GI System Flashcards
Mebeverine
Antispasmodic
IBS
200mg BD
Symptomatic relief: max. single dose is 135 mg, max. daily dose is 405 mg;
For uses other than symptomatic relief of irritable bowel syndrome: max. single dose is 100 mg and max. daily dose is 300 mg.
Suspension not for children under 10, Tablet/MR capsule not for use in children.
Avoid in pregnancy
Side effects: mild, rarely causes problem, allergy (itchy rash, swelling), angiodema/face oedema
Peppermint Oil
Relief of abdominal colic and distension, particularly in IBS
1–2 capsules 3 times a day for up to 3 months if necessary, capsule to be swallowed whole with water; Manufacturer advises capsules should not be broken or chewed because peppermint oil may irritate mouth or oesophagus. (Colpermin, Mintec)
> Do not take indigestion remedies 2 hours before or after you take this medicine
Take 30 to 60 minutes before food
Swallow this medicine whole. Do not chew or crush
Caution: Sensitivity to Menthol
Side Effects: Heartburn, indigestion
Mesalazine
Aminosalicylate
Treatment of mild to moderate ulcerative colitis, acute attack
> 2.4g in divided doses (Asacol MR 400)
2.4g-4.8g in divided doses (Asacol MR 800)
2.4g-4.8g OD or divided doses (Octasa)
4g OD or divided doses (Pentasa tablets: Manufacturer advises tablets may be halved, quartered, or dispersed in water, but should not be chewed.
Pentasa granules: Manufacturer advises granules should be placed on tongue and washed down with water or orange juice without chewing
In Children: Expert sources advise contents of one sachet should be weighed and divided immediately before use; discard any remaining granules.)
Hepatic/Renal Impairment: caution in mild to moderate, avoid in severe
MR tablet: Take with or just after food, or a meal, Swallow this medicine whole. Do not chew or crush
GR tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, Swallow this medicine whole. Do not chew or crush
MR granules: Swallow this medicine whole. Do not chew or crush
Hepatic/Renal impairment: caution in mild to moderate, avoid in severe
>Renal function should be monitored before starting, at 3 months, and annually during treatment
Breast feeding: diarrhoea in breast-fed infant
Contra-indicated: blood clotting abnormalities
Stick to same brand
Side Effects: gastrointestinal symptoms, aches and pains, blood disorder: unexplained bleeding, bruising, red or purple discolourations of the skin (purpura), sore throat, a high temperature (fever), or if you feel generally unwell (malaise).
Sulfasalazine
Treatment of acute and mild to moderate and severe ulcerative colitis I Active Crohn’s disease
1-2g QDS until remission occurs
Maintenance
500mg QDS
Doses in children upon body weight
> Tablet: This medicine may colour your urine. This is harmless
GR Tablet: Do not take indigestion remedies 2 hours before or after you take this medicine, This medicine may colour your urine. This is harmless, Swallow this medicine whole. Do not chew or crush
Caution: G6PD deficiency, asthma, hepatic toxicity
Monitoring: full blood count, renal/liver function
Hepatic: caution
Renal: caution in mild to moderate, avoid in severe
Drink plenty of water
Side Effects: nausea, loss of appetite, diarrhoea, abdominal pain, headache, rash, dizzy, Gives body fluids (such as tears and urine) a yellow/orange colour. This is harmless. >More severe: Trouble sleeping (insomnia). Altered Taste. Bleeding disorder. Allergy, Jaundice.
***HAS BEEN CONFUSED WITH SULFADIAZINE, CARE TO BE TAKEN WHEN DISPENSED
Beclometasone dipropionate
Corticosteroid
Adjunct to aminosalicylates in acute mild to moderate ulcerative colitis
5mg daily max duration of treatment of 4 weeks, dose to be taken in the morning
Hepatic: Avoid in severe
Budesonide
Glucocorticoid, anti-inflammatory effects
Mild to moderate Crohn’s disease affecting the ileum or ascending colon
9mg OD for 8 weeks, to be taken in the morning, reduce dose gradually over two weeks following treatment (Budenofalk)
Side Effects: muscle twitching, oedema, oral disorder, diarrhoea, GI disorders
Teduglutide
Amino Acid and Derivative
glucagon-like peptide-2 (GLP-2), preserves mucosal integrity by promoting growth and repair of the intestine
Short Bowel Syndrome
Macrogol 3350
Osmotic Laxative
(Laxido, Movical)
Onset 24-48hrs
Bowel cleansing
Moviprep: 1L for 2 doses
Plenvu: 500mL for 2 doses
1st dose on evening before procedure, 2nd dose on morning of procedure
Chronic Constipation
Child 12-17: FS 1-3 satchets, HS 2-6
Adult: FS 1-3 satchets, HS 2-6
full strength: 13.125g, half strength/paediatric 6.563g
Caution: CVD impairment, 2 FS or 4HS in any one hour
Isphaghula Husk
Bulk-Forming Laxative
(increases faecal mass which stimulates peristalsis)
Constipation
up to 11 yrs: 2.5-5mL BD, dose to be given as a half or whole level spoonful in water, preferably after meals, morning and evening
12-Adult: 1 satchet BD
1 satchet equal to 2 level 5mL spoonful
To be taken with at least 150mL
Contra: faecal impaction, intestinal obstruction, reduced gut motility
Adequate fluid intake
Fybogel
Lactulose
Osmotic Laxative
Constipation
Adult: 15mL BD
Docusate Sodium
Softening Laxative
Oral onset: 1-2 days, Rectal within 20 min
Chronic Constipation
Oral:
up to 11 yrs: 12.5-25 mg TDS (oral solution)
12-Adult: 500mg in divided doses
Rectum: 120mg for 1 dose
Contra: abdominal obstruction
Caution: excess use of stimulant can cause diarrhoea and hypokalaemia
Dioctyl
Liquid Parrafin
Softening Laxative
Constipation
10-30mL daily at night
Side effect: anal irritation, contact dermatitis, rectal discharge of drug, granuloma (cluster of white blood cells)
Bisacodyl
Stimulant Laxative
Acts in 10-12hrs, suppository in 20-60min
Constipation
4-17yrs: 5-20mg ON
Adult: 5-10mg, increased to 20mg ON
Rectum:
2-17yrs: 5-10mg OM
Adult: 10mg OM
may be used for constipation but higher dose not licensed in children
Co-danthramer
Stimulant Laxative
Constipation in Palliative Care (standard stregnth capsule)
6-11yrs: 1 capsule ON, oral suspension 2.5-5mL ON
12-Adult: 1-2capsules OD, oral suspension 5-10mL ON
Glycerol
Stimulant Laxative
1-11months: 1g as required
Children1-11yrs: 2g suppository as required
12-Adult 4g suppository as required
Moisten suppository before insertion
Senna
Stimulant Laxactive
Constipation
6-17 yrs: 7.5-30mg OD
Adult: 7.5-15mg ON (max. 30mg) start dose low then gradual increase
Naloxegol
Opiod Receptor Antagonist
(Moventig)
decreases the constipating effects of opioids without altering central analgesic effects
25mg OM
concurrent use of CYP3A4 inhibitors
SE: abdominal pain, diarrhoea, flatulence, headache, vomitting, nausea
Loperamide HCl
Antidiarrohoeals
Initially 4mg, followed by 2mg for up to 5 days, dose to be taken after each stool (max 16mg)
not licensed in children under 8
***REPORTS OF SERIOUS CARDIAC ADVERSE REACTIONS (QT PROLONGATION, CARDIAC ARREST, TORSADES DE POINTES) WITH HIGH DOSES WITH ABUSE/MISUSE, NALOXONE ANTIDOTE
ALGINIC ACID
Alginate Antacid
Management of GORD
Gaviscon Infant
uptown 4.5kg: 1 dose as req
4.5+: 2 doses as req
contra: intestinal obstruction, preterm neonates, excess water loss
renal impairment: avoid antacids with large amounts of sodium in patients with fluid retention
Sodium Alginate with Potassium Bicarbonate
Alginate Antiacid
Acidex/Gaviscon Advance
Management of mild symptoms of dyspepsia and GORD
up to 11: under medical advice only
12-Adult: 5-10ML after meal/bedtime
Co-magaldrox
Aluminium and Magnesium
Maalox/Mucogel
Dyspepsia: 10-20mL taken 20-60 min after eating/bedtime or when required
renal impairment: effervescent preparations of analgesics contain citrates which increases aluminium absorption=risk of aluminium toxicity
Simeticone
Antifoaming Drugs
Infacol
Colic/Wind Pains
1month-1yr: 0.5-1mL with/after each feed
Windeze
Bismuth Subsalicylate
Antacid
Helicobacter Pylori eradication
525mg QDS for 7 days
children under 16 at risk of Reyes syndrome
SE: black stools, black tongue/saliva
Famotidine
H2-Receptor Antagonist
Treatment of Benign gastric and duodenal ulceration
40mgON 4-8 week
Maintenance treatment of duodenal ulceration 20mgON
Reflux Oesophagits
20-40mg BD 6-12 weeks
SE: constipation, diarrhoea, dizzy, fatigue, headache