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Pre-reg revision > Gastro-intestinal system > Flashcards

Gastro-intestinal system Flashcards

1
Q

‘Ulcerative colitis increases your chances of developing venous thromboembolism and colorectal Ca’
True or False?

A

True

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2
Q

Name some aminosalicylates

A

Mesalazine, sulfasalazine, olsalazine, balsalazide

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3
Q

Why should mesalazine be prescribed by brand?

A

Oral preparations may have different delivery characteristics

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4
Q

How is a flare of UC usually treated?

A
  1. Topical/oral aminosalicylate
  2. Oral prednisolone
  3. Tacrolimus or budesonide multimatrix
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5
Q

How is diarrhoea in UC treated?

A

With loperamide/codeine during remission

This is CONTRA-INDICATED during active UC as there is a risk of toxic megacolon

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6
Q

What is usual maintenance treatment for Crohns disease?

A
  1. No treatment, patients must be aware of signs of relapse
    OR
  2. Azathioprine/mercaptorine monotherapy
  3. Methotrexate

Do not offer a steroid for maintenance treatment

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7
Q

Can loperamide/codeine be used to manage diarrhoea in Crohns?

A

Yes- if no colitis

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8
Q

What abx are used to treat fistulating Crohns?

A

Metronidazole/ ciprofloxacin

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9
Q

What lifestyle factors can reduce the risk of relapse in Crohns?

A
  • Smoking cessation

- High fibre diet

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10
Q

What is first line treatment for an acute flare of Crohns?

A

Corticosteroids

Prednisolone, methylpred or IV hydrocortisone

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11
Q

How should patients on aminosalicylates be counselled?

A

Risk of blood disorders/dyscrasia

Report any unexplained bleeding, bruising, sore throat etc

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12
Q

What monitoring is required for patients on aminosalicylates?

A
  • FBC if signs of blood disorders

- Renal function, risk of neprotoxicity

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13
Q

Why should aminosalicylates be avoided during breast feeding?

A

Risk of diarrhoea in the newborn

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14
Q

Which aminosalicylate can turn bodily fluids including contact lenses orange?

A

Sulfasalazine

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15
Q

Why should mesalazine not be given with lactulose?

A

Lactulose lowers pH of stools, can prevent sufficient release of MR/EC preparations of mesalazine

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16
Q

Which lifestyle advice can be offered to patients suffering with IBS?

A
  • Increase exercise
  • Eat regular meals
  • Limit fresh fruit to 3 portions per day
  • Increase fibre and fluid intake
  • Reduce caffeine, alcohol and fizzy drinks
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17
Q

Why should lactulose not be recommended in IBS?

A

Can cause bloating

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18
Q

How does NICE define constipation?

A

Defecation less than 3 times per week

Differs for each person

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19
Q

Which ‘red flags’ would ean you referred a patient presenting with constipation?

A
  • New onset constipation aged over 50
  • Anaemia
  • Abdo pain/vomiting/bloating
  • Unintentional weight loss
  • Blood/mucus in stools
  • Painful defecation
  • Secondary caused by drug, drug should be reviewed
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20
Q

Which patient would you NOT refer?

  • Woman in her late 50s presenting with 3 weeks of constipation and this is the first time she has had these symptoms
  • Man aged 23 with new constipation after being prescribed co-drydamol for an injury
  • Man aged 47 with constipation and a 2 month history of weight loss
  • Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past
  • Woman aged 60 with constipation, abdominal pain and blood in stools
A

Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past - if no new/unusual bowel habits or other red flags

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21
Q

What is a sign of laxative abuse?

A

Hypokalaemia

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22
Q

What is the recommended first line treatment for constipation?

A

Bulk-forming laxatives

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23
Q

Name some bulk-forming laxatives?

A

Ispaghula husk, methylcellulose (also softener), sterculia

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24
Q

How long do bulk-forming laxatives take to work?

A

72 hours

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25
Q

What patient counsellign should be given with bulk-forming laxatives?

A
  • Ensure adequate fluid intake

- Don’t take before bed to avoid obstruction

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26
Q

What laxative is recommended for pregnant women?

A

bulk-forming laxatives

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27
Q

Name some stimulant laxatives?

A

Bisacodyl, sodium picosulfate, senna, co-danthramer, co-danthrusate, docusate, glycerol suppositories

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28
Q

How long do stimulant laxatives take to work?

A

6-12 hours, take before bed for an effect the following morning
Suppositories take 15-30 mins

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29
Q

What can be caused by excess use of stimulant laxatives?

A
  • lazy bowel
  • diarrhoea
  • hypokalaemia
  • cramps
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30
Q

Which stimulant laxative also works as a faecal softener?

A

Docusate

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31
Q

How long should stimulant laxatives usually be used for?

A

Approx 7 days

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32
Q

Which stimulant laxatives should only be used in terminally ill patients?

A

Co-danthramer and co-danthrusate - potential carcinogens

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33
Q

Name some osmotic laxatives?

A

Macrogol 3350, lactulose, magnesium hydroxide

34
Q

Why is lactulose also useful in hepatic encephalopathy?

A

Lowers faecal PH and stops proliferation of ammonia-producing bacteria

35
Q

Which laxatives can be used for chronic constipation that is unresponsive to other laxatives for at least 6 - 12 months?

A
  • Linaclotide (in IBS)
  • Lubirprostone
  • Prucalopride
36
Q

How should opioid-induced constipation be treated?

A
  1. Osmotic laxative WITH stimulant laxative
  2. Naloxegol
  3. Methylnaltrexone

AVOID bulk-forming as can cause obstruction

37
Q

Why should senna not be recommended in the third trimester / near term?

A

Can stimulate uterine contractions

38
Q

First line for constipation in children?

A

Macrogol with diet/behaviour intervention

39
Q

What are some ‘red-flags’ when to refer in diarrhoea?

A
  • Unexplained weight loss
  • Rectal bleeding
  • Persistent diarrhoea
  • Systemic illness
  • Recent hospital treatment/abx
  • Recent foreign travel
  • Signs of dehydration
40
Q

When would you refer these patients with diarrhoea?

  • Baby under 1
  • Elderly patient over 90
  • Adult
  • Child under 3
  • Child aged 12
A
  • Baby under 1 - over 1 day
  • Elderly - over 2 days
  • Adult - over 3 days
  • Child under 3 - over 2 days
  • Child aged 12 - over 3 days
41
Q

What age can you sell loperamide OTC?

A

12 plus

For diagnosed IBS over 18s only

42
Q

What is the maximum dose of loperamide?

A

16mg

43
Q

What is the MHRA warning associated with loperamide?

A
  • Risk of cardiac adverse reactions at high doses
  • Can cause QT prolongation, torsades de point, cardiac arrest
  • Remind patients not to take over recommended dose
44
Q

How can loperamide overdose be reversed?

A

Naloxone - acts on opioid receptors in GI tract

45
Q

What antibiotic is occasionally given as prophylaxis for travellers diarrhoea?

A

Ciprofloxacin

46
Q

Contra-indications for loperamide?

A
  • Active UC

- Antibiotic associated colitis

47
Q

‘Red flags’ that mean an urgent endoscopic referral is needed in acid reflux/dyspepsia?

A 
A - Anaemia
L - Loss of weight
A - Anorexia
R - Recently changes symptoms/new symptoms if >55
M - Malaena, dysphagia, heamotemesis
48
Q

What are the 2 main causes of peptic ulcer?

A

NSAIDs + H. pylori

49
Q

What is the treatment for H. Pylori?

A

Twice daily PPI + Clarithromycin + Amoxicillin OR metronidazole for one week

50
Q

How long should PPI therapy be given for H. Pylori?

A

Usually just for one week

Can be given for 4 weeks if ulcer is large or complicated (eg, haemorrhage)

51
Q

How is H. Pylori tested for?

A

C-Urea breath test

52
Q

Which patients are at high risk for developing an NSAID-associated ulcer?

A
  • Over 65s
  • History of peptic ulcers/GI complications
  • Other meds with GI side effects
  • Those with serious co-morbidities
53
Q

What is sucralfate used for and what is the associated risk?

A

Prophylaxis of gastric ulceration

Risk of bezoar formation esp, in seriously ill patients

54
Q

Name some H2 receptor antagonists?

A

Ranitidine, cimetidine, nizatidine, famotidine

55
Q

Caution to remember with H2 antagonists?

A

Can mask the symptoms of gastric cancer

If patients have alarm features then must rule out malignancy

56
Q

What side effect is associated with H2 antagonists?

A

Psychiatric reactions - confusion, depression, dizziness and hallucinations esp in the elderly
GI side effects - nausea, diarrhoea, constipation
Erectile dysfunciton
Tachycardia

57
Q

Who can buy ranitidine OTC?

A
  • Over 16s
  • Max 2 weeks treatment
  • 75mg per dose/ max daily dose 300mg
58
Q

Which H2 receptor antagonist is considered safest in pregnancy?

A

Ranitidine

59
Q

What is misoprostol used for?

A

Treatment/prophylaxis of ulcer

60
Q

Why should misoprostol be avoided in pregnancy?

A

Teratogenic

Can induce uterine contractions and is associated with abortion

61
Q

How do PPIs work?

A

Inhibit gastric acid secretion by blocking the ‘proton pump’ of the gastric parietal cell

62
Q

‘PPIs are associated with a low risk of subacute cutaneous lupus eythematosus’
True or false?

A

True - If a patient develops lesions consider this diagnosis and advise them to keep skin protected from sunlight

63
Q

3 cautions with PPIs?

A
  • Mask symptoms of gastric Ca
  • Risk of osteoporosis/fractures, advise patients to have adequate calcium and vitamin D intake
  • Can increase the risk of GI infections including C. Diff
64
Q

What monitoring is required with PPIs?

A
  • Serum magnesium - risk of hypomagnesaemia and more common if over 1 year of treatment.
  • Sodium - can cause hyponatraemia
65
Q

Why should a patient taking omeprazole + digoxin be monitored?

A

PPIs can cause hypomagnesaemia

Low magnesium increases the risk of digoxin toxicity

66
Q

Important interactions with omeprazole?

A
  • Methotrexate - omeprazole is an enzyme inhibitor and can decrease methotrexate clearance
  • Clopidogrel - omeprazole can decrease the anti-platelet effect
67
Q

Which PPIs can be sold OTC?

A

Esomeprazole (nexium) 20mg - GSL
Omeprazole 10mg - maximum treatment 20mg OD for 4 weeks
Pantoprazole 20mg OD for 4 weeks

Can only be sold to 18+

68
Q

Which drugs can interact with antacids so must be taken after a 2 hour gap?

A
  • Tetracyclines
  • Quinolones
  • Bisphosphonates

Antacids can impair absorption

69
Q

‘Antacids can lower gastric PH’

True or false?

A

False - they increase gastric pH and therefore can damage medicines with enteric coating

70
Q

In what conditions should antacids with high sodium content be used with caution?

A
  • Hypertension
  • Heart, liver and kidney failure
  • Patients on lithium - monitor levels
71
Q

What are anti-muscarinic side effects?

A

Fight/fight
Can’t see, can’t wee, can’t shit, can’t spit
Also tachycardia, pupils dilate, confusion (elderly)

72
Q

Which antimuscarinics can be used to treat gastro-intestinal spasm?

A

Hyoscine butylbromide
Dicycloverine
Propantheline

73
Q

When are anti-muscarinics contraindicated?

A
  • Enlarged prostate/urinary retention
  • GI obstruction
  • Myasthenia gravis
  • Glaucoma
74
Q

What is the MHRA warning associated with hyoscine butylbromide?

A

Risk of serious adverse effects in patients with underlying cardiac disease
Can cause tachycardia, hypotension + anaphylaxis

75
Q

When can you sell buscopan (hyoscine butylbromide) OTC?

A
  • Over 6s
  • Medically confirmed IBS
  • Max single dose 20mg
76
Q

Which BMI is classed as obese?

A

Over 30

77
Q

When can orlistat be sold OTC?

A
  • Over 18s
  • P medicine
  • Treatment can only be continued past 12 weeks if 5% reduction in body weight
78
Q

Which vitamins can orlistat impair the absorption of?

A

Fat soluble

D, E, A, K

79
Q

‘Olistat may decrease the plasma concs of some drugs’

True or false?

A

True - eg, anticoagulants, amiodarone, ciclosporin

80
Q

What advice should be given to patients receiving Creon (pancreatin)?

A
  • Take with meals and snacks as inactivated by gastric acid
  • Inactivated by heat, don’t take with hot food/drinks
  • Ensure adequate hydration
  • Avoid reduced fat diets and food that is hard to digest

Pre-reg revision (14 decks)

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