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Professional Pharmacy Practice > GI > Flashcards

GI Flashcards

1
Q

How long must a child have symptoms to diagnose him with functional constipation?

A

One month of at least 2 defining symptoms

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2
Q

What are some symptoms of functional constipation in children?

A
  • 2 or fewer defecations per week
  • history of excessive stool retention
  • history of painful or hard bowel movements
  • history of large diameter stools
  • presence of a large faecal mass in the rectum
  • at least one episode per week of incontinence after acquisition of toilet skills
  • history of retentive posturing or excessive retention in toilet-trained children
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3
Q

What is the stepwise treatment approach for functional constipation?

A
  1. regular doses of a stool softener or osmotic laxative
  2. if step 1 fails, use stimulant
  3. if monotherapy is ineffective, use combination of laxatives
  4. glycerol suppositories
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4
Q

What stool softeners can be used in children and from what ages?

A

Poloxamer (from under 6 months)
Docusate (from 3 years)
Liquid paraffin (from 1 year) - not recommended

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5
Q

What osmotic laxatives can be used in children and from what age?

A

Lactulose (from under 1 year)
Macrogol +/- electrolytes (from 1 year)

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6
Q

What stimulant laxatives can be used in children and from what age?

A

Senna (from 2 years)
Bisacodyl (from 3 years)
Sodium picosulfate drops (from 4 years)

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7
Q

What suppositories can be used in children?

A

Glycerol suppositories from under 1 year (infant)

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8
Q

How long can a course of laxatives be used in children with functional constipation?

A

May be used for several months, medication should be gradually reduced

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9
Q

What treatments should be avoided in constipated children?

A

Prune juice, brown sugar in water

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10
Q

When to refer a constipated child?

A

Fecal impaction, ineffective treatment, lasting more than 6 months, pain, affecting child’s lifestyle

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11
Q

Define diarrhoea

A

> 3 loose or liquid bowel movements, usually accompanied by increased frequenecy and fluidity to normal bowel pattern

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12
Q

When to refer diarrhoea?

A
  • alternating with constipation
  • occurring intermittently
  • blood or mucus in the stool
  • > 14 days
  • severe, more than 8-10 motions per day
  • persistent fever and severe vomiting
  • severe abdominal pain
  • pregnancy
  • weight loss
  • recent travel overseas
  • child <6 months or <1 year if >24h
  • chronic medical conditions
  • suspected laxative misuse
  • family hx of GI disease
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13
Q

What are the diarrhoea treatment? (1st and 2nd line)

A

1 - oral rehydration therapy
2 - antimotility agents

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14
Q

When can antimotility (anti-diarrhoeal) agents be used?

A

In adults and children >12
Mild to moderate acute diarrhoea
Short term control for convenience

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15
Q

When should antimotility agents never be used?

A
  • Severe diarrhoea, possibly caused by invasive organisms
  • Severe IBD
  • Children
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16
Q

What anti-diarrhoea agents are available?

A

Loperamide (+/- simethicone)
Diphenoxylate (+/- atropine)

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17
Q

What schedule is loperamide?

A

Unscheduled <8 pills, Schedule 2 <20 pills, PBS listing - authority required

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18
Q

What schedule is diphenoxylate?

A

Schedule 3 <8 pills, Schedule 4 >20 pills, PBS listing available

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19
Q

List 3 brand names for loperamide?

A

Imodium, Gastro-stop, Gastrex

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20
Q

List 2 brand names for diphenoxylate?

A

Lomotil, lofenoxal

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21
Q

What is giardiasis?

A

Parasitic infection of the small intestine caused by Giardia lamblia

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22
Q

How is giardia transmitted?

A

From contaminated water by raw sewage or animal waste, also human to human

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23
Q

What are some symptoms of giardiasis?

A

Diarrhoea (foul smelling)
Stomach cramps
Gas / flatulence
Nausea

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24
Q

What is the treatment for giardia infection?

A

Metronidazole, 3 times a day for 5 days (80-90% effective)

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25
Q

What is a common cause of viral gastroenteritis in children?

A

Rotavirus

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26
Q

How is rotavirus infection managed?

A

Prevention with the vaccine, oral rehydration solution, hospitalisation when severe

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27
Q

Define dyspepsia

A

Pain or discomfort in the upper abdomen

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28
Q

What is heartburn/reflux

A

Common symptom of dyspepsia causing a burning sensation that rises from the stomach to the chest

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29
Q

What is GORD

A

Prolonged exposure of the oesophageal lining to refluxed gastric contents leading to troublesome symptoms such as heartburn and reflux and mucosal damage

30
Q

What causes GORD?

A

Weakened or impaired function of the lower esophageal sphincter; increased intra-abdominal pressure; reduced oesophageal clearance; impaired mucosal defences

31
Q

What frequency of heartburn and reflux indicates possible GORD?

A

2 or more days per week and becoming troublesome

32
Q

List signs and symptoms of GORD

A

Heartburn, excessive burping, regurgitation of food or acid, upper abdominal pain or discomfort, waterbrash, difficulty swallowing, sore throat, persistent dry cough, angina-like chest pain

33
Q

What are some exacerbating factors for GORD?

A

Fatty and spicy food, supine position after eating, gastric pressure increased, smoking, bending or straining, tight clothes, stress, MEDICATIONS

34
Q

What medications can make GORD worse?

A

Anticholinergics (sedating antihistamines), antidepressants, nitrates, CCBs, Nicotine, benzodiazepines, beta-blockers, alpha-blockers, opiates, oral corticosteroids, aspirin, NSAIDs, bisphosphonates, tetracyclines, quinine, Vit C, potassium chloride, iron

35
Q

When do you refer a case of GORD?

A

Anaemia, weight loss, anorexia, recurrent or recent onset of symptoms, dark stools (blood), swallow impairment, nocturnal choking, persistent cough, vomiting blood, radiating chest pain.

36
Q

What classes of drugs can be used for GORD?

A

Antacids (S2) - quick onset, last 3-6 h
+/- simethicone to reduce flatulence
+/- alginates to form a raft on top of the stomach contents
H2 Antagonists (S2, S3, S4 and unscheduled) , reduce gastric acid secretion, can be used in pregnancy
PPIs (S2, S3, S4) Reduce gastric acid secretion, most potent

37
Q

Name 3 H2 antagonists

A

famotidine, nizatidine, ranitidine

38
Q

How quickly do H2 antagonists work

A

Anti-secretory activity begins within 1 h and persist for 6 to 12 h

39
Q

Name some PPIs

A

omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole

40
Q

Name some AEs of PPIs

A

Common: headache, diarrhoea, GI upset, constipation, flatulence;
Infrequent: rash, itch, dry mouth, dizziness, fatigue
Rare: blurred vision, myalgia, myopathy, taste disturbance

41
Q

Counselling for PPIs

A

Take 30 to 60 mins before meal; Do not crush or chew; slow onset of action, can use an antacid first;

42
Q

What is the GORD Step-Down Approach

A

Start with H2 antagonist; PPIs are initiated at standard dose as trial for 4-8 weeks; maintenance therapy to be reviewed frequently; if symptoms are well controlled consider stopping treatment, intermittent use and step down to low-dose

43
Q

List medicines for motion sickness

A

Promethazine, Dimenhydrinate, hyoscine hydrobromide

44
Q

What are common effect of motion sickness tablets

A

Sedation, anticholinergic effects

45
Q

Which motion sickness drug is the most long acting?

A

Promethazine, can be taken every 8h

46
Q

What motion sickness drug can be used in children?

A

Promethazine >2 yo, Dimenhydrinate >4 yo, hyoscine >2 yo

47
Q

What are some non-pharmacological treatments for motion sickness

A

Acupressure and ginger (safe in pregnancy)

48
Q

What is Diphenoxylate?

A

Antimotility drug

49
Q

Why is atropine added to diphenoxylate?

A

It discourages misuse at it triggers anticholinergic effects - causes dry mouth, blurred vision, urinary retention

50
Q

What are some symptoms of haemorrhoids?

A

Pain, tag around anus, irritation, swelling, burning, discomfort, itching, bleeding

51
Q

What are some causes of hamorrhoids?

A

Constipation, pregnancy, straining, obesity, sitting down a lot

52
Q

What is a common S3 medication for haemorrhoids?

A

Proctodesyl - cinchocaine + hydrocortisone

53
Q

What is an S4 medication for haemorrhoids?

A

Scheriproct - cinchocaine + prednisolone

54
Q

How long does an acute anal fissure take to heal?

A

4 to 8 weeks

55
Q

What treatments are used for anal fissure?

A

Increase fiber and laxatives, warm baths, topical ointments - glyceryl trinitrate, lignocaine, hydrocortisone, CCB (topical diltiazem and nifedipine)

56
Q

What is the common ointment used for anal fissure?

A

Restogesic - glyceryl trinitrate

57
Q

What are the counterindications for rectogesic?

A

PDE5 inhibitors - sildenafil, tadalafil, vardenafil

58
Q

What medications can be used for threadworm?

A

Pyrantel (S2), mebendazole (S2), albendazole (S4)

59
Q

Which anti-helminthic medicine is used in the aboriginal population under the PBS?

A

Albendazole

60
Q

What tests can be done to diagnose Coeliac disease?

A

Serological - in px consuming gluten, but 5% of px with disease have negative serology; not reliable in children <5
Gastroscopy and biopsy - no need to stop gluten, shows damage to villi
Genotype - for px on gluten free diet, screen for Human Leukocyte antigen (HLA), >99% px with Coeliac test positive; 30-50% of population has gene, but only 10% have disease

61
Q

What are some signs and symptoms of coeliac?

A

Can be asymptomatic, fatigue, weakness, lethargy, GI problems (bloating, flatulence, diarrhoea/constipation, abdominal pain, indigestion), weight loss or gain , nutritional deficiencies, anaemia, osteoporosis, infertility in women

62
Q

How do you manage coeliac disease?

A

Gluten free diet - avoid wheat, barley, rye; use vitamin supplements, including calcium, temporarily restrict lactose if px becomes intolerant, refer to dietician

63
Q

Who is at increased risk of bowel cancer?

A

> 50 yo
family hx
have had polyps
have IBD
smoking and drinking
overweight
poor diet - low fibre, high fat

64
Q

What is the routine test done for bowel cancer screening?

A

FOBT (faecal occult blood test) - detects blood in stool

65
Q

Which population is targeted in the bowel screening program?

A

All australians 50 to 74 yo, screened every 2 years

66
Q

What interferes with the FOBT?

A

No food, no medication but:
- do not collect 3 days outside menstrual period
- if bleeding haemorrhoids
- after recent colonoscopy
- if visible blood present

67
Q

What is the pharmacist’s role in bowel cancer prevention?

A

Educate px, facilitate screening for those ineligible fro the national program; Bowel Screen Australia - pharmacy based program

68
Q

What are the advantages of Macrogol for colonoscopy preparation?

A

Less risk of dehydration and electrolyte imbalance; needs to be dissolved in 3 L water; reduced fluid shifts

69
Q

What are some advantages and disadvantages of magnesium plus sodium picosulfate for colonoscopy prep?

A

Dissolved in less volume, easier to take; more likely to cause fluid shifts, electrolyte imbalances and dehydration; use with caution in >65, kidney or heart disease

70
Q

What is an alternative (not 1st line) drug for colonoscopy preparation?

A

Sodium phosphate - higher risk of complications, avoid in elderly, kidney and heart problems, dehydration of hypercalcaemia , reduced renal function

Professional Pharmacy Practice (5 decks)

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