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BNF Chapters > GI > Flashcards

GI Flashcards

1
Q

What does H. Pylori infection cause

A

Peptic ulcer disease (responsible for more than70%), acute/chronic gastritis, gastric cancer, MALT lymphoma

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2
Q

What has an additive effect with H. pylori

A

NSAIDS

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3
Q

When to test for H pylori`

A
  • Those with dyspepsia that are unresponsive to lifestyle changes, antacids and following a one month treatment of PPI,
  • those at high risk (north African, high risk areas, older people - can be tested in parallel with PPI course,
  • history of peptic ulcers/bleeds,
  • before initiating NSAIDS in those with history of peptic ulcers/bleeds,
  • unexplained iron deficiency anaemia after malignancy(and other causes) excluded via endoscopy
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4
Q

H pylori tests

A
  • The urea (13C) breath test,
  • Stool Helicobacter Antigen Test (SAT),
  • or laboratory-based serology where its performance has been locally validated
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5
Q

When/what h pylori tests should not be done in certain circumstances

A

Urea/SAT within 2 weeks of PPI or 4 weeks of Abx due to false negatives

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6
Q

When should h pylori retesting be done

A

Retesting should be performed at least 4 weeks (ideally 8 weeks) after treatment.

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7
Q

What instances require a H pylori retest

A

Severe persistent treatment not consistent with GORD, taking aspirin without PPI, peptic ulcer/MALT/resection of gastric carcinoma, high local resistance rates, if first test was done incorrectly like within 2 weeks of PPI etc.

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8
Q

H pylori treatment

A

Triple therapy, one PPI Two Abx

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9
Q

What Abx courses increase risks of resistance

A

Clarithromycin, metronidazole, or quinolone

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10
Q

What bacteria is associated with diarrhoea

A

C diff

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11
Q

First/second line treatment if no penicillin allergy h pylori

A

PPI+ amoxicillin + clari/metro (second line = same but use which ever one of clari/metro not used) all for 7 days

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12
Q

Alternative second line if no penicillin allergy h pylori

A

PPI+ amoxicillin + tetracycline/levofloxacin (used if clari and metro used)

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13
Q

h pylori Third line if no penicillin allergy

A

PPI+bismuth + 2 other unused Abx or rifabutin or furazolidone

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14
Q

Pen allergy first/alt first line h pylori treatment

A

PPI+Clari+metro, alt= PPI+ bismuth+ metro + tetracycline (if clari used first line)

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15
Q

Penicilin allergy second line h pylori

A

7 days of PPI+ metro+levofloxacin or PPI+ Bismuth+metro+tetra

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16
Q

H pylori Third line penicillin allergy

A

PPI+ bismuth+rifabutin/furazolidone

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17
Q

Two main types of antispasmodics

A

Antimuscarinics and smooth muscle relaxants

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18
Q

Examples of antimuscarinics

A

Atropine, dicycloverine, propantheline, hyoscine

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19
Q

Examples of smooth muscle relaxants

A

Alverine citrate, mebeverine, peppermint oil

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20
Q

Antimuscarinic GI MOA

A

Reduce intestinal motility and are used for GI smooth muscle spasm

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21
Q

What antimuscarinics are less likely to cross the BBB

A

Quaternary ammonium compounds = propantheline, hyoscine butylbromide meaning less CNS side effects

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22
Q

What antimuscarinics are less well absorbed from GI tract

A

Quaternary ammonium compounds = propantheline, hyoscine butylbromide

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23
Q

Constipation is

A

Infrequent stools, difficult stool passage, or seemingly incomplete defaecation.

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24
Q

When is urgent investigation needed for constipation

A

New onset constipation in over 50s / accompanying symptoms like anaemia, abdominal pain, weight loss, overt/occult blood in stool due to risk of malignancy/serious bowl disorder

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25
Q

Lifestyle advice for constipation

A

Increase dietary fibre, adequate fluid intake and exercise advised,, balanced diet, fruits/juice high in sorbitol

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26
Q

Why and how should fibre be given

A

Fibre intake should be increased gradually (to minimise flatulence and bloating). Effects of a high-fibre diet may be seen in a few days although it can take as long as 4 weeks.

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27
Q

Key downside to laxative

A

Hypokalaemia

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28
Q

Types of laxative

A

Bulk forming
Stimulant
Faecal softeners
osmotic

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29
Q

Other drugs used in constipation

A

Linaclotide, prucalopride

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30
Q

Bulk forming examples

A

Methylcellulose, ispaghula husk and sterculia Methylcellulose also acts as a faecal softener.

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31
Q

Bulk forming side effects

A

Exacerbation of flatulence, bloating , cramping

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32
Q

When is it best to use bulk forming

A

Small hard stools if fibre cannot be increased in the diet

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33
Q

Onset of bulk forming

A

72 hours

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34
Q

Stimulant laxatives

A

Bisacodyl, sodium picosulfate, and senna, co-danthramer and co-danthrusate, docusate a stimulant and softener, glycerol a stimulant and lubricant

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35
Q

Stimulant laxative MOA

A

Increase intestinal motility

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36
Q

Stimulant side effects

A

Abdominal cramp

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37
Q

When to avoid stimulant

A

Intestinal obstruction

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38
Q

What stimulants are only limited to terminally ill

A

Co-danthramer, co-fanthrusate

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39
Q

Faecal softeners

A

Docusate, glycerol, arachis oil

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40
Q

Faecal softener mechanism of action

A

Decreasing surface tension and increasing penetration of intestinal fluid into the faecal mass

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41
Q

Arachis oil use and ingredients

A

Ground nut and peanut oil, lubricant, softener and promoter of bowel movement

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42
Q

Liquid paraffin use and downfall

A

Lubricant but caution as it can result in anal seepage and granulomatous disease of GI tract. Liquid pneumonia on aspiration

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43
Q

Osmotic laxatives

A

Lactulose macrogol

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44
Q

Osmotic MOA

A

Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with.

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45
Q

What else can lactulose be used for

A

Hepatic encephalopathy

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46
Q

How to reduce dehydrating effect of osmotic

A

Fluids

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47
Q

Linaclotide indication

A

IBS associated with constipation

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48
Q

Prucalopride indication

A

Chronic constipation when other options fail

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49
Q

Short duration treatment

A

Bulk forming, ensure adequate fluid then add/switch to osmotic if needed because of hard stools, switch to stimulant if stool soft but hard to pass/ inadequate emptying

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50
Q

What to do in opioid induced constipation

A

Osmotic laxative/docusate and stimulant or naloxegol if other laxatives not effective, methylnaltrexone can also be used

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51
Q

What laxative should be avoided in opioid induced constipation

A

Bulk forming

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52
Q

What to do if unresponsive to faecal impaction treatment

A

Arachis oil or sodium acid phosphate with sodium phosphate sodium, may need to be repeated several times

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53
Q

Treating chronic constipation

A
  1. Bulk forming+ water
  2. If still hard add/change to osmotic laxative( macrogol then lactulose)
  3. If ineffective add stimulant
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54
Q

Aim of chronic constipation treatment

A

Adjust until producing one/two soft stools a day

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55
Q

When to use prucalopride in chronic constipation

A

Only in women that have tried at least two laxatives at highest tolerable dose for at least six months, re-examine if not effective after 4 weeks

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56
Q

First choice laxative in breast feeding

A

Bulk forming if diet changes fail osmotic used or short course stimulant

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57
Q

What laxative should not be used in pregnancy

A

Senna

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58
Q

General pregnancy constipation advise

A

Lifestyle, fibre supplements (bran/wheat), they have no side effects on mother or fetus

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59
Q

Treating constipation in pregnancy

A

Bulk forming first line then osmotic if necessary then bisacodyl senna should definitely be avoided near term and if unstable pregnancy (stimulants more likely to cause side effects. Docusate/glycerol suppositories can be used

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60
Q

First line constipation treatment in children

A

Laxative and diet modification (diet modification alone is not recommended as first line)

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61
Q

What dietary suggestions is not recommended for children

A

Unprocessed bran may cause bloating and flatulence and reduces absorption of micronutrients

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62
Q

First line pharmacological treatment of constipation in children

A

Macrogol if inadequate/not tolerated then stimulant

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63
Q

What to do if stools remain hard after treatment in children for constipation

A

Lactulose or a softener like docusate

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64
Q

How to stop constipation treatment in children

A

Continue several weeks after regular pattern then taper gradually over months based on response

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65
Q

In adults what laxative should be stopped first

A

Stimulant but may need to adapt osmotic dose

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66
Q

How to stop laxative in adults

A

Wait till regular without difficulty then reduce and stop one laxative at a time

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67
Q

Treating faecal impaction in > 1 yo in children

A

Macrogol if disimpaction does not occur after 2 weeks then stimulant added but if stools hard used in combination with an osmotic laxative .

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68
Q

Who is cholera vaccine licensed for

A

Adults and children from 2YO travelling to endemic/epidemic areas

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69
Q

When should cholera vaccine be given

A

At least one week before potential exposure

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70
Q

Aim of short bowel syndrome management

A

Ensuring adequate nutrition and drug absorption reducing risk of complications

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71
Q

What deficiencies may arise due to short bowel

A

Deficiencies in vitamins A, B12, D, E, and K, essential fatty acids, zinc, and selenium - hypomagnesaemia

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72
Q

Hypomagnasaemia treatment

A

Oral/iv magnesium supplementation but may cause diarrhoea

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73
Q

Treating diarrhoea/high output stoma

A 
Oral rehydration salts
Antimotility drugs like loperamide at high unlicensed doses, co-phenotrope
Colestyramine
Antisecretory drugs(PPI/Octreotide)
Growth factors
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74
Q

Colestyramine action

A

Bind unabsorbed bile salts and reduce diarrhoea

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75
Q

What do you monitor when giving colestyramine

A

Fat malabsorption (steatorrhoea) or fat-soluble vitamin deficiencies

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76
Q

Octreotide is/does

A

Antisecretory drug, reduces

ileostomy diarrhoea and large volume jejunostomy output by inhibiting multiple pro-secretory substances.

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77
Q

Most important part of intestine for drug absorption and why

A

Small intestine, its large surface area and high blood flow

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78
Q

What preparations can’t be used in short bowel

A

Enteric/ modified release especially in ileostomy

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79
Q

What preparations are preferred in short bowel

A

Soluble tablets for quick dissolution, uncoated tablets, liquid formulations

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80
Q

What alters absorption in SBS

A

Length of intestine left and which section removed

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81
Q

What to consider before prescribing liquids in SBS

A

Osmolarity, excipient content and volume required as Hyperosmolar liquids and some excipients (such as sorbitol) can result in fluid loss.

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82
Q

What is coeliac

A

Autoimmune condition which is associated with chronic inflammation of the small intestine

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83
Q

Gluten role

A

A dietary protein found in wheat barley rye activate abnormal immune response leafing to malabsorption of nutrients

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84
Q

Aim of coeliac management

A

Eliminate symptoms and reduce risk of complications like malabsorption

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85
Q

Coeliac symptoms

A

Diarrhoea, bloating and abdominal pain

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86
Q

Coeliac treatment

A

Strict, life-long, gluten-free diet

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87
Q

Stoma is

A

Artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside of the body

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88
Q

What preparations are unsuitable with stomas

A

Modified, enteric, sorbitol excipient (laxative side effects)

89
Q

What to look for when NSAID used with stoma

A

Gastric irritation and bleeding; faecal output should be monitored for traces of blood

90
Q

Considerations of antacids with stoma

A

Magnesium can cause diarrhoea, aluminium/calcium = increased constipation

91
Q

Antacid ingredients and GI

A

Magnesium can cause diarrhoea, aluminium/calcium = increased constipation

92
Q

Role of gastric secretion in stoma

A

Gastric secretion increases stoma output so antisecretory drugs like octreotide/lareotide used to reduce risk

93
Q

Loperamide/codeine role in stoma

A

Reduce intestinal motility and decrease water and sodium output from an ileostomy

94
Q

Loperamide effective mechanism of action

A

Circulates through the enterohepatic circulation, which is disrupted in patients with a short bowel;

95
Q

Digoxin and stoma

A

Susceptible to hypokalaemia due to fluid and sodium depletion, can consider potassium supplement and potassium sparing diuretic

96
Q

Laxatives and stoma

A

Ideally should not be used use bulk firming if needed if not then low dose stimulant, try diet and fluid intake first

97
Q

What is sucralfate

A

A complex of aluminium hydroxide and sulfated sucrose but has minimal antacid properties

98
Q

Role of sucralfate

A

Protecting the mucosa from acid-pepsin attack in gastric and duodenal ulcers.

99
Q

Sucralfate indication

A

Benign gastric ulceration, Benign duodenal ulceration, Chronic gastritis, Prophylaxis of stress ulceration,

100
Q

What is crohn’s

A

Chronic, inflammatory bowel disease that mainly affects the gastro-intestinal tract.

101
Q

Crohn’s characterisation

A

Thickened areas of the GI wall, inflammation, deep ulceration/fissuring of mucosa, granulomas in any part of GI tract

102
Q

Crohn’s symptoms

A

Adjacent structures, fistulae, anaemia, malnutrition, colorectal and small bowel cancers, and growth failure and delayed puberty in childrens

103
Q

Crohn’s complications

A

Adjacent structures, fistulae, anaemia, malnutrition, colorectal and small bowel cancers, and growth failure and delayed puberty in children

104
Q

Aim of Crohn’s treatment

A

Induce/maintain remission

105
Q

Non drug crohn’s treatment

A

Smoking cessation, nutrition, surgery , closing fistula

106
Q

Treating acute crohns

A

Corticosteroid (pred/methylpred/IV hydro) to induce remission, budesonide if not then aminosalicylates (sulfasalazine/mesalazine) which have fewer side effects but is less effective than budesonide

107
Q

Add on crohn’s treatment

A

Azathioprine/mercaptopurine if ineffective the methotrexate

108
Q

When can’t you use azathioprine/mercaptopurine

A

Thiopurine methyltransferase TPMT activity deficient

109
Q

What can’t be used for maintaining remission

A

Corticosteroids and budesonide

110
Q

What do you use in severe crohn’s

A

TNF alpha inhibitors, adalimumab, infliximab if not the vedoluzumab/ustkinumab

111
Q

What happens if no maintenance treatment on remission

A

Unintended weight loss, abdominal pain, diarrhoea and general ill-health

112
Q

What is used to maintain remission

A

Azathiprine/mercaptopurine or methotrexate onlu in those who used it to induce remission

113
Q

Maintaining remission following surgery

A

Azathioprine in combination with up to 3 months postop metronidazole (ileocolonic crohn’s disease in those with macroscopic resection)

114
Q

Treating diarrhoea in crohns

A

Loperamide/codeine in those without colitis and colestyramine

115
Q

Why can’t metonidazole be given for more than 3 months

A

Peripheral neuropathy

116
Q

Treating fistulae

A

Metronidazole(less than 3 months)/cipro combined or alone if not infliximab
Azathioprine, mercaptopurine, or infliximab should be continued as maintenance treatment for at least one year

117
Q

What is ulcerative colitis

A

Chronic inflammatory condition

https://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

Diffuse mucosal inflammation, relapsing-remitting pattern

118
Q

What is ulcerative colitis characterised by

A

https://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

119
Q

When does ulcerative colitis commonly present

A

15-25 years

://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

120
Q

What is inflammation of the rectum

A

Proctitis

121
Q

What is inflammation of the rectum and sigmoid colon

A

Proctosigmoiditis

122
Q

Common symptoms of active disease of UC

A

Bloody diarrhoea, urgent need to defecate, abdominal pain

123
Q

Complications due to UC

A

Increased colorectal cancer, secondary osteoporosis, VTE, toxic megacolon

124
Q

How is severity of UC classified

A

Truelove and Witts’ Severity Index to assess bowel movements, heart rate, erythrocyte sedimentation rate and the presence of pyrexia, melaena or anaemia

https://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

125
Q

Preparation used to treat distal inflammation

A

Rectal but systemic if inflammation is extended

126
Q

UC treatment aims

A

Managing symptoms, inducing and maintaining remission

https://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

127
Q

Types of rectal preparations

A

Enemas, suppositories

128
Q

What anti-diarrhoeal drugs are contraindicated in UC and why

A

Loperamide and codeine as they increase risk of toxic megacolon

129
Q

Treating proximal faecal loading in proctitis

A

Macrogol containing osmotic laxative

130
Q

Pros and cons of single daily dose of aminosaliciylates

A

Can be more effective than multiple but may result in more side effects

https://bnf.nice.org.uk/treatment-summary/ulcerative-colitis.html

131
Q

Duration of corticosteroid course in UC

A

4-8 weeks , depends on corticosteroid used

132
Q

Proctitis treatment mild-moderate

A

Topical aminosalicylate first-line treatment, if remission is not achieved within 4 weeks, adding an oral aminosalicylate. If response remains inadequate, consider topical or an oral corticosteroid for 4 to 8 weeks.

133
Q

Proctosigmoiditis/left sided UC mild-moderate

A

Topical aminosalicylate first-line treatment, if remission is not achieved within 4 weeks, adding a high dose oral aminosalicylate.
Switching to a high-dose oral aminosalicylate and 4 to 8 weeks of a topical corticosteroid. If response remains inadequate, stop topical and offer an oral corticosteroid for 4 to 8 weeks

134
Q

Extensive UC treatment - mild-moderate

A

A topical aminosalicylate and a high-dose oral aminosalicylate are recommended as first-line treatment for patients. If remission is not achieved within 4 weeks, stop topical aminosalicylate treatment and offer a high-dose oral aminosalicylate and 4 to 8 weeks of an oral corticosteroid.

135
Q

Treating moderate-severe UC

A

Treating adalimumab, golimumab, infliximab, vedolizumab

136
Q

Treating acute severe UC

A

IV corticosteroids, if not then ciclosporin

137
Q

Second line acute severe UC treatment

A

IV corticosteroid + ciclosporin or surgery if ineffective within 72 hours of IV corticosteroids, infliximab used if ciclosporin not possible

138
Q

Maintaining remission

A

Aminosalicylate, but azathioprine and mercaptopurine can be considered, no evidence for MTC but often used

139
Q

PPI indications

A

Short treatment for gastric and duodenal ulcers, prevention/treatment NSAID-associated ulcers, following peptic bleed, reduce bleeding (IV)

140
Q

Why is PPI used in CF

A

Reduces degradation of enzyme supplements in patients with CF
https://bnf.nice.org.uk/treatment-summary/proton-pump-inhibitors.html

141
Q

What is primary biliary cholangitis/cirrhosis

A

Chronic cholestatic disease which develops due to progressive destruction of small and intermediate bile ducts within the liver, subsequently evolving to fibrosis and cirrhosis.

142
Q

Treating primary biliary cholangitis

A

Ursodeoxycholic acid

143
Q

Where does dyspepsia occur

A

Upper GI

144
Q

How long do dyspepsia symptoms last

A

4/more weeks

145
Q

Dyspepsia symptoms

A

Upper abdominal pain or discomfort, heartburn, gastric reflux, bloating, nausea and/or vomiting

146
Q

Underlying cause of dyspepsia symptoms

A

GORD/ peptic ulcer disease

147
Q

Cause of dyspepsia in pregnant women

A

Most often GORD

148
Q

Aim of dyspepsia treatment

A

Manage symptoms and treat underlying cause if possible

149
Q

Lifestyle dyspepsia tips

A

Healthy eating, weight loss (if obese), avoiding any trigger foods, eating smaller meals, eating the evening meal 3–4 hours before going to bed, raising the head of the bed, stop smoking and reducing alcohol consumption

150
Q

What conditions exacerbate dyspepsia

A

Stress anxiety depression

151
Q

When is urgent endoscopy needed for dyspepsia

A

Acute GI bleeding/ in over 55s with unexplained weight loss, upper abdominal pain, reflux or dyspepsia

152
Q

Drugs that cause dyspepsia

A

Alpha blocker, antimuscarinics, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCB , corticosteroids, nitrates, NSAIDS, theophylline, TCA

153
Q

Short term control of dyspepsia

A

Alpha blocker, antimuscarinics, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCB , corticosteroids, nitrates, NSAIDS, theophylline, TCA

154
Q

TREATING uninvestigated dyspepsia

A

PPI for 4 weeks

155
Q

Short term control of dyspepsia

A

Antacids and/or alginates (not long term)

156
Q

Treating functional dyspepsia

A

If no h pylori PPI/ Histamine2 receptor antagonist for 4 weeks

157
Q

Dyspepsia and h pylori

A

Test for h pylori

158
Q

Diverticulosis

A

Asymptomatic condition with holes in walls of intestine

159
Q

Who is most likely to have diverticulosis

A

Aged 40 and over

160
Q

Diverticular disease

A

When diverticula (holes) are present with symptoms

161
Q

Diverticular symptoms

A

Abdominal tenderness and/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds

162
Q

Acute diverticulitis

A

Diverticula become inflamed

163
Q

Acute diverticulitis symptoms

A

Fever, sudden change in bowel habits, significant rectal bleeding, palpable abdominal mass, constant lower abdominal pain

164
Q

Diverticular lifestyle tips

A

Balanced diet, constipation advice - gradually increase fibre

165
Q

Diverticular disease treatment

A

Management of diarrhoea/constipation (high fibre diet/bulk forming), paracetamol for pain, opioid and NSAID not recommended

166
Q

Why aren’t opioids and NSAIDS used in diverticula treatment

A

May exacerbate diverticular perforation

167
Q

Acute diverticulitis treatment

A

Paracetamol

168
Q

What is acute diarrhoea

A

Abnormal passing of loose/liquid stools with increase frequency, volume / both for less than 14 days

169
Q

Cause of diarrhoea

A

Infection, side effect, GI disorder like IBD/IBS

170
Q

Aim of diarrhoea treatment

A

Reversal of fluid/electrolyte depletion

171
Q

Antibacterial drugs for acute diarrhoea

A

Ciprofloxacin prophylactically against travellers diarrhoea

172
Q

Sorting severe acute diarrhoea

A

IV rehydration fluid

173
Q

How to treat faecal incontinence

A

Loperamide

174
Q

Traveller’s diarrhoea treatment

A

Loperamide

175
Q

When can’t you use loperamide

A

Significant abdominal pain (suggests inflammatory diarrhoea), bloody

176
Q

Treating acute diarrhoea

A

Oral rehydration therapy

177
Q

Cause of exocrine pancreatic insufficiency

A

Chronic pancreatitis, cystic fibrosis, constructive pancreatic tumours, coeliac

178
Q

Clinical effect of exocrine pancreatic insufficiency

A

Maldigestion, malnutrition, low levels of micronutrients, fat soluble vitamins, lipoproteins

179
Q

Exocrine pancreatic insufficiency treatment

A

Pancreatin

180
Q

Physical manifestations of exocrine pancreatic insufficiency

A

Diarrhoea, abdominal cramps, Steatorrhoea

181
Q

What food to avoid in exocrine pancreatic insufficiency

A

Legumes (peas, beans, lentils) and high-fibre foods. Alcohol should be avoided completely. Reduced fat diets are not recommended

182
Q

What are haemorrhoids/piles

A

Abnormal swellings of the vascular mucosal anal cushions around the anus

183
Q

Who is particularly predisposed to piles

A

Pregnant women

184
Q

Lifestyle piles treatment

A

Soft stools by increasing dietary fibre/fluid intake

185
Q

General piles pain treatment

A

Paracetamol not opioid

186
Q

What do topical piles treatment typically contain

A

Local anaesthetics, corticosteroids, lubricants, antiseptics, astringents

187
Q

What to avoid with topical local anaesthetics and why

A

Excessive application as it can cause irritation

188
Q

Local topical anaesthetics

A

Lidocaine, benzocaine, cinchocaine, pramocaine

189
Q

How long should topical corticosteroid be used for piles and why

A

7 days due to thinning of perianal skin and ulceration

190
Q

Treating food induced anaphylaxis

A

Bulk forming laxative

191
Q

Treating symptoms of food allergy

A

Chlorphenamine

192
Q

Diet avoidance adjunct

A

Sodium cromoglicate - anti-allergic medicine which is prescribed to help prevent allergic reactions from occurring

193
Q

H2 receptor antagonist indication /moa

A

gastric and duodenal ulcers by reducing gastric acid output as a result of histamine H2-receptor blockade; they are also used to relieve symptoms of GORD

194
Q

Obese waist sizes

A

94cm men, 80cm women

195
Q

Drugs that cause weight gain

A

Atypical antipsychotics, beta-adrenoceptor blocking drugs, insulin (when used in the treatment of type 2 diabetes), lithium carbonate, lithium citrate, sodium valproate, sulphonylureas, thiazolidinediones, and tricyclic antidepressants

196
Q

When should drugs be considered for obesity

A

> 30 BMI, >28 BMI is risk factors

197
Q

What drug is used for obesity

A

Orlistat

198
Q

When is bariatric surgery considered

A

> 40 BMI

199
Q

Gallstone drug treatment

A

Paracetamol/ NSAID for pain can give opioid if needed

200
Q

Gallstone treatment

A

Leave if asymptomatic, or surgical removal

201
Q

Result of excessive laxative use

A

Hypokalaemia

202
Q

Cholethiases is

A

Gallstone other name

203
Q

Drugs for GORD in pregnancy

A

Antacids/alginate if not then omeprazole/ranitidine

204
Q

First line GORD treatment in pregnancy

A

Diet lifestyle

205
Q

Refractory GORD treatment

A

Further PPI dose for a month, double PPI dose for a month or add H2 for nocturnal symptoms

206
Q

Severe oesophagitis treatment

A

PPI 8 weeks

207
Q

What to offer in confirmed GORD

A

4-8 weeks PPI if not then H2 receptor antagonist

208
Q

What drugs exacerbate GORD

A

Alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, and tricyclic antidepressants should be reviewed and lowest dose used

209
Q

When to have urgent endoscopic investigation

A

Dysphagia and acute GI bleed or if over 55 and unexplained weight loss/upper abdominal symptoms, reflux or dyspepsia

210
Q

GORD symptoms

A

Chest pain hoarseness cough wheezing genital erosions but more commonly heartburn and acid regurgitation

211
Q

GORD is

A

Reflux of gastric contents back into the oesophagus

212
Q

Treating IBS

A

Antispasmodic , laxative if constipation, linaclotide if persistent and loperamide if diarrhoea, A TCA like amitriptyline can be used for abdo pain second line if antispasmodics don’t work as can SSRIs

213
Q

Lifestyle tips for IBS

A

Regular eating no long gaps, physical activity, less than 3 portions of fresh fruit a day, potentially increase dietary fibre via oats or isapaghula husk , increase water less caffeine/alcohol, fizzy, monitor probiotic use to see effectiveness

214
Q

When are IBS symptoms relieved

A

On defecating

215
Q

IBS symptoms

A

abdominal pain or discomfort, disordered defaecation (either diarrhoea, or constipation with straining, urgency, and incomplete evacuation), passage of mucus, and bloating

216
Q

Who is IBS more common in

A

20-30, women

217
Q

IBS is

A

Common, chronic, relapsing, and often life-long condition

218
Q

Inborn errors of primary bile acid synthesis treatment

A

Cholic acid, chenodeoxycholic acid, ursodeoxycholic acid

BNF Chapters (11 decks)

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