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Clinical therapeutics 1 > GI diseases I > Flashcards

GI diseases I Flashcards

1
Q

Dyspepsia: what is it, symptoms, red flags

A
  • Also known as indigestion, usually after eating too quickly, spicy foods, or alchol
  • SYM: > 4 weekss, upper abdominal pain, heartburn, gastric reflux, nausea and vomitting, burping
  • RED F: ‘alarm’
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2
Q

If a patient has severe dyspepsia what concerns would we have and what will be done next?

A
  • Could be cancer, GI bleed, peptic ulcer disease, cardiac event
  • Refer them for an endoscopic investigation
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3
Q

A patient walks in with symptoms of dyspepsia, what steps should the pharmacist take?

A
  • Assess her symptoms, any ALARM signs?
  • What is the cause? Is it her medication?
  • Offer lifestyle advice
  • Offer OTC med e.g.
  • Help with any POM and advice on when to consult GP
  • Record any adverse reactions to meds
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4
Q

Treatment for dyspepsia - OTC

A
  • Think about formulation for patient
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5
Q

Non-pharmacological advice for dyspepsia

A
  • Avoid spicy foods, chocolate, fatty foods, caffeine
  • Healthy eating
  • Weight loss
  • Manage stress
  • Dont wear tight clothes
  • Dont eat to late (3-4 hours before bed)
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6
Q

What drugs interact with antacids

A
  • Antacids e.g. rennie
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7
Q

GORD: what is it, symptoms and red flags?

A
  • Gastro-oesophageal reflux disease - chronic condition where there is reflux of gastric contents back into the oesophagus. This irritated lining of oes and leads to symotoms..
  • CAUSE: smoking, pregnancy, diet, obesity, lying down after eating
  • SYM: Heartburn, regurgitation (sour taste), chest pain, difficulty swallowing (dysphagia), chronic cough
  • RED F:
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8
Q

Treatment for GORD

A
  • Full does of PPI for four weeks to aid healing OR eight weeks for severe oesophagitis e.g. lansporazole 30mg
  • If symptoms reoccur - lowest does of PPI to control symptoms lansporazole 15mg
  • If still not controlled switch to H2RA (ranitidine)
  • If barretts oesophagus present - long term full dose PPI
    [proton pump inhibitors Inhibit gastric secretion by blocking hydrogen-potassium adenosine triphosphatase enzyme system]
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9
Q

What are PPIs, side effects

A
  • Proton pump inhibitors Inhibit gastric secretion by blocking hydrogen-potassium adenosine triphosphatase enzyme system
  • This can mask gastric cancler - ALARM
  • Prescribed for GORD
  • 30mg or 15mg
  • SIDE EFFECTS; GI disturbances, head aches, rare is B12 deficiency
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10
Q

What is peptic ulcer disease (PUD), symptoms, cause and red flags

A
  • When open sores or ulcers form on the inner lining of the stomach or upper part of small intestine (duodenum)
  • SYM: Burning stomach, bloating or feeling full, nausea, dark stool, unexplained weight loss
  • CAUSE: NSAIDs (ibuprofen, aspirin), corticosteroids, H.pylori infection, excess stomach acid (smoking, stress, alcohol, spicy, fatty food)
  • RED F: Severe pain, hematemesis (vomitting blood) and malaena (dark stool)
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11
Q

Treatment for PUD

A
  • If its due to NSAIDs stop them
  • Give full dose of PPI or H2RA (ranitidine) for 8 weeks
  • If not med related: test for H. pylori with carbon-14 breath test or stool test
  • Ensure no AB or PPis within four weeks
  • If positive treat infection
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12
Q

What is H.pylori, cause, symptoms and red flags

A
  • H.pylori is caused by gram -ve bacteria, it causes gastric ulcers and chronic gastritis (inflammation of stomach lining)
  • CAUSE: infection duh, direct contact via saliva, vomit or stool, food or water
  • SYM: gastritis, peptic ulcers, abdominal pain, nausea, bloating
  • RED F: risk factor for stomach cancer
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13
Q

H. pylori testing

A
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14
Q

H. pylori treatment

A
  • 2x ABs for one week, high dose of PPI
  • If large or bleeding ulcer continue PPI until healed
  • Take into account: allergies, freq of AB, interactions with other meds
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15
Q

Treatment for actively bleeding ulcer (H. pylori)

A
  • STOP causative drug
  • Transfusion of blood, or platelets
  • Urgent endoscopy to confirm cause
  • IV PPI
  • Continue with oral PPI until ulcer is healed
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16
Q

Examples of inflammatory bowel disease and what is it

A
  • Chronic relapsing, inflammatory disease
  • Crohn’s and ulcerative colitis
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17
Q

Difference between ulcerative colitis and crohns

A
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18
Q

Treatment for IBD

A
  • Goal is induce remission while improving QoL
  • Steroids usually start at high dose (40mg+) then go down
  • Long term steroids risk Osteoporosis
19
Q

What is fistula?

A
  • Fistulas are small tunnels that form between two organs or an organ and a surface of the body
  • Most likely to form in crohns as gut inflammation spreads through all layers
  • This inflammation causes small leaks
  • Most likely to form above strictures (narrowing part of intestine due to scar tissue in the wall)
20
Q

Diagnosis of IBD

A
21
Q

SYM outside of GI for IBD

A
22
Q

Classification of disease severity

A
23
Q

Bowel anatomy - small and large intestine

A
24
Q

What is a risk of long term steroids?

A
  • Osteoporosis
  • Poor nutritional uptake/absorption
  • So give supplemanys e.g. ca and vitamin d
25
Q

Types of ulcerative colitis

A
26
Q

UC inducing remission - proctitis

A
27
Q

UC inducing remission - proctosigmoiditis + distal UC

A
28
Q

UC inducing remission - extensive UC

A
29
Q

UC inducing remission - moderate to severe UC

A
  • Further treatment for moderate to severe colitis includes biologics
  • Examples include Infliximab, Adalimumab, Vedolizumab, Ustekinumab, Tofacitinib and more!
30
Q

UC inducing remission - acute severe UC

A
31
Q

UC - maintaining remission

A
32
Q

CD - inducing remission

A

Or surgery - disease section removed and add healthy section

33
Q

CD - maintaining remission

A
  • Maintain remissions with azathioprine or mercaptopurine
  • Aim to taper down any steroids
34
Q

Aminosalicylates

A
  • Used for induction and maintenance of remission in mild to moderate IBD
  • Mainly for UC
  • Mesalazine is the main drug option
  • MR preparation - release drug in the terminal ileum and colon
  • Sulfasalazine can also be used
  • Must be swallowed whole
  • Contact doctor: sore throught, rash, bleeding
35
Q

Mesalazine: site of action

A
  • Depends on the type of brand
  • What brand does the patient normally take?
  • Where has the disease been confirmed?
  • Where is the site of action of the mesalazine brand?
  • Is this for maintenance or for treating a flare up?
36
Q

Rectal preparations - site of action

A
37
Q

Use of corticosteroids for GI - used for what? which ones and doses?

A
  • Mainly used for Crohns flare and sometimes for UC flare
  • Prednisolone 40mg OD
  • IV hydrocortisone 100mg QDS for acute and severe Crohns
  • Budesonide used in CD if conventional glucocorticoid is in use
  • It has few side effects
38
Q

Thiopurines

A
  • Check if the person is at risk of developing severe side effects
  • Assess thiopurine methyltransferase (TPMT) activity before offering azathioprine or mercaptopurine
  • Consider azathioprine or mercaptopurine at a lower dose if TPMT activity is below normal but not deficient
39
Q

Azathioprine

A
  • Azathioprine is an immunosuppressive drug
  • Prodrug for mercaptopurine (active metabolite)
  • Its most severe side effect is bone marrow suppression – counsel patients to report any signs of bruising, bleeding or infection immediately! Must monitor for neutropenia – weekly for first 4 – 8 weeks, then every 3 months
  • Common side effect – nausea, but resolves after a few weeks
  • Drug interaction: Allopurinol increases the production of the active metabolite, but also increases risk of bone marrow suppression! But sometimes the combination is used…
40
Q

Methotrexate

A
  • Anti-metabolite/anti-folate
  • Option in active and relapsing Crohn’s when other immunosuppressants not tolerate or contraindicated
  • Monitor FBC and LFTs
  • Maintenance dose to prevent remission
    ONCE weekly dosing
  • Concomitant folic acid to reduce side effects
41
Q

Ciclosporin

A
  • Therapy for acute severe ulcerative colitis in hospital
  • Consider adding IV ciclosporin to IV corticosteroids or consider surgery for people:
  • who have little or no improvement within 72 hours of starting IV corticosteroids or
  • whose symptoms worsen at any time despite corticosteroid treatment.
  • Take into account the person’s preferences when choosing treatment
  • IV are oral is not appropriate due to diarrhoea (flare up)
  • Drug levels (TDM) need to be taken
  • Baseline BP, FBC, cholesterol, LFTs, GFR, Mg2+
42
Q

Biologics

A
43
Q

Stoma bags:

A
44
Q

Treatment options for pain in IBC

A

Clinical therapeutics 1 (34 decks)

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