Brainscape's Knowledge GenomeTM

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


See full index

Pre-reg exam > GI > Flashcards

GI Flashcards

1
Q

What is the treatment for dyspepsia?

A

PPI up to 4 weeks

If no response to PPI - test for H. pylori

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

What should happen if a patient does not respond to a PPI for dyspepsia after 4 weeks?

A

Test for H. pylori

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

What is the treatment for mild GORD?

A

Antacids and alginates
PPI

PPIs preferred over H2 antagonists

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

PPI or H2 antagonist for GORD?

A

PPI is preferred over H2 antagonist

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

What is the treatment for severe GORD?

A

Continued PPI - lower dose once symptoms are under control

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

What is the treatment of GORD in pregnancy?

A

1) Lifestyle advice
2) Antacid
3) H2 antagonist (ranitidine)
4) Omeprazole - severe/complicated reflux disease

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

Name 3 types of medicine that may worsen the symptoms of GORD

A

Calcium channel blockers
Anti-depressants
NSAIDs

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

What times of day are antacids given?

A

After meals and at bedtime

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

What are the effects of aluminium-containing and magnesium-containing antacids

A

Magnesium - laxative
Aluminium - constipation

Antacid containing both bases can avoid this problem

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

What is the purpose of simeticone in antacids?

A

Relieve flatulence

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

What is the purpose of alginates in antacids?

A

Relieve symptoms of GORD - forms raft

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

How do antacids help to reduce the symptoms of GORD?

A

Neutralise gastric acid

Contain bases - aluminum, magnesium

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

What should be considered when deciding on an antacid in renal impairment?

A

Avoid antacids that contain magnesium or large amounts of sodium

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

What should be considered if a patient is using an antacid and is on other medication

A

Do not take antacid at the same time as other medicines

Leave 2-4 hours after taking antacid before taking other medicines

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

What is Maalox?

A

Antacid
Low sodium
Aluminium only

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

What do Gaviscon and Peptac contain?

A

Calcium carbonate (no Mg or Al)
Bicarbonate
Alginate

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

What does Gaviscon Advance contain?

A

Potassium bicarbonate

Alginate

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

What effect do anti-spasmodics have on the GIT?

A

Relax intestinal smooth muscle

Anti-muscarinics

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

What kind of drug are anti-spasmodics?

A

Anti-muscarinics

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

Name 2 conditions that antispasmodics are commonly used in

A

IBS

Diverticular disease - small bulges/sacs (diverticula) form in the wall of the colon

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

Name 4 examples of antispasmodics

A

Atropine
Hyoscine butylbromide
^^Antimuscarinics

Peppermint oil
Mebeverine

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

List 5 main side effects of antispasmodics

A 
Typical of antimuscarinics:
Constipation
Bradycardia
Urinary retention
Dilated pupils
Dry mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name an antispasmodic that should not be used in pregnancy

A

Hyoscine butylbromide - Buscopan

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

Describe the legality surrounding the sale of Hyoscine Butylbromide (Buscopan)

A

POM

Can be sold for diagnosed IBS - 20mg up to QDS

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

Name a side effect of peppermint oil (IBS and diverticular disease)

A

Heartburn

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

Which antispasmodic can be used in pregnancy?

A

Peppermint oil capsules

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

How is H. pylori diagnosed?

A 
Breath test
or
Stool sample
or
Blood test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Broadly, how is H. pylori eradicated?

A

Acid inhibition + antibacterial treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What must happen before H. pylori is treated?

A

Confirmation of H. pylori presence

Using breath test, stool sample or blood test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for H. pylori?

A

1 week triple therapy

  • PPI
  • Clarithromycin
  • Amoxicillin / Metronidazole

If severe ulceration - continue PPI/H2 antagonist for another 3 weeks

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

What does H. pylori cause?

A

Duodenal and gastric ulcers

Most of these ulcers are caused by H. pylori, if not by NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

For H. pylori - why is 1 week triple therapy preferred over a 2 week regimen?

A

Increased eradication rates
BUT
Adverse effects are common
Compliance rates are lower

So not worth the extra week

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

What are the 2 main causes of gastric or duodenal ulcers?

A

H. pylori

NSAIDs

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

4 risk factors for NSAID-associated ulcers

A

1) Age - over 65
2) History of ulceration
3) Serious co-morbidity - CVD, diabetes, renal/hepatic impairment
4) Taking drug that increases risk of GI side effects

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

What should be done with the NSAID if it causes an ulcer?

A

Discontinue the NSAID

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

What can be used to prevent NSAID-associated ulcers?

A

PPI for non-selective NSAIDs

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

Name 2 non-selective NSAIDs

A

Diclofenac

Naproxen

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

Name a group of selective NSAIDs (COX-2 selective)

A

The -Coxibs

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

What should be changed with meds if an NSAID-ulcer occurs and the NSAID cannot be stopped?

A

PPI
Switch to COX-2 selective inhibitor

Misoprostol good in elderly

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

List 2 side effects of misoprostol

NSAID-associated ulcer

A

Colic

Diarrhoea (severe)

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

What effect do H2 receptor antagonists have?

A

They reduce gastric acid secretion through H2 receptor blockade
To treat ulcers and relieve symptoms of GORD

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

2 main indications for H2 antagonists

A

Ulcers

GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Name 2 H2 receptor antagonists

A

Ranitidine

Cimetidine

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

3 side effect of H2 antagonists

A

Diarrhoea
Headache
Dizziness

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

What is important to consider regarding Cimetidine?

A 
It is an enzyme inhibitor
Increases plasma concentration of:
- Carbamazepine
- Warfarin
- Phenytoin
- Sodium valproate
- Theophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What drugs does cimetidine affect?

A 
Enzyme inhibitor - 
Carbamazepine
Warfarin
Phenytoin
Sodium valproate
Theophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which H2 antagonist has the least interactions?

A

Ranitidine

Cimetidine has more interactions

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

What misoprostol?

A

Prostaglandin analogue
Anti-secretory and protective properties
Can prevent NSAID ulcers
Used in elderly patients who rely on NSAID continuing after ulcer formation

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

What is misoprostol used for?

A

Prevention of NSAID ulcers

Elderly patients - when NSAID cannot be stopped after ulcer formation

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

Consideration for misoprostol in women?

A

Should not be used in women of child-bearing age unless pregnancy ruled out
Potent uterine stimulant
Teratogenic
Can be sued for abortions and to induce labour

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

How do PPIs work?

A

Block hydrogen-potassium proton pump

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

List 8 groups of patient which are at an increased risk of osteoporosis

A

Family history
Underweight

Alcoholics
Corticosteroids - long term

Post-menopausal women
Rheumatoid arthritis
Crohn’s
Hyperthyroidism

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

How can those at risk of developing osteoporosis reduce their chances?

A

Maintain adequate intake of calcium + vitamin D

Adcal D3

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

What extra precautions should be taken if at risk of osteoporosis and on PPI

A

Maintain adequate intake of calcium + vitamin D

Adcal D3

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

Name 2 electrolytes which should be watched if on PPI

A

Magnesium
Sodium

PPIs can cause hypomagnaesia & hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which electrolyte should be monitored if patient is on PPI + digoxin?

A

Magnesium

= Hypomagnaesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which electrolyte can digoxin affect?

A

Magnesium
Hypomagnaesia
Especially if on other drugs which affect Mg - e.g. PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

List 6 side effects of PPIs

A 
Nausea
Vomiting
Abdominal pain
Flatulence
Diarrhoea or constipation
Headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Name an adverse effect of using a PPI

A

Rebound acid hypersecretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which 2 PPIs should not be used in pregnancy or breastfeeding?

A

Lansoprazole + Pantoprazole

Should not be used in PG/BF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Which PPI can be used in pregnancy and breastfeeding?

A

Omeprazole

Can be used in PG + BF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When should PPIs be taken?

A

PPIs should be taken 30-60 minutes before food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the primary concern in acute diarrhoea?

A

Electrolyte depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which group is anti motility drugs not recommended in for acute diarrhoea?

A

Young children

Should not be given anti-motility drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are most cases of diarrhoea due to?

A

Viruses

Does not need antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Name the drug used for diarrhoea following ileal disease (Crohn’s) or resection

A

Colestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is colestyramine used for?

A

Diarrhoea following ideal disease (Crohn’s) or resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What should be considered if patient taking colestyramine and other medicines?

A

Take other medicines an hour before or 4-6 hours after colestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How do anti motility drugs work?

A

Anti-motility drugs work by:

Binding to the opioid receptors in the GIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Name 3 anti-motility drugs

A

Loperamide
Codeine
Morphine/kaolin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

From what age can morphine/kaolin be used?

A

Over 12 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the minimum age for loperamide?

A 
POM = 4 years old
OTC = 12 years old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How is inflammatory bowel disease treated?

A

Mild - oral aminosalicylate
Moderate - oral corticosteroid (prednisolone, budesonide)
Severe - immunosuppressant (ciclosporin, azathioprine, methotrexate)
No response - infliximab

74
Q

How is mild inflammatory bowel disease treated?

A

Oral aminosalicylate alone

sulfasalzine, mesalazine

75
Q

How is moderate inflammatory bowel disease treated?

A

Oral corticosteroid - prednisolone, budesonide

76
Q

Name 2 oral corticosteroids used in the treatment of moderate inflammatory bowel disease

A

Prednisolone

Budesonide

77
Q

How is severe inflammatory bowel disease treated?

A

Immunosuppressant:

  • Azathioprine
  • Ciclosporin
  • Methotrexate
78
Q

Name 3 immunosuppressants used in the treatment of severe inflammatory bowel disease

A

Azathioprine
Ciclosporin
Methotrexate

79
Q

How do oral aminosalicylates work?

A

Compounds contain 5-ASA (API)
Interferes with body’s response to inflammation
Sulfasalazine - 5-ASA bonded to sulfapyridine
Sulfapyridine delivers 5-ASA to intestine

80
Q

Which 2 conditions does IBD cover?

A

Crohn’s

Ulcerative colitis

81
Q

Why is sulfapyridine (in sulfasalazine) not an ideal compound?

A

Side effects of sulfapyridine:
Headache
Nausea
Rash

82
Q

What are the 2 main compounds in sulfasalazine?

A

5-ASA (5-aminosalicylic acid)

Sulfapyridine

83
Q

Why may certain aminosalicylates be preferred to others? (IBD)

A

1) Tolerance (sulfapyridine side effects)

2) Formulation - area of 5-ASA delivery

84
Q

What different formulations of aminosalicylate are available?

A

Enema - left-sided disease (colon)
Suppository - rectum to sigmoid colon
Delayed release/extended release - small intestine/ileum/colon

85
Q

List 8 side effects of sulfasalzine

A 
Headache
Nausea
Rash
Loss of appetite
Vomiting
Fever
Decreased WBC count
Decreased sperm production
86
Q

Mesalazine and renal function

A

Caution in kidney disease/renal impairment

Monitor eGFR annually

87
Q

2 indications of mesalazine

A

Treatment of ulcerative colitis

Maintenance of remission of ulcerative colitis

88
Q

What symptoms should be reported when on aminosalicylates?

A 
Unexplained bleeding/bruising
Sore throat
Fever
Malaise
Purpura - purple spots on skin caused by burst small blood vessels

^^ signs of blood dyscrasias

89
Q

List 4 signs of possible blood dyscracias

A

Unexplained bruising/bleeding
Sore throat
Temperature
Malaise

90
Q

What is important in the prescribing of mesalazine?

A

Brand-specific
Asacol
Octasa
Pentasa

91
Q

What is used in IBD if patients do not respond to aminosalicylates/steroids/immunosuppressants?

A

Infliximab

92
Q

Which drugs can be used for maintenance of remission in inflammatory bowel disease?

A

Aminosalicylates + immunosuppressants

Can be used to maintain remission in IBD

93
Q

Which drugs should not be used to maintain remission in inflammatory bowel disease?

A

Corticosteroids

Aminosalicylates and immunosuppressants for maintenance of remission in IBD

94
Q

What should be used for constipation in inflammatory bowel disease?

A

Movicol

For constipation in IBD

95
Q

What should be used for diarrhoea in inflammatory bowel disease?

A

Colestyramine

For diarrhoea in IBD

96
Q

What should be used for constipation and diarrhoea in IBD?

A

Movicol - constipation

Colestyramine - diarrhoea

97
Q

Which drugs are used in the treatment of C. diff?

A

Vancomycin or metronidazole

98
Q

What is a common cause of C. diff?

A

Antibiotic therapy:

  • Fluoroquinolones
  • Cephalosporins
  • Penicillins
  • Clindamycin
99
Q

Response to diarrhoea following course of Clindamycin?

A

Immediate referral
Possible C. diff

Clindamycin is a common cause of C. diff

100
Q

Which 4 drugs/classes are known to commonly cause C. diff?

A

Cephalosporins
Fluoroquinolones
Penicillins
Clindamycin

101
Q

What is diverticular disease?

A

When small bulges/sacs (diverticula) form in the wall of the colon

102
Q

What is the treatment of diverticular disease?

A

Ispaghula husk (Fybogel)
Antispasmodics (Buscopan)
Antibacterials - if infected

103
Q

Which class of GI drug should not be used in diverticular disease?

A

Antimotility drugs should not be used diverticular disease:

  • Loperamide
  • Codeine
  • Morphine/kaolin
104
Q

How does irritable bowel syndrome usually present?

A

IBS usually presents as:

  • Pain
  • Constipation
  • Diarrhoea
105
Q

Why may antidepressants be useful in irritable bowel syndrome?

A

Aggravating psychological factors

106
Q

Why may amitriptyline be useful in irritable bowel syndrome?

A

Reduce abdominal pain

107
Q

Which tricyclic antidepressant may be used in irritable bowel syndrome?

A

Amitriptyline

Reduces abdominal pain

108
Q

List 4 drugs that may be used in IBS

A

Fybogel (husk)
Movicol
Loperamide
Buscopan (hyoscine butylbromide)

109
Q

Which laxatives are recommended for irritable bowel syndrome (IBS)?

A

Fybogel (ispaghula husk)

Movicol

110
Q

Which anti motility drug is recommended for irritable bowel syndrome?

A

Loperamide

111
Q

Which antispasmodic is recommended for use in irritable bowel syndrome?

A

Buscopan (hyoscine butylbromide)

112
Q

When are laxatives most appropriate?

A

Drug-induced constipation
Straining issue - haemorrhoids, angina

Avoid in healthy individuals

113
Q

How should constipation be treated in infants?

A

Prune juice
Lactulose
Movicol
Glycerol suppositories

114
Q

How should constipation be treated in children?

A 
Prune juice
Lactulose
Movicol
Glycerol suppositories
Stimulant laxative if no response (Senna, bisacodyl, sodium picosulphate)
115
Q

List 6 stimulant laxatives

A

Senna
Bisacodyl
Sodium picosulphate
Docusate sodium (stimulant & faecal softener)
Glycerol suppositories (rectal stimulant & lubricant)
Co-danthramer - palliative use only

116
Q

How do stimulant laxatives work?

A

Increase intestinal motility by stimulating nerves involved in peristalsis

117
Q

What is a common side effect of stimulant laxatives?

A

Abdominal cramp

118
Q

Why is co-danthramer limited to palliative care only?

A

Co-danthramer is:

  • Carcinogenic
  • Genotoxic
119
Q

How do glycerol suppositories have their laxative effect?

A

Irritant action of glycerol

Rectal stimulant and lubricant

120
Q

List 3 bulk-forming laxatives

A

Ispaghula husk
Methylcellulose (also faecal softener)
Bran

121
Q

When are bulk-forming laxatives particularly useful

A

Adults with small, hard stools where fibre cannot be increased

122
Q

How long is the onset of action for bulk-forming laxatives?

A

72 hours

123
Q

3 common side effects of bulk-forming laxatives

A

Flatulence
Bloating
Abdominal cramp

124
Q

What must be ensured to avoid intestinal obstruction with bulk-forming laxatives

A

Adequate fluid intake

125
Q

Main counselling point of bulk-forming laxatives

A

Adequate fluid intake to avoid intestinal obstruction

126
Q

All info on bulk-forming laxatives

A
  • Ispaghula husk, methylcellulose, bran
  • Absorbs liquid in intestine = softer stool, peristalsis
  • 72 hours for onset of action
  • Good for adults with small hard stools where fibre cannot be increased
  • Side effects: flatulence, bloating, abdominal pain
  • Adequate fluid intake must be maintained - intestinal obstruction
127
Q

How do bulk-forming laxatives work?

A

Absorb/retain liquid in intestine
= Softer stool - easier to pass
And stimulates peristalsis

128
Q

All info on stimulant laxatives

A
  • Senna, bisacodyl, sodium picosulfate, docusate sodium, glycerol suppositories, co-danthramer
  • Most common side effect = abdominal cramp
  • Avoid in intestinal obstruction
  • Stimulate nerves involved in peristalsis
  • Co-danthramer = carcinogenic & genotoxic
129
Q

How do faecal softeners work?

A

Reduce surface tension of faecal mass and increasing fluid penetration into it

130
Q

Name 5 drugs that act as faecal softeners

A 
Docusate sodium
Glycerol suppositories
Arachis oil enema (nut oil)
Methylcellulose
Liquid paraffin
131
Q

How do archis oil enemas work?

A

Lubricates and softens impacted to faeces and encourages bowel movements

132
Q

What kind of laxative is docusate sodium?

A

Stimulant and faecal softener

133
Q

What kind of laxative is glycerol suppositories?

A

Stimulant - rectal irritant

Faecal softener

134
Q

What kind of laxative is methyl cellulose?

A

Bulk-forming

Faecal softener

135
Q

Why should liquid paraffin be used with caution as a laxative/faecal softener?

A

Used as a lubricant

Adverse effects - anal seepage, granulomatous disease

136
Q

All info on faecal softeners

A

Reduce surface tension and increase fluid penetration of faecal mass
Docusate sodium, glycerol suppositories, methylcellulose, arachis oil, liquid paraffin
Arachis oil = nuts
Liquid paraffin - caution - seepage, granulomatous disease

137
Q

How do osmotic laxatives work?

A

Increase water content of stool in the large bowel

By drawing water from body into bowel or retaining water present

138
Q

Name 3 osmotic laxatives

A

Lactulose
Macrogols
Polyethylene glycol

139
Q

Why is lactulose useful in hepatic encephalopathy?

A

Not absorbed from GIT
Lowers faecal pH
Discourages proliferation of ammonia-producing bacteria
Ammonia worsens HE

140
Q

What is a common side effect of macrogols? (osmotic)

A

Dehydration

Can be reduced by giving with fluid

141
Q

How can dehydration from use of macrogols be reduced?

A

Give with fluid

142
Q

When should a bulk-forming laxative be used?

A

Short duration constipation
Where dietary measures are ineffective
If stools remain hard - add or switch to osmotic laxative
Ensure adequate fluid intake

143
Q

Which type of laxative should be used for short-duration constipation?

A

Bulk-forming laxative for short-duration constipation
Where dietary measures are ineffective
If still hard stools - add or switch to osmotic laxative
Ensure adequate fluid intake

144
Q

Which type of laxative for soft stool but difficult to pass?

A

Bulk-forming + Stimulant laxative

145
Q

Which type of laxative for inadequate emptying?

A

Bulk-forming + Stimulant laxative

146
Q

Which type of laxative in opioid-induced constipation?

A

Osmotic + stimulant laxative
Docusate sodium can be used in place of osmotic
For opioid induced constipation

147
Q

Which type of laxative should be avoided in opioid induced constipation?

A

Bulk-forming laxatives

Should be avoided for opioid-induced constipation

148
Q

Which laxative should be used in opioid induced constipation if no response to 1st line approach?

A

Naloxegol

149
Q

When should naloxegol be used?

A

Opioid induced constipation

If no response to 1st line (osmotic/docusate + stimulant)

150
Q

How should chronic constipation be treated?

A

1) Bulk-forming laxative
2) + or change to osmotic laxative (macrogol)
3) Lactulose - if macrogol ineffective/not tolerated
4) + stimulant

Dose adjusted to = 1-2 soft stools a day

151
Q

When and how can laxatives be withdrawn in chronic constipation?

A

Slowly withdraw
When regular bowel movements occur without difficulty
If combination laxatives have been used - reduce and stop 1 at a time
Reduce stimulant laxative first

152
Q

How should constipation in pregnancy be managed?

A

1) Dietary fibre, lifestyle changes
2) Fibre supplements - bran, wheat
3) Bulk-forming laxative - ispaghula
4) Lactulose
5) Senna, bisacodyl if stimulant effect necessary - but avoid near full term/history of unstable pregnancy
6) Docusate sodium, glycerol suppositories

Stimulant laxatives more effective than bulk-forming but more likely to cause side effects (diarrhoea, abdominal discomfort)

153
Q

Why are bulk-forming laxatives preferred to stimulant laxatives in pregnancy?

A

Stimulant more effective than bulk-forming

But more likely to cause side effects - diarrhoea, abdominal discomfort

154
Q

How should constipation be managed during breastfeeding?

A

1) Dietary measures
2) Bulk-forming laxative
3) Lactulose or macrogol (osmotic)
4) Short course stimulant laxative - Senna/bisacodyl

155
Q

How should constipation in children be managed?

A

1) Macrogol laxative + dietary modifications/behavioural interventions
- Fibre
- Fluids
- Exercise

Unprocessed bran is not recommended - bloating, flatulence, reduced micronutrient absorption

2) Add stimulant if inadequate, change to stimulant if not tolerated
3) If stools remain hard - add lactulose or softener (docusate)

156
Q

What is 1st line for constipation in children?

A

Macrogol laxative + dietary modification/behavioural intervention

Dietary modification alone not enough for 1st line

157
Q

Why is unprocessed bran not recommended for constipation in children?

A

Flatulence
Bloating
Micronutrients not absorbed

158
Q

How should chronic constipation be managed in children?

A

Continue laxatives for several weeks after regular bowel habits return
Taper dose gradually over months

159
Q

Which type of laxative can be used for diarrhoea in diverticular disease?

A

Fybogel - bulk forming

160
Q

Which electrolyte may become imbalanced by excessive use of laxatives?

A

Potassium

Hypokalaemia

161
Q

5 red flags for constipation

A

Red flags for constipation:

  • Over 50 years old
  • Anaemia
  • Abdominal pain
  • Weight loss
  • Blood in stool
162
Q

Is lactulose suitable for diabetic patients

A

Yes

Even though it is a synthetic sugar - not absorbed from GIT

163
Q

What is the onset of action for lactulose?

A

48 hours

164
Q

What is the main difference between Crohn’s and Ulcerative Colitis?

A

UC = just colon

Crohn’s any part of GIT

165
Q

Where does Crohn’s affect?

A

Any part of GIT

166
Q

Where does UC affect?

A

Limited to the colon

167
Q

How do symptoms differ in dyspepsia vs GORD?

A

Dyspepsia:

  • Upper abdominal pain
  • Bloating
  • Nausea

GORD:

  • Heartburn
  • Acid regurgitation
  • Ulceration
168
Q

What is ursodeoxycholic acid used for?

A
  • Dissolution of gall stones

- Primary biliary cirrhosis

169
Q

What drug is used for the dissolution of gall stones?

A

Ursodeoxycholic acid

170
Q

What is Terlipressin used for?

A

Oesophageal varices
Vasoconstrictor
Reduce portal hypertension

171
Q

What is the BMI at above which a person is considered ‘obese’?

A

Over 30 kg/m2

172
Q

When is Orlistat used?

A

Obese patient - <30 kg/m2

When diet, excercise and behaviour changes fail to reduce weight

173
Q

What is the licensing of Orlistat in terms of BMI?

A

> 30 kg/m2
or
28 kg/m2 if also other risk factors

174
Q

When should orlistat be discontinued?

A

Discontinue after 12 weeks if weight loss has not exceeded 5% of starting weight

175
Q

Which laxative is recommended in haemorrhoids?

A

Bulk-forming laxatives for haemorrhoids
Osmotic as alternative

Focus on soft and easily passed stools

176
Q

What should be used for haemorrhoids in pregnancy?

A

No licensed preparations

Consider simple soothing solution

177
Q

What are the indicators of exocrine pancreatic insufficiency?

A

Maldigestion
Malnnutrition
Low levels of micronutrients, fat soluble vitamins & lipoproteins

Also - diarrhoea, abdominal cramps, steatorrhoea (fat in faeces)

178
Q

What is the main treatment for exocrine pancreatic insufficiency?

A

Pancreatic enzyme replacement therapy

179
Q

When are pancreatic enzymes given?

A

With meals and snacks

180
Q

What does pancreatin contain?

A

Amylases
Lipases
Proteases
Assists digestion of starch, fats, proteins

181
Q

What should be considered regarding choice of food when taking pancreatin?

A

Its enzymes are denatured by heat + gastric acid
Avoid excessive heat
Best taken with food

Pre-reg exam (2 decks)

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