GI Drugs Flashcards
Tx a “severe” flare of UC?
(>6 bowel movements and systemically unwell)
IV hydrocortisone and fast fluids
Tx a “mild” flare of UC?
oral prednisolone 30mg given over 24 hours
what types of laxatives are there?
“BOSS”
- bulk forming
- osmotic
- stimulant
- stool softening
examples of bulk forming laxatives?
methylcellulose
ispaghula husk
sterculia
downsides of bulk forming laxatives?
- slow to work
- adequate fluid intake should be maintained to avoid intestinal obstruction
- not used in atony or faecal impaction
examples of osmotic laxatives?
lactulose
macrogol
Mg-hydroxide/sulfate
phosphate enema
which laxative is used for hepatic encephalopathy?
lactulose
how do osmotic laxatives work?
↑ water in the small bowel
CI for osmotic laxatives?
bloating
obstruction or risk of perforation
(don’t use phosphate enema in acute abdo!)
CIs for stimulant laxatives?
intestinal obstruction
cramping
(atony)
(undiagnosed acute abdo!)
examples of stimulant laxatives?
senna
sodium picosulfate
bisacodyl
glycerol
examples of stool softeners?
docusate sodium arachis oil (rectal)
CIs for stool softeners?
already soft stool! but good for faecal impaction
Tx acute GI bleed?
“8 Cs”
- ABC, O2, protect airway (NBM) C - 2 x large bore cannula (14-16G) C - cross-match 6 units C - crystalloid IV fluids <1 litre - if shocked, give blood, otherwise only if Hb<7 C - correct abnormal clotting (vit k, FFP, plts) C - catheter (fluid output) C - call surgeons C - camera (urgent endoscopy) C - stop culprit drugs
(risk of varices - alcohol/liver? terlipressin IV 1-2mg + IV Abx)
Tx flare of Crohn’s?
mild flare with prednisolone 30 mg daily orally
severe flare with hydrocortisone 100 mg 6-hourly IV and IV fluid, nil by mouth and antibiotics
if the patient has rectal disease, use rectal hydrocortisone too