viscous gel (‘raft’) that floats on the surface of the stomach contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

GORD IN PREGNANCY

First, you gotta give diet+lifestyle advice

If that’s an L?

If above is also an L?

A

If that’s an L? antacid/alginate

If above is also an L? omeprazole/ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

GORD TREATMENT

First, you gotta review the current medicines.

Uninvesigated GORD?
Confirmed GORD?

A

Uninvesigated GORD? 4 weeks of PPI (same as dyspepsia)

Confirmed GORD? 4-8 weeks of PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

GORD

INITIAL LIFESTYLE ADVICE?

A 
Healthy eating
Weight loss (obese)
Avoid trigger foods
Smaller meals
Evening meal 3-4hrs before bed
Raise head of bed
Smoking cessation
Reduce alcohol consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

GORD increases with…?

A 
Consuming fatty foods
Pregnancy
Hiatus Hernia
Family History
Stress/anxiety
Obesity
Smoking
Alcohol
Some drugs: e.g. a/b-blockers, CCBs, benzos (use lowest effective dose OR STOP)

Nitrates- loosens up sphincter between windpipe/stomach, more acid? Mad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

H. PYLORI TREATMENT?

3 COMBOS?

w/ Omeprazole? n maybe esomep

IF PENICILLIN ALLERGY?

A

H. PYLORI TREATMENT?
PPI+2 ANTIBIOTICS
PPI: BD (Omeprazole 20-40 | Lansoprazole 30)
Amoxicillin: 1000mg BD (other 2 in pen allergy)
Clarithromycin: 500mg BD
Metronidazole: 400mg BD
7 DAYS TREATMENT

3 COMBOS?
PAC OR PAM OR PCM

PPI+bismuthsubsalicylate+metronidazole+tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How do you test for H. pylori?

2 conditions?

A

How do you test for H. pylori? Urea (13C) breath test OR Stool Helicobacter Antigen Test (SAT)

2 conditions?
PPIs should’ve been stopped 2 weeks before test
&
Antibiotics should’ve been stopped 4 weeks before test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

FUNCTIONAL DYSPEPSIA TREATMENT?
TEST FOR?
NOT INFECTED?

A

FUNCTIONAL DYSPEPSIA TREATMENT? Can’t identify underlying cause

TEST FOR? H. pylori- treat if +

NOT INFECTED? 4 weeks of PPI/H-2 receptor antagonist, e.g. cimetidine/famotidine, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

UNINVENSTIGATED DYSPEPSIA TREATMENT?

TEST FOR?

A

UNINVENSTIGATED DYSPEPSIA TREATMENT?
PPI for 4 weeks

TEST FOR?
H. pylori if PPI didn’t work, treat if positive (PPI+ 2 antibacterials)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

2 TYPES OF DYSPEPSIA?

A

UNINVENSTIGATED
&
FUNCTIONAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Dyspepsia/GORD

Urgent Referral Symptoms?

A

GI bleeding
55 years+
Unexplained weight loss
Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

GASTRIC ACID DISORDERS & ULCERATION

Dyspepsia
What is it?

A

Upper abdominal pain/heartburn/gastric reflux/bloating/nausea/vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

LOPERAMIDE

OTC AGE?
Diarrhoea w/ IBS?
PRESCRIPTION AGE?
HOW TO TAKE IT?
MHRA WARNING?
HOW TO TREAT OVERDOSE?
A

OTC AGE? 12 years+
Diarrhoea w/ IBS?- 18 years+
PRESCRIPTION AGE? 4 years+

HOW TO TAKE IT? 1-2 doses (2-4mg), then 1 w/ every loose stool, max. 8 doses (16mg) per day

MHRA WARNING? Serious cardiac reactions (QT prolongation) w/ high doses

HOW TO TREAT OVERDOSE? Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

DIARRHOEA

1st LINE FAECAL INCONTINENCE? (can’t control bowels, just leaks)

A

Loperamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

DIARRHOEA

Rapid control needed/traveller’s diarrhoea?

BUT avoid in…

A

Use loperamide

BUT avoid in…

BLOODY/SUSPECTED inflammatory diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

DIARRHOEA

SEVERE/CAN’T DRINK?

A

Hospital-> IV fluids ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

ACUTE DIARRHOEA- usually settles itself but can use ORT to prevent/correct dehydration. Obvs

A
56
Q

CONSTIPATION IN CHIDLREN

1st LINE? L?

STILL HARD STOOLS?

A

1st LINE? Dietary advice+macrogol (if no faecal impaction) L? Stimulant

STILL HARD STOOLS? Lactulose/Docusate

57
Q 
CONSTIPATION IN PREGNANCY/BREAST-FEEDING?
1st LINE?
2nd LINE?
L?
Still an L?
A

1st LINE? Diet+lifestyle, fibre key!
2nd LINE? Bulk-forming, e.g. ISPAGHULA HUSK.
L? Lactulose
Still an L? Bisacodyl/senna (don’t use senna near birrth)?

58
Q

OPIOID-INDUCED CONSTIPATIENT TREATMENT
1st LINE?
L?

AVOID?

A

1st LINE? OSMOTIC+STIMULANT
L? NALOXEGOL

AVOID? BULK-FORMING (peristalsis already slow mate!)

59
Q

FAECAL IMPACTION TREATMENT

HARD STOOLS? once softened?
L?

SOFT STOOLS?
L?

A

HARD STOOLS? Macrogol & once softened? Stimulant
L? Rectal glycerol ONLY OR glycerol+bisacodyl

SOFT STOOLS? Stimulant
L? Rectal bisacodyl

60
Q

CHRONIC CONSTIPATION TREATMENT?
Still hard stools?
Still no change after 6 months?

A

Bulk-forming+good hydration

Still hard stools? Add/change to Macrogol/Lactulose

Still no change after 6 months? Prucalopride

Withdraw lactulose slowly when patient improves by the way!

61
Q

SHORT-DURATION CONSTIPATION TREATMENT?

A

Bulk-forming+good hydration.

L? Osmotic

62
Q

OSMOTIC LAXATIVES
Examples?
How does it work?
How long?

A

Examples? Lactulose, Macrogol

How does it work? Increases amount of fluid in the large bowel-> peristalsis

How long? 2-3 days

63
Q

LIQUID PARAFFIN CAUTION DUE TO SIDE-EFFECTS..?

A

Anal seepage
Risks of:
Granulomatous disease of GI tract
Lipoid pneumonia on aspiration

64
Q

LAXATIVES

FAECAL SOFTENERS
Examples?
How it works?
Quickest-acting?

A

Examples? Liquid paraffin, docusate, glycerol

How it works? Increases water penetration into stool

Quickest-acting? GLYCEROL SUPPOSITORY THE QUICKEST!

65
Q

STIMULANT LAXATIVES USED IN TERMINALLY ILL PATIENTS?

A

CO-DANTHRAMER (red urine)
CO-DANTHRUSATE (orange urine)

limited use due to carcinogenicity..

66
Q 
STIMULANT LAXATIVES
Examples?
How it works?
How long?
Avoid in?
A

Examples? Senna, Sodium Picosulfate, Bisacodyl, docusate, glycerol

How it works? Stimulates intestinal motility

How long? Takes 6-12hrs to work

Avoid in? Intestinal obstruction

67
Q 
BULK-FORMING LAXATIVES
Examples?
How it works?
How long?
Advice?
A

Examples? Methylcellulose/Ispaghula Husk/Sterculia

How it works? Small, hard stools- increases faecal mass, stimulates peristalsis

How long? 2-3 days to work

Advice? Take w/ plenty of water to prevent intestinal blockage

68
Q

LAXATIVES

4 TYPES? BSFSO

A

BULK
STIMULANT
FAECAL SOFTENERS
OSMOTIC

69
Q

CONSTIPATION

NON-DRUG TREATMENT?

A 
FIBRE 
WATER
EXERCISE
\+
Review possibly medications-causing? E.g. opioids, aluminium?, CLOZAPINE (BIG RED FLAG!) intestinal peristalsis?
70
Q

CONSTIPATION- RED FLAG? BAAW>?

A 
Blood in stool
Anaemia
Abdominal pain
Weight loss
New onset constipation> 50 years
71
Q

CONSTIPATION

What is it?

A

Infrequent, difficult stools

72
Q

SHORT BOWEL SYNDROME

DIARRHOEA/HIGH OUTPUT STOMAS TREATMENT?

A

LOPERAMIDE/CODEINE TO REDUCE INSTETINAL MOTILITY

73
Q

SHORT BOWEL SYNDROME

NUTRITIONAL DEFICIENCIES?
Replace…

A

Vitamins A, B12, D, E, and K, essential fatty acids, zinc, and selenium

74
Q

SHORT BOWEL SYNDROME

What is it?

A

Shortened bowel due to large surgical resection. Need to ensure adequate absorption of nutrients+fluid!

75
Q

IBS TREATMENT- OTC an L for abdominal pain/discomfort

2nd LINE?
Alternative?

A

2nd LINE? TCA: Amitriptyline
Alternative? SSRIs

[UNLICENSED]

76
Q

IBS TREATMENT

x4 OTC? LALA

A

LAXATIVES: if constipated (X lactulose, can cause bloating)
ANTISPASMODICS: alverine, mebeverine & peppermint oil
LOPERAMIDE: if experiencing diarrhoea
ANTIMUSCARINICS: hyoscine BUTYLbromide (avoid in cardiac disease)

hyscoine BUTYLbromide- IBS, your BUTT
hyoscine HYDRObromide- ship, water, motion sickness, HYDRO

77
Q

IBS

NON-DRUG TREATMENT?

A 
Exercise
Regular meals
Reduce fresh fruit-3/day
Reduce insoluble fibre
Drink >/= 8 cups of water
Reduce caffeine/alcohol/fizzy drinks
Avoid sorbitol if you have diarrhoea
Reduce stress
78
Q

IBS CAN BE EXACERBATED BY..?

A

COFFEE/ALCOHOL/MILK
LARGE MEALS
FRIED FOODS
STRESS

79
Q

IRRITABLE BOWEL SYNDROME

What is it?

A

Common/chronic/relapsing/life-long-> abdomina pain/diarrhoea/constipation/urgency/incomplete defaecation/passing mucus

80
Q

AMIONOSALICYLATES CONTRAINDINCATED IN..

SULFASLAZINE COLOURFUL SIDE-EFFECT?

A

AMIONOSALICYLATES CONTRAINDINCATED IN SALICYLATE HYPERSENSITIVITY. Obvs…

SULFASLAZINE COLOURFUL SIDE-EFFECT? Stains contact lenses orangey-yellow

81
Q

AMINOSALICYLATES- SIDE-EFFECTS & MONITORING
NHB

NEPHROTOXIC? RENAL

HEPATOTOXIC?

BLOOD DISORDERS?

A

NEPHROTOXIC? Monitor before, at 3 months & /year

HEPATOTOXIC? Monitor at monthly intervals for first 3 months

BLOOD DISORDERS? Monitor at monthly intervals for first 3 months
Perform blood count+stop drug ASAP if signs of blood dyscrasia

82
Q

ULCERATIVE COLITIS- MAINTENANCE TREATMENT

PROCTITIS/PROCTOSIGMOIDITIS?

LEFT-SIDED/EXTENSIVE?

2+ FLARES IN 12 MONTHS?

A

PROCTITIS/PROCTOSIGMOIDITIS?
RECTAL AND/OR ORAL AMINOSALICYLATE

LEFT-SIDED/EXTENSIVE?
LOW-DOSE ORAL AMINOSALICYLATE

2+ FLARES IN 12 MONTHS?
ORAL AZATHIOPRINE/MERCAPTOPURINE (Give monoclonal antibodies if no effect)

83
Q

ULCERATIVE COLITIS- MAINTENANCE TREATMENT

WHY DO WE AVOID CORTICOSTEROIDS?

A

Cos of side-effects

AMINOSALICYLATES>CORTICOSTEROIDS

84
Q

ULCERATIVE COLITIS- ACUTE SEVERE TREATMENT

1st LINE?
2nd LINE?

Symptoms not helped within 72hrs?

Alternative to Ciclosporin?

A

1st LINE? IV hydrocortisone/methylprednisolone-> need for surgery?

2nd LINE? IV cyclosporin/surgery

Symptoms not helped within 72hrs? IV steroid+IV ciclosporin OR surgery

Alternative to Ciclosporin? Infliximab

85
Q

ULCERATIVE COLITIS- ACUTE MILD-MODERATE TREATMENT

EXTENSIVE ULCERATIVE COLITIS
1st LINE?
2nd LINE?

A

1st LINE? TOPICAL AMINOSALICYLATE+HIGH-DOSE ORAL AMINOSALICYLATE

2nd LINE? NO CHANGE AFTER 4 WEEKS?
STOP TOPICAL AMINOSALICYLATE, GIVE:
HIGH-DOSE ORAL AMINOSALICYLATE+4-8 WEEKS ORAL CORTICOSTEROID

NOTE: Aminosalicylates contraindicated? Consider ORAL (ONLY) corticosteroid 4-8 weeks.

86
Q

ULCERATIVE COLITIS- ACUTE MILD-MODERATE TREATMENT

PROCTOSIGMOIDTIS/LEFT-SIDED ULCERATIVE COLITIS
1st LINE?
2nd LINE?
3rd LINE?

A

1st LINE?
TOPICAL AMINOSALICYLATE

2nd LINE?
ADD-ON HIGH-DOSE ORAL AMINOSALICYLATE if no improvement after 4 weeks
OR
SWITCH TO HIGH-DOSE ORAL AMINOSALICYLATE+4-8 WEEKS OF TOPICAL CORTICOSTEROIDS

3rd LINE?
STOP TOPICAL TREATMENT, GIVE:
ORAL AMINOSALICYATE+4-8 WEEKS OF ORAL CORTICOSTEROIDS

NOTE: Aminosalicylates contraindicated? Consider topical/oral corticosteroid 4-8 weeks.

87
Q

ULCERATIVE COLITIS- ACUTE MILD-MODERATE TREATMENT

PROCTITIS
1st LINE?
2nd LINE?
3rd LINE?

A

1st LINE? Topical aminosalicylate (sulfasalazine, mesalazine…)
2nd LINE? Oral aminosalicylate (if no improvement after 4 weeks)
3rd LINE? Topical/oral corticosteroid for 4-8 weeks

NOTE: Aminosalicylates contraindicated? Consider topical/oral corticosteroid 4-8 weeks.

88
Q

DIARRHOEA IN ULCERATIVE COLITIS?

A

AVOID LOPERAMIDE/CODEINE-> can cause toxic megacolon (as gastric emptying is slowed down, build-up)
Only use on advice of a specialist!^

89
Q

DIARRHOEA IN ULCERATIVE COLITIS?

A

AVOID LOPERAMIDE/CODEINE-> can cause toxic megacolon (as gastric emptying is slowed down, build-up)
Only use on advice of a specialist!^

90
Q

ULCERATIVE COLITIS- ACUTE MILD-MODERATE TREATMENT

DISTAL-RECTAL?

EXTENDED?

A

DISTAL-RECTAL? Suppositories/Enemas-> foam preps used if patient has difficulty retaining liquid enema

EXTENDED? Systemic medication

91
Q

ULCERATIVE COLITIS

INCREASING SEVERITY?

A
  1. Proctitis
  2. Proctosigmoiditis
  3. Left-sided
  4. Extensive colitis
  5. Pancolitis
92
Q

UC has a continuous pattern, CD is patchy

A
93
Q

ULCERATIVE COLITIS

MOST COMMON AGE?

COMPLICATIONS?

A

MOST COMMON AGE? 15-25years

COMPLICATIONS? 
Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon
94
Q

ULCERATIVE COLITIS

What is it?

A

Can affect region from rectum-whole colon- blood diarrhoea/defecation urgency/abdominal pain

95
Q

FISTULATING CROHN’S DISEASE

ASYMPTOMATIC?

TO IMPROVE SYMPTOMS?

MAINTENANCE?

A

ASYMPTOMATIC? Let it be

TO IMPROVE SYMPTOMS?
Metronidazole AND/OR Ciprofloxacin
(Metronidazole- ~1 month, NOT >3 months due to peripheral neuropathy)

MAINTENANCE?
Azathioprine OR Mercaptopurine (Infliximab if response L)
Treatment >/= 1 year by the way

96
Q

FISTULATING CROHN’S DISEASE

WHAT IS IT?

A

When a fistula develops between intestine & perianal skin/bladder/vagina

97
Q

CROHN’S DISEASE- DIARRHOEA TREATMENT?

A

LOPERAMIDE
CoDeine (CD) UC, you can’t by the way!
COLESTYRAMINE

98
Q

CROHN’S DISEASE- MAINTENANCE OF REMISSION

STOP SMOKING+NUTRITION KEY

DO NOT USE CORTICOSTEROIDS/BUDESONIDE FOR MAINTENANCE!

MONOTHERAPY?
-Alternative?

POST-SURGERY?

A

STOP SMOKING+NUTRITION KEY

MONOTHERAPY? Azathioprine OR Mercaptopurine
-Alternative? Methotrexate

POST-SURGERY?
Azathioprine+Metronidazole (3 months)
OR
Aazathioprine alone

99
Q

CROHN’S DISEASE- ACUTE

2+ FLARE UPs in 12 MONTH PERIOD
Add-on 1st LINE?

2nd LINE?

SEVERE?

A

Add-on 1st LINE? Azathioprine OR Mercaptopurine

2nd LINE? Above an L-> add-in Methotrexate

SEVERE? Monoclonal antibodies

100
Q

CROHN’S DISEASE TREATMENT- ACUTE

1 FLARE-UP IN 12 MONTH PERIOD
1st LINE?

Patient has distal ilea/ileocaecal/right-sided disease?
-Alternative?

A

1st LINE? Prednisolone/methylprednisolone/IV hydrocortisone (monotherapy)

Patient has distal ilea/ileocaecal/right-sided disease? Budesonide
-Alternative? Aminosalicylates (sulfasalazine/mesalazine)-> less side-effects, less effective

101
Q

CROHN’S DISEASE

Can lead to complications such as…?

A

INTESTINAL FISTULAE
ANAEMIA/MALNUTRITION
COLORECTAL/SMALL BOWEL CANCER
GROWTH FAILURE/DELAYED PUBERTY IN CHILDREN
EXTRA-INTESTINAL MANIFESTATION: arthritis/joints/eyes/liver/skin abnormalities

102
Q

CROHN’S DISEASE

What is it?

A

Affects whole GI-tract- thickened wall, all layers, deep ulceration

103
Q

TREATMENT

DIVERTICULAR DISEASE/ACUTE DIVERTICULITIS? mynaaa

COMPLICATED?

A

DIVERTICULAR DISEASE/ACUTE DIVERTICULITIS?
Paracetamol- ongoing abdominal pain
Bulk-forming laxatives- constipation

COMPLICATED? SURGERY ASAP

AVOID NSAIDs by the way-> higher risk of diverticular perforation

104
Q

DIVERTICULAR DISEASE & DIVERTICULITIS

DIVERTICULOSIS?

DIVERTICULAR DISEASE?

ACUTE DIVERTICULITIS?

COMPLICATED ACUTE DIVERTICULITIS?

A

DIVERTICULOSIS? small pouches but asymptomatic (no treatment needed)

DIVERTICULAR DISEASE? small pouches but symptomatic- abdominal pain, constipation, diarrhoea, rectal bleeding

ACUTE DIVERTICULITIS? when pouches become inflamed/infected- severe abdominal pain, fever, significant rectal bleeding

COMPLICATED ACUTE DIVERTICULITIS? abscess, perforation, fistula, obstruction, sepsis, haemorrhage

105
Q

COELIAC DISEASE- AIMS

MANAGE SYMPTOMS?

AVOID MALNUTRITION?

A

MANAGE SYMPTOMS? diarrhoea/bloating/abdominal pain

AVOID MALNUTRITION? give vitamin D, calcium+other nutrients (supervised)

106
Q

COELIAC DISEASE

Occurs in..?

Asscoiated w/..?

May cause malabsorption of..?

A

Occurs in small intestine

Asscoiated w/ gluten/wheat/barley/rye
-Causes immune response in intestinal mucosa (JUST AVOID GLUTEN)

May cause malabsorption of nutrients

107
Q

CHRONIC BOWEL DISORDERS

3 TYPES???????

A

COELIAC DISEASE
CROHN’S
ULCERATIVE COLITIS

108
Q

H PYLORI- GASTRIC ULCER- TREATMENT!

A
109
Q

ATENOLOL DYSPEPSIA? IT DOESN’T HAPPEN

A
110
Q

MEBEVERIN ALTERNATIVE?

A

HYOSCINE

111
Q

PREGNANT, DIET, LIFESTYLE, CONSTIPATED?

A

START BULK FORMING

112
Q

SULFASALAZINE, SORE THROAT?

A

GP BRUH

BLOOD DISORDER/DYSCRASIA

113
Q

STOMA CARE, LOPERAMIDE CODEINE?

A

The antidiarrhoeal drugs, loperamide hydrochloride and codeine phosphate, reduce intestinal motility and decrease water and sodium output from an ileostomy. Loperamide hydrochloride circulates through the enterohepatic circulation, which is disrupted in patients with a short bowel.

114
Q

CROHN’S SEVERE?

A

Aminosalicylates and budesonide are not appropriate for severe presentations or exacerbations.

115
Q

PPI LONG-TERM L?

A

B12 absorption lacking

116
Q

Ms. B comes into the pharmacy asking to speak to the pharmacist. She tells you her stools
have been hard and pellet like. You can see that she may be pregnant and on questioning,
you confirm that she is 7 months pregnant. She has tried to change her diet and drink more
water but this has been ineffective. She has no other medical condition and on no other
medication

A

Recommend the use of Lactulose – Ms B is suffering from constipation so she needs
a laxative if dietary measures have been ineffective.

PeptoBismol & Milk of Magnesia -for indigestion;

117
Q

Astringent?

A

Bismuth oxide

118
Q

H. Pylori eradication treatment must be given to all patients with gastric ulcers – The
test must be done before giving treatmen

A
119
Q

Mr T has been diagnosed with a blocked bile duct and has been prescribed the drug
colestyramine in an attempt to control the itching he is experiencing. He enquires about the
potential side effects of the drug.
Which one of the following adverse effects is not normally associated with
colestyramine?

A

Myalgia

Other side-effects?
Diarrhoea, GI discomfort, hypertriglyceridaemie (aggravation),
hypoprothrombinaemia associated with Vit K deficiency, vomiting

120
Q

A patient has been taking clindamycin for the past three days and has developed nausea
and diarrhoea. They ask for your advice about what to do. They have been taking
Clindamycin as prescribed: 450mg QDS. They still have four more days of treatment to go.
What is the most appropriate advice to give the patient?

A

They should stop taking the Clindamycin immediately and go and get an urgent
appointment with their doctor

121
Q

METHOTREXATE SIDE-EFFECTS? (D)USSBM

A 
DARK URINE/ABDOMINAL DISCOMFORT
SOB
SORE THROAT
BRUISING
MOUTH ULCERS
122
Q
A
123
Q

Coeliac disease test?

A
124
Q

IBD TEST FOR UC/CROHN’S?

A

FAECAL CALPROTECTIN,

normal in IBS, raised in IBD

125
Q

addison’s disease, raised cholesterol, weight gain, cold, test?

A

Thyroid test

126
Q

test for DVT?

A

D-dimer

127
Q

VTE test?

A

D-dimer

128
Q

Patient, abdominal pain, bloating, diarrhoea, lactose intolerant. Test?

A

Hydrogen breath test- detects intestinal bacterial overgrowth or lactose/fructose intolerance

129
Q

vitamin deficiency, scurvy, gum disease?

A

Vitamin C is key!

130
Q

WHAT IS VITAMIN B9?

A

folic acid (give with methotrexate, separate day, etc)

131
Q

+ inotrope n - chronotropic drug?

A

digoxin

132
Q
  • inotrope and - chronotrope drug?
A

diltiazem

133
Q

drug affected by alcohol, give by brand, 10-20 target?

A

theophylline!

134
Q

sulfasalazine, diarrhoea does occur but?

A

it does not need to be reported

135
Q

carbon 13 urea test?

A

h pylori

136
Q

crp test for?

A

inflammation, infection/arthritis/ lupus?

137
Q
A

ANAL FISSURE

GPhC BNF (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions