GI Drugs Flashcards

1
Q

Tx a “severe” flare of UC?

A

(>6 bowel movements and systemically unwell)

IV hydrocortisone and fast fluids

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2
Q

Tx a “mild” flare of UC?

A

oral prednisolone 30mg given over 24 hours

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3
Q

what types of laxatives are there?

A

“BOSS”

  • bulk forming
  • osmotic
  • stimulant
  • stool softening
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4
Q

examples of bulk forming laxatives?

A

methylcellulose
ispaghula husk
sterculia

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5
Q

downsides of bulk forming laxatives?

A
  • slow to work
  • adequate fluid intake should be maintained to avoid intestinal obstruction
  • not used in atony or faecal impaction
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6
Q

examples of osmotic laxatives?

A

lactulose
macrogol
Mg-hydroxide/sulfate
phosphate enema

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7
Q

which laxative is used for hepatic encephalopathy?

A

lactulose

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8
Q

how do osmotic laxatives work?

A

↑ water in the small bowel

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9
Q

CI for osmotic laxatives?

A

bloating
obstruction or risk of perforation
(don’t use phosphate enema in acute abdo!)

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10
Q

CIs for stimulant laxatives?

A

intestinal obstruction
cramping
(atony)
(undiagnosed acute abdo!)

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11
Q

examples of stimulant laxatives?

A

senna
sodium picosulfate
bisacodyl
glycerol

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12
Q

examples of stool softeners?

A
docusate sodium
arachis oil (rectal)
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13
Q

CIs for stool softeners?

A

already soft stool! but good for faecal impaction

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14
Q

Tx acute GI bleed?

“8 Cs”

A
- 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)

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15
Q

Tx flare of Crohn’s?

A

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

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16
Q

Tx for maintaining remission in Crohn’s?

A

azathioprine/6-mercaptopurine (pro-drug, metabolized by the liver to 6-mercaptopurine)

10% of the population have abnormal accumulation of 6-mercaptopurine , ↑ risk of liver and BM toxicity

check TPMT (enzyme) levels before starting either drug

If TPMT is found to be ↓, consider starting methotrexate instead

17
Q

Tx chronic D (that has proven to be non-infectious)?

A

loperamide

codeine

18
Q

usual dosage of omeprazole for GORD?

A

10 mg orally daily

increasing to 20 mg orally daily if Sx return

19
Q

can you use PPI to Tx GI S/E of alendronic acid?

A

bisphosphonates are direct irritants to the upper GI tract

Sx not improved by PPIs

20
Q

Tx C Diff?

A

first episode - oral metronidazole 10–14 days
second or subsequent episode - oral vancomycin 10-14d
life-threatening infection, or in patients with ileus - oral vancomycin + i/v metronidazole