GI System

Question 1

What medications have dyspeptic pain as ADRs?

Answer 1

NSAIDs, bisphosphonates, iron, corticosteroids

Question 2

When is the best time to take an antacid and what is the evidence like?

Answer 2

• best when symptoms occur or are expected (after meals or at bed)
• remain in the stomach longer at these times so have longer to act
• evidence: limited on the efficacy of management but symptomatic reload reported

Question 3

What interaction often occurs with antacids (ADME)

Answer 3

Affects absorption of other meds

Question 4

Combination antacids containing both magnesium and aluminium are less likely to upset stomach. What’s salts alone cause diarrhoea and which cause constipation?

Answer 4

Magnesium- diarrhoea
Aluminium- constipation

Question 5

What are alginates and H2 antagonists?
How do they work?
Who can’t they be sold to OTC?

Answer 5

Alginates - gaviscon
Work by forming a raft on stomach contents
H2 antagonists- ranitidine
Supress acid secretion as a result of histamine 2 receptor being blocked
U16, pregnant or breastfeeding

Question 6

Non pharmacological interventions for dyspepsia

Answer 6

Weight loss, smoking cessation, avoid trigger foods (caffeine, chocolate, alcohol, fatty spicy foods)

Question 7

Emergency symptoms related to dyspepsia which require 999 & how can you differentiate cardiac pain from dyspepsia?

Answer 7

Possible cardiac pain - cold, clammy, loss of consciousness)
Breathing difficulties
Vomiting blood/ coffee ground vomit
Differentiate - cardiac pain won’t be relieved by antacid, brought on by exercise and relieved by rest and GTN, can travel down either arm

Question 8

When should you refer to A&E and GP with dyspepsia?

Answer 8

A&E - Malaena (black stools), abdominal pain radiating to back (aortic aneurysm)
GP - dysphasia (difficulty swallowing)

Question 9

What drugs relax the lower oesophageal sphincter and can cause GORD?

Answer 9

CCBs, theophylline, nitrates

Question 10

What electrolyte imbalances are seen with PPIs?

Answer 10

Low sodium and magnesium

Question 11

Non pharmacological advice for GORD

Answer 11

Raising head of bed
One possible cause is relaxation of lower oesophageal sphincter lying flat may increase episodes as gravity does not prevent acid regurgitation

Question 12

What are the danger symptoms of colic?

Answer 12

Post natal depression (baby sensing anxiousness)
Meningitis symptoms (floppy, unresponsive)

Question 13

Non-pharmacological advice for colic

Answer 13

1. Hold baby upright to help wind pass
2. If breastfeeding avoid products in diet which could trigger it (fatty, spicy, caffeine, alcohol)
3. Bottle feeding make sure teat size correct
4. Avoid jiggling and lifting baby too much