Gastrointestinal Flashcards
What is prucalopride indicated for
Constipation
What class of drug is lubiprostone
Chloride channel agonist
When is vedolizumab used
IBD refractory to all other techniques
What counselling points are there for GI corticosteroids?
Take in the morning
Report visual disturbance
Apply sparingly
What 3 antimuscarinics are used as antispasmodics?
Dicycloverine, hyoscine and propantheline
What is the action of linaclotide?
Guanylate cyclase C receptor agonist. Causing release of cAMP and Cl. Laxative for constipation.
What is teduglutide indicated for
Short bowel syndrome
How does naloxegol exert its action for constipation
Opioid receptor antagonist. Acts on receptors in periphery so opioid central effects still occur but constipating effects blocked
What 3 classes of drugs are used in ulcer prevention and treatment?
proton pump inhibitors, h2 antagonists and prostoglandins
When and how is orlistat used?
When the BMI is over 30 and lifestyle changes are inadequate for obesity. Or over 28 with other risk factors. Max 12 weeks unless more than 5% weight loss. Taken up to 1h after meal and only if it contains fat.
Can racecadotril be mixed with food?
Yes
What additional considerations are there with sulfasalazine than with other amino salicylate?
Colours urine. Need FBC LFTs monthly for first 3 months.
What MHRA warning exists for eluxadoline?
Pancreatitis risk. Beware of worsening abdominal pain radiating to the back or shoulder.
What is given in loperamide overdose?
Naloxone
What drugs should be considered for stopping around the use of macrogol and for how long
Ace inhibitors, ARB, nsaid. Up to 72 hours after. No drugs 1h before and after
What other osmotic laxatives are there besides macrogol containing products?
Citric acid with magnesium carbonate
Lactulose
Magnesium hydroxide
sodium acid phosphate with sodium phosphate
What is the maximum amount of time before stimulant laxatives work?
12 hours
What are the common and excessive use side effects of stimulant laxatives?
Abdominal cramp common.
Diarrhoea and hypokaleamia with excessive use
Why are co-danthramer and Co-danthrusate not used commonly?
Carcinogenicity
What drugs belong to multiple classes of laxative?
Glycerol & docusate - stimulant and softening
Methyl cellulose - bulk forming and softening
Why is liquid paraffin not used much any more?
Side effects such as anal seepage, granulamatous disease, lipoid pneumonia
Why is gaviscon cautioned in hypertensive patients?
Sodium content
What are the GI side effects of antacids and how are they counteracted?
Aluminium constipating; magnesium laxative. Combine.
What proton pump inhibitor has an interaction with clopidogrel
Omeprazole
What antibiotic therapy commonly causes clostridium difficile?
Ampicillin, amoxicillin, Co amoxiclav, clindamycin, 2nd/3rd gen cephalosporins and quinolones
What can c diff be treated with?
Metronidazole, vancomycin, fidoxomycin
A high fibre diet should be given in diverticulitis. True or false
False. That and bulk forming drugs can be given in diverticular disease. Low residue diet and bowel rest given in diverticulitis
Which of these is not suitable to tell an IBS patient: eat 5 portions of fruit a day, increase physical activity, avoid sweeteners
Eat 5 portions as they should nto have more than 3
What types of cereal is gluten found in?
Wheat, barley, rye
What supplements are coeliac patients most likely to take?
Folic acid 5mg, calcium, vitamin D (risk of osteoporosis)
What should you advise to a coeliac patient requesting over the counter supplements?
Should not self medicate
What drug may be used in celiac disease?
Prednisolone (refractory)
What is the difference between diverticular disease and diverticulitis
Wihh or without inlfammation/infection
What is the most suitable treatment for uncomplicated diverticulitis
Low residue diet and bowel rest. Fibre has lacking evidence. Bulk forming laxatives may be used
If antibiotics are indicated for diverticulitis, what should be given?
IV covering Gram negative and anaerobes
A diverticular disease patient wants to buy buscopan. Is this suitable?
There is insufficient evidence to justify its role.
What differs sulfasalazine from other amino salicylate?
Combination with sulfapyridine to carry it to colonic site of action, producing more side effects. Extra testing - FBC initially and monthly for 3m and LFTs monthly for first 3m. Contact lenses may be stained.
Which form of IBD has continuous inflammation rather than interspersed?
Ulcerative colitis
What 3 options are there for chrons exacerbation, in descending order of effectiveness, if it is the patients first in 12 months?
Corticosteroid
Budesonide
Amino salicylate
What is added on to first line therapy if a patient has had 2 or more exacerbations of chrons disease in 12 months? What tests should be completed?
Azathioprine or mercaptopurine. TPMT activity - if deficit, use methotrexate