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GI OTC Flashcards

1
Q

What are red flags for chest symptoms?

A
  • Chest pain
  • Shortness of breath
  • Wheezing
  • Swollen ankles
  • Blood in sputum
  • Palpitations
  • Persistent cough
  • Whooping cough
  • Croup
  • Sputum mucoid, coloured??
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2
Q

What are red flags for your gut?

A
  • Difficulty swallowing
  • Blood in vomit
  • Bloody diarrhoea
  • Vomiting with constipation
  • Weight loss
  • Sustained alteration of
    bowel habit
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3
Q

What are red flags for your eye?

A
  • Painful red eye
  • Loss of vision
  • Double vision
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4
Q

What are red flags for your ear?

A
  • Pain
  • Discharge
  • Deafness
  • Irritation
  • Tinnitus
  • Vertigo
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5
Q

what are genitourinary red flags?

A
  • Difficulty in passing urine
  • Blood in urine
  • Abdominal/loin/back pain with cystitis
  • Urethral discharge
  • Vaginal discharge
  • Vaginal bleeding in pregnancy
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6
Q

what are other general red flag symptoms?

A
  • Neck stiffness/ rigidity with temperature
  • Vomiting (persistent)
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7
Q

what things do you consider when selling someone a product OTC?

A
  • Interactions= with prescribed, non prescribed
    and herbal medications
  • Contraindications= with conditions already
    present
  • Age of patient!!!!
  • License restrictions
  • Legal issues
  • Confidentiality
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8
Q

what questions would you ask around abdominal pain?

A

– Where is the pain?
– When did it start?
– Is it constant or intermittent?
– Has it moved and/or spread?
– Have you had it before?
– Is the area tender?
– Have you taken anything which helps?

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9
Q

when would you refer abdominal pain?

A

– continuous severe pain lasting more than 1 hour
– mild/moderate lasting on/off for 7 days
– swelling – associated with hernias
– Over 45ys v 55yrs and suffering persistent dyspepsia (NICE)
– recent unexplained weight loss
– vomiting/constipation/diarrhoea + persistent abdominal pain
– blood in vomit or stools (red or coffee grounds)
– abdominal pain + chronic back pain
– babies – projectile vomiting, constipation, diarrhoea – Gastro-enteritis

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10
Q

what medications could cause abdominal pain?

A

– gastric pain – NSAID’s,
– constipation – opioids, tricyclic
antidepressants, iron
– oesophageal ulceration – potassium
chloride, alendronic acid, doxycycline

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11
Q

what is the cause of oral thrush? where does it exist?

A

Candida infection
Exists normally in the mouth, GIT and vagina.

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12
Q

what are some factors which can cause an increase in the number of organisms for oral thrush?

A

Antibiotic therapy
Immunocompromised.
Diabetes.
Ill-fitting dentures.
Pregnancy.
Inhaled corticosteroids.

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13
Q

what are the symptoms of oral thrush?

A
  • White raised patches on oral mucosa
  • Tendency to bleed
  • Can be painful
    – baby may be refusing feeds
    – sometimes associated with nappy rash
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14
Q

what is the treatment for oral thrush?

A

miconazole 20mg/g- daktarin oral gel

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15
Q

what advice would you give when using daktarin?

A

– treatment of choice from 4 months
– Dose is age related
* Maintain good oral hygiene
* Apply after food
* Continue treatment for 7 days after symptoms
have gone (SmPC advice)
* People with dentures
* Inhaler technique
* Application to babies

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16
Q

what is miconazole? what is it contraindicated with?

A

it is an enzyme inhibitor
c/i with warfarin, sulphonylureas, phenytoin

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17
Q

when would you refer someone with oral thrush?

A

when patient is pregnant/ breast feeding

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18
Q

what can cause mouth ulcers?

A
  • Sometimes unknown
  • Deficiency? Vit B, Folic Acid?
  • Stress?
  • Physical illness….Crohn’s, IBD
  • Nutrition
  • Trauma
  • Carcinoma
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19
Q

what are the symptoms of mouth ulcers?

A
  • Shallow yellow/white ulcers on tongue, cheek
    and lip mucosa
  • Painful, can look swollen
  • Single or in clusters
  • Can be recurrent
  • Relatively common complaint
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20
Q

how would you treat mouth ulcers?

A
  • Topical local anaesthetics/analgesics eg bonjela
    or/and
    Antiseptic mouth washes
    e.g Chlorhexidine (Corsodyl Mouthwash)
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21
Q

what advice would you give surrounding bonjela treatment?

A

– limited use
– short duration of action
– should not take before a meal

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22
Q

what is the benefits of antiseptic mouth washes for mouth ulcers?

A
  • reduces incidence of secondary infection
  • accelerates healing process
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23
Q

how can you use difflam oral rince- benzydamide HCl to treat mouth ulcers?

A

Can use every 1.5 to 3 hrs prn, max 7 days.
* Rinse not to be used on children under 13 yrs

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24
Q

what tablets are available to treat mouth ulcers? how are they used?

A

Hydrocortisone 2.5 mg Muco-Adhesive Buccal
Tablets
Over 12 years - keep in the mouth and allow
to dissolve slowly in close proximity to the
ulcers QDS

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25
Q

when should you refer a patient with mouth ulcers?

A
  • Recurrent ulcers
  • If ulcer more than 3 wks old
  • If patient is:
    – pregnant, breast feeding, diabetic, or ulcers due
    infection – refer
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26
Q

what would be symptoms of oral cancer?

A

· A white patch and/or red patch on the gums,
tongue, or lining of the mouth
· A small sore that looks like a common mouth
ulcer that fails to heal
· A lump or mass that can be felt on the lip or in the mouth or throat

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27
Q

what is other terms used to describe dyspepsia?

A

Indigestion, heartburn, trapped wind

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28
Q

what are some of the causes of dyspepsia?

A

Hurried meals
* Overindulgence (food and drink)
* Spicy food
* Smoking
* Overweight
* Pregnancy
* Medication (NSAID’s, digoxin, iron)
* Heart failure
* H. pylori

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29
Q

what are the symptoms of dyspepsia?

A
  • Epigastric discomfort shortly after
    eating/drinking
  • Feeling of fullness
  • Heartburn
  • Trapped wind
  • Nausea/vomiting
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30
Q

what are the antacids that treat indigestion?

A

– Magnesium salts (Milk of Magnesia)
* can cause diarrhoea
– Aluminium salts (now only in combination products)
* can cause constipation
– Bismuth salts (Pepto-Bismol)
* avoid if aspirin sensitive
* avoid if pregnant
* Not suitable under 16 years
– Combination preparations
* Kolanticon Gel
* Co-magaldrox

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31
Q

what is activated simeticone?

A

it is an antifoaming agent used to treat indigestion
it reduces surface tension of gas bubbles
ie wind settlers

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32
Q

how do alginates work?

A

useful to treat acid reflux
make a raft
usually in combination with antacids
eg gaviscon

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33
Q

what interactions do you have to be cautious of when using antacids?

A

– digoxin
– enteric coated tablets
– Lithium…serum levels reduced by Sodium Bicarb
– tetracycline
– warfarin
– Iron
– Alendronic acid

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34
Q

what advice should you give to someone whos on an interacting medication with antacids?

A

Avoid concomitant administration 2-4 hours either
side of dose *Note SmPC’s differ

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35
Q

how are h2 receptor antagonists useful in indigestion treatment?

A

– OTC license for short term symptomatic relief of
excess acid, dyspepsia and heartburn

36
Q

who can use h2 receptor antagonists?

A

adults and children over 16
not for use in pregnancy
not for long term use- refer

37
Q

when would PPIs otc be appropiate for indigestion treatment?

A

for recurrent heartburn

38
Q

when should you refer indigestion with PPI use?

A

No improvement after 2 weeks - refer

39
Q

what should be considered when using PPI otc>

A

use the lowest effective dose

40
Q

what counselling would you give for indigestion?

A
  • Small regular meals
  • Avoid meals late at night
  • Avoid highly spiced food
  • Avoid bending/stooping
  • Don’t wear tight clothing
  • Raise the head of the bed
  • Take antacids about 1 hour after food
41
Q

when would you refer for indigestion?

A

Caution: GP Referral??
- 1st time dyspepsia age 45 yrs +
* Refer: Endoscopy???
– over 55yrs and with alarm signs or persistent
unexplained symptoms
* Persistent vomiting
* loss of appetite
* difficulty swallowing
* feeling of lump in throat
* Gastrointestinal bleeding

42
Q

what is common triggers of IBS?

A
  • Emotion/stress?
  • Food intolerances?
43
Q

what are the common symptoms of IBS?

A

– Bloating
– alternating bouts of constipation/diarrhoea
– abdominal pain
* Rectal fullness, incomplete evacuation
* Non-colonic symptoms: nausea, back pain,
urinary frequency/urgency

44
Q

when can you offer IBS treatment OTC?

A

Should only offer IBS treatment OTC if the
condition has been previously diagnosed by
a Dr

45
Q

what should treatment of IBS be based on?

A

based on the major presenting symptom

46
Q

what are the usual major symptoms of IBS?

A

abdominal bloating, diarrhoea or constipation

47
Q

what is an anti-spasmodic, when and what is it used for?

A

Intestinal smooth muscle relaxants
– Hyoscine butylbromide (Buscopan IBS)

48
Q

when is anti-spasmodics c/i?

A

in paralytic ileus

49
Q

what antidiarrhoeal can be used to treat IBS?

A

Loperamide- imodium
bulking agent- may improve constipation and diarrhoea- ispaghula husk

50
Q

what counselling would you give for IBS?

A

Food diary – identify triggers
* Ask if taking any other medicines
* Try not to rush meals
* Eat balanced diet and plenty fluids
* Take regular exercise
* Relaxation

51
Q

when would you refer for IBS?

A

f symptoms persist for more than 2wks despite
treatment, or if symptoms have changed
– blood in stool
– not had IBS diagnosed by Dr
– fever
– Unexplained weight loss

52
Q

what are the common causes of constipation?

A
  • Change in lifestyle
  • Change in eating habit
  • Reduced fluid intake
  • Lack of exercise
  • Medication
  • Depression
  • IBS
  • Anal fissures
  • Haemorrhoids
  • Pregnancy
  • Refusal to obey urge to pass stool
53
Q

what are the main symptoms of constipation?

A

Decrease in frequency of bowel movement.
Hard stools. Straining.

54
Q

what is the first line treatment for constipation?

A

alter diet and lifestyle and increase fluids….however patients are likely to want/need a quick fix!!

55
Q

what are bulk forming laxatives and how do they work?

A

closest to the natural process
– e.g ispaghula husk
– slow action (24 to 72 hours)
– take with plenty of water
– not to be taken at bedtime
– not for the frail elderly
– can alter absorption of medication

56
Q

how long do stimulant laxatives take to work?

A

– stimulate the nerve endings in the bowel
wall
– Anthraquinones: senna (Senokot, Ex-lax)
* act within 8 to 12 hours

57
Q

what are the restrictions around stimulant laxatives?

A

GSL – 18 years +
P – 12 years +

58
Q

what advice should you give for a stimulant laxative about overuse/ inappropiate use?

A

short term occasional relief only.

59
Q

how do osmotic laxatives work?

A

retain fluid in the bowel so stimulating peristalsis and forming a loose stool
more powerful than bulk
eg lactulose/macrogol
longer action up to 72 hours of regular dosing

60
Q

when should you be cautious for use of osmotic laxatives?

A

c/i in use in patients lactose/ glucose intolerant
caution for use in diabetes

61
Q

how quick do glycerol suppositories work?

A

within 1-2 hours

62
Q

how do faecal softners help constipation? how long does it take?

A

– Docusate sodium (Dioctyl caps)
– little if any straining required
– effect within 1 - 3 days

63
Q

what are some counselling points for constipation?

A

Improve diet, exercise, increase fluids
* Do not take laxatives regularly
* Do not take bulk laxatives at bedtime

64
Q

what constipation treatment should be given to someone who is pregnant?

A

– Osmotic/bulk forming safe
– stimulant laxatives – C/I

65
Q

can you use stimulant laxatives while breast feeding?

A

no- c/i

66
Q

what advice would you give for a baby who is constipated?

A

breast-fed: may need extra water from a bottle
– bottle-fed: are they making feed with sufficient water?

67
Q

what advice would you give to an elderly patient who is breast feeding?

A

– increase fluids–possible dehydration
– bulk laxatives - care in bed bound or inactive
patients

68
Q

when should you refer constipation?

A

– illness and unable to work
– children/babies who exhibit ill symptoms
– blood in the stool
– continuous severe pain lasting more than 2 days
– weight loss
– diarrhoea
– self medication not effective after 4-5 days
– fever/night sweats
– nausea/vomiting

69
Q

what are haemorrhoids?

A

Piles) - varicose dilatations of the veins in the lower part of the
large intestine and/or anus. Become engorged with blood.

70
Q

what are some of the causes of haemorrhoids?

A
  • Anal infections – scratching/STI
  • Sports eg cycling
  • Sitting/standing for long periods
  • Pregnancy
  • Constipation
  • Lesions of pelvic area
  • Abuse of laxatives
71
Q

what are the symptoms of haemorrhoids?

A
  • Itching in perianal area
  • Not always but can be painful
  • Can be sharp pain on defaecation
  • Bright red blood on stool and toilet paper
72
Q

what are the contribution factors for haemorrhoids?

A
  • Increase in intra-abdominal pressure
  • Old age
  • Dehydration
  • Inadequate fibre in diet
  • Medication
73
Q

what are some of the haemorrhoid treatments made up from?

A

Astringents Emollients
Local anaesthetics Antiseptics
Antipruritics
Heparinoids

74
Q

what is an example of a haemorrhoid treatment?

A

annusol

75
Q

what is the best way to treat haemorrhoids?

A

Will produce the best results!!
– use for no more than 7 days
– not to be used in pregnancy/BF
– for adults > 18yrs
– not to be used if broken skin or infection

76
Q

what counselling would you give for haemorrhoids?

A
  • Hygiene
  • Diet
  • Try not to scratch area
  • Try to avoid straining
  • Increase activity
  • Laxative (Faecal
    softener)
77
Q

when would you refer haemorrrhoids?

A

– Duration > 3 wks
– Internal anal pain
– rectal bleeding
– Suspected drug
induced constipation
– recurrent piles
(regular recurrence)

78
Q

what can cause nausea and vomiting?

A
  • Viral/Bacteria/Bacterial toxins
  • Inner ear disorders
  • Migraine
  • Motion sickness
  • Meningitis
  • Medication – digoxin, theophylline, nsaids
  • Pregnancy
79
Q

what counselling would you give for nausea and vomiting?

A
  • Ensure patient does not become
    dehydrated/Offer electrolyte replacement
  • Sip water/little and often
  • Avoid dairy products + greasy foods for 24 hrs.
  • Pregnancy - morning sickness
    – frequent small meals
    – ginger
    – sea-bands
  • Re-introduce light diet when hungry
80
Q

when should you refer nausea and vomiting?

A

– projectile vomiting – babies and adults
– vomit stained with blood
– vomiting with associated weight loss
Reference sources for referral timelines differ…..2
days often a cut off but look at the overall health
/presentation of the patient!!!!!
– babies <12mths and symptoms for 24hrs
– children <3 yrs and elderly and symptoms for
48hrs
– people with diabetes (if persistent)

81
Q

what are some of the causes of diarrhoea?

A
  • Bacterial/Viral
  • Diet changes /overindulgence
  • Medication
  • Food allergies
  • Secondary to a medical condition
    – e.g diabetes; hyperthyroidism; IBS
  • Stress
82
Q

what advice/ treatment can you give for diarrhoea?

A

Usually resolves itself!!
* Must maintain fluid intake
– oral rehydration sachets (Dioralyte)
– mix with recommended amount of water
– will keep for 1hr or 24 hrs if in fridge
– sip little and often

83
Q

how does loperamide work?

A

it is an anti-diarrhoea
it decreases bowel motility
over 12’s

84
Q

when is pepto-bismol (bismuth salicylate) contra indicated?

A

C/I if allergic to aspirin

85
Q

what advice would you give to babies with diarrhoea?

A

ensure bottles are properly sterilised and making the feeds properly
– Refer*……text book recommendations….
* if <12mths and symptoms more than 24hrs
* if <3 years and elderly and symptoms more than 48hrs
* Older adults and children more than 72 hours

86
Q

when would you refer patients with diarrhoea?

A

Elderly
– if symptoms persist for 48hrs – refer
* Refer if
– chronic diarrhoea
– recurrent diarrhoea
– with fatigue/pain lasting more than 2 days
* Refer all patients if
– weight loss
– blood in stool
– persistent mucous in stool
– symptoms change/worsen
– alternating diarrhoea/constipation

MO1 (50 decks)

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