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PSA > GI > Flashcards

GI Flashcards

1
Q

If anyone over 55 has ALARMS symptoms what should be done

A

OGD

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2
Q

If no ALARMS symptoms what is initially recommended

A
  • Lifestyle advice
  • Antacids OTC
  • Stop dyspepsia inducing medication
  • Review in 4W
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3
Q

If no improvement in 4W what should be done

A
  • Test for H.Pylori
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4
Q

If H.pylori test is positive what is done

A
  • Treat for H.Pylori
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5
Q

When does H.pylori not need to be re-tested for

A
  • If symptoms improve. If not, re-test in 4W
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6
Q

If initial H.Pylori test is negative what is done

A
  • PPI for 4W or H2 antagonist
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7
Q

If no improvement using a PPI or H2-antagonist what is done

A
  • Long-term PPI and OGD
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8
Q

What are 12 dyspepsia inducing drugs

A
  • A blockers
  • B blockers
  • Calcium channel blockers
  • Nitrates
  • Benzo’s
  • TCAs
  • Corticosteroids
  • Bisphosphonates
  • Aspirin
  • NSAIDs
  • Anti-muscarinics
  • Theophylline
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9
Q

What dose/route/frequency of alginate is given

A

SODIUM ALGINATE WITH POTASSIUM BICARBONATE

1 Tablet BD
PO
Chew immediately after meals or before bedtime

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10
Q

What 3 medications are given to eradicate H.Pylori

A

PPI

Amoxicillin

Clarithromycin

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11
Q

What 3 medications are given to eradicate H.pylori if someone is penicillin allergic

A

PPI
Metronidazole
Clarithromycin

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12
Q

What dose/route/frequency of PPI is given

A

OMEPRAZOLE
40mg BD
PO
Review: 7d

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13
Q

What dose/route/frequency of amoxicillin is given

A 
AMOXICILLIN
1g BD
PO
Review:7d 
Indication: H.Pylori Eradication
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14
Q

What dose/route/frequency of clarithromycin is given

A

CLARITHROMYCIN
500mg BD
PO
Review:7d

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15
Q

What dose/route/frequency of metronidazole is given

A

METRONIDAZOLE
20mg OD
PO
Review: 7d

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16
Q

If someone is H.pylori negative with dyspepsia what is given

A

H2 receptor antagonist or PPI

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17
Q

What dose/route/frequency is used for long-term H2 receptor antagonist use

A

RANITIDINE
150mg BD
PO
Review: 6W

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18
Q

What is an alginate/antacid

A

Salt (magnesium, aluminum) and sodium bicarbonate

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19
Q

What can magnesium alginates cause

A

Diarrhoea

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20
Q

What can aluminum alginates cause

A

Constipation

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21
Q

When should potassium/sodium antacids be used with caution

A

Renal failure - risk fluid overload and hyperkalaemia

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22
Q

Explain antacids and taking other drugs

A

Wait 2h before taking other drugs (listed below) as antacids reduce their absorption

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23
Q

What 6 drugs does antacids reduce absorption of

A
  • ACEi
  • Antibiotics (Cephalosporin, Ciprofloxacin, Tetracycline)
  • Bisphosphonates
  • Digoxin
  • Levothyroxine
  • PPI
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24
Q

What two drugs does antacids increase the excretion of and why

A
  • Aspirin. Lithium - increases alkalinity of urine
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25
Q

What is the MOA of omeprazole

A

Inhibits H+ - K+ channels in gastric pareital cells reducing acid excretion

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26
Q

What are two common side effects of omeprazole

A

Headache

GI disturvance

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27
Q

What can omeprazole use result in

A

Increases C. Diff risk

28
Q

What electrolyte abnormality can long-term omeprazole use cause

A

Hypomagnaesaemia

29
Q

How does hypomagnesaemia present clinically

A
  • Tetany

- Ventricular arrhythmias

30
Q

What is a relative contraindication of omeprazole and why

A
  • Osteoporosis. Long-term omeprazole use increases risk of fractures
31
Q

What drug does omeprazole reduce the efficacy of

A
  • Clopidogrel.
32
Q

If a patient is on clopidogrel what should they be given

A
  • Lansoprazole

- Pantoprazole

33
Q

What advice should be given to patients on omeprazole

A

Report any ALARMS symptoms

34
Q

If a patient is on omeprazole for more than one year, how should it be monitored

A

Serum magnesium

35
Q

What is the MOA of amoxicillin

A

Inhibits cross-linking of peptidoglycan chains causing water to enter and lysis

36
Q

What class of drug does amoxicillin belong to

A

Broad spec penicillin

37
Q

What are GI side effects of amoxicillin

A
  1. Nausea. Diarrhoea
  2. Increases risk C.Diff
  3. Acute liver injury - causes cholestatic jaundice and hepatitis
38
Q

What immunology SE does amoxicillin predispose to

A
  • Penicillin allergy

- Anaphylaxis

39
Q

If first exposure of amoxicllin in a patient with an allergy, when will the rash appear

A

7-10d

40
Q

If a repeat exposure of amoxicllin in a patient with an allergy, when will the rash appear

A

2d

41
Q

What is an absolute CI to amoxicillin

A

Allergy

42
Q

What are 3 relative CI to amoxicilin

A
  • Risk of C Diff
  • Penicillin associated liver injury
  • Renal impairment
43
Q

What drug does amoxicillin enhance the effect of and why

A

Warfarin.

Kills gut flora that produce vitamin K.

44
Q

What advice should be given to patients on amoxicillin

A

If develop a rash - seek medical advice

45
Q

What is checked before starting amoxicillin

A

Allergy

46
Q

What are 5 SEs of clarithromycin

A
  • GI disturbance (Nausea,
    Diarrhoea, Abdo Pain)
  • Allergy
  • Antibiotic associated colitis
  • Cholestatic jaundice
  • Prolong QT
  • Ototoxicity
47
Q

What is an absolute CI of clarithromycin

A

Allergy

48
Q

What is the effect of clarithromycin on CYP450

A

CYP450 Inhibitor

49
Q

Due to inhibiting CYP450 what can clarithromycin cause when given with warfarin

A

Bleeding

50
Q

Due to inhibiting CYP450 what can clarithromycin cause when given with statins

A

Myopathy

51
Q

What drugs may clarithromycin interact with to cause arrhythmias

A

Other drugs that prolong WT (SSRI, Amiodarone, Anti-psychotics, Quinine, Quinolones)

52
Q

What is checked before starting clarithromycin

A

Allergies

53
Q

What are two common side effects of metronidazole

A
  • GI upset, N+V

- Hypersensitivity reactions

54
Q

What are 4 neurological SEs of metronidaozle

A
  • Peripheral neuropathy
  • Optic neuropathy
  • Seizures
  • Encephalopathy
55
Q

When should metronidazole dose be reduced

A

Liver impairment

56
Q

What is an absolute CI to metronidazole and why

A

Alcohol.

Metronidazole inhibits acetaldehyde dehydrogenase causing acetaldehyde to build up and hang-over life effects.

57
Q

What drug does metronidazole increase toxicity of

A

LITHIUM

58
Q

What is the effect of metronidazole on CYP450

A

Inhibitor

59
Q

What can metronidazole cause when given with warfarin

A

Causes bleeding - due to inhibiting CYP450

60
Q

What advice is given to patients on metronidazole

A

Do not drink alcohol whilst on metronidazole and 48h post treatment

61
Q

What is checked before starting metronidazole

A

Allergy

62
Q

What should be checked before 10d following starting metronidazole

A

LFTs

FBC

63
Q

What is the MOA of ranitidine

A

H2 antagonist.

Stops histamine release stimulating gastric parietal cells

64
Q

What are 3 SEs of ranitidine

A
  • Headache
  • Dizziness
  • GI (diarrhoea or constipation)
65
Q

When should dose of ranitidine be reduced

A

Hepatic impairment

PSA (3 decks)

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