Gastro-Intestinal System -Medium Flashcards
What are the 4 types of laxatives?
- Osmotic
- Stimulant
- Bulk-forming
- Faecal softeners
Name some osmotic laxatives
Lactulose
Macrogol
Name some faecal softening laxatives
Docusate sodium
Glycerol enemas
Name some stimulant laxatives
Senna
Bisocodyl
Docusate sodium
Docusate sodium acts as what kind of laxative?
Both stimulant and faecal softener
Name some bulk-forming laxatives
Ispaghula husk
Sterculia
Which laxatives are used for hepatic encephalopathy?
Osmotics
(lactulose/macrogol)
What kind of laxatives should be avoided in opioid-induced constipation?
Bulk-forming
What are the first line options for the treatment of opioid-induced constipation?
Stimulant + Osmotic
What is used to relieve opioid-induced constipation that has not responded to other laxatives?
Naloxegel
Methylnaltrexone bromide is also licensed for this indication
What kind of laxative is the first choice in pregnancy and breastfeeding?
Bulk-forming
What are some important adverse effects associated with the use of antimuscarinics such as hyoscine butylbromide?
- Tachycardia
- Dry mouth
- Blurred vision
- Drowsinees
- Confusion
- Constipation
- Urinary retention
What are the first line options for the treatment of Crohn’s disease?
Corticosteroid
OR
Budesonide
OR
Aminosalicylates
Aminosalicylates are ;less effective but have fewer adverse effects
What are the possible add-on treatments for Crohn’s disease?
Azathioprine
Methotrexate
Infliximab
Which drugs can be used to maintain remission of Crohn’s disease?
Azathioprine (+metronidazole post-surgery)
Methotrexate (only if it was needed to induce remission)
Corticosteroids or budesonide should not be used to maintain remission
What are the first line options for the treatment of mild to moderate ulcerative collitis?
Topical amonosalicylate
Addition of oral aminosalicylate if necessary
Addition of oral or topical corticosteroid if necessary
What are the first line options for the treatment of severe ulcerative collitis?
IV corticosteroids
Addition of IV ciclosporin if necessary
Infliximab if ciclosporin contraindicated
How is remission of ulcertaive collitis maintained?
Using an aminosalicylate (sulfasalazine)
Which laxative is used for bowel cleansing?
Citric acid with magnesium carbonate
Is loperamide a GSL, P-med, or PoM?
PoM, except for Imodium orodispersible and Imodium plus
Which drugs can cause dyspepsia?
Benzodiazepines
NSAIDs
Alpha-blockers
Antimuscarinics
Aspirin
Beta-blockers
Bisphosphonates
Calcium-channel blockers
Corticosteroids
Nitrates
Theophyllines
Tricyclic antidepressants
What are the first line treatment options for dyspepsia?
PPIs
H2-receptor antagonists
Patients should also be tested for Helicobacter pylori
List the most commonly used H2-receptor antagonists
Famotidine
Cimetidine
Ranitidine
What is misoprostol indicated for?
Gastric ulcers
What are the H2-receptor antagonists indicated for?
- Gastric ulceration
- GORD and dyspepsia
Which drugs do H2-receptor antagonists interact with?
Cimetidine interacts with warfarin by inhibiting its metabolism
What is the MHRA warning associated with the use of PPIs?
Very low risk of subcute cutaneous Lupus erthematosus (September 2015)
What is the first line treatment for H.pylori infection?
PPI + Amoxicillin + Metronidazole (or Clarithromycin)
Which stimulant laxatives is indicated for the treatment of chronic constipation in palliative care?
Co-danthramer
Which laxative can turn the urine pink?
Co-danthramer
