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Random Pre Reg Questions > GI system > Flashcards

GI system Flashcards

1
Q

Where does ulcerative colitis affect

A

Mucosal inflammation and ulcers
restricted to colon and rectum

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2
Q

Symptoms of UC

A
  • bloody diarrhoea or rectal bleeding
  • abdominal pain (cramps) and tenesmus)
  • systemic features (severe); malaise and fever
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3
Q

Symptoms of acute flare up of UC

A

Mouth ulcers
Arthritis
Sore skin
Weight loss
Fatigue

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4
Q

What drugs are contraindicated in acute flare up of UC

A

Loperamide
Codeine phosphate

avoid anti-motility drug/antispasmodics: paralytic ileus = increased risk of toxic megacolon

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5
Q

What is chrohns disease?

A

Chronic inflammation of the GI tract from mouth to anus

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6
Q

What is fistulating Chrons disease (CD)

A

A complication that involves the formation of abnormal connection between two organs or vessels

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7
Q

Link between smoking and CD

A

Smoking cessation reduces risk of relapse

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8
Q

Drugs used in IBD

A

Aminosalicylates
Corticosteroids
Immunosuppressive
Biological drugs
Antibiotics
Surgery

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9
Q

Examples of aminosalicylates

A

Masalazine
Sulfasalazine

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10
Q

Examples of corticosteroids

A

Methyl prednisolone
Prednisolone

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11
Q

Examples of immunosuppressive

A

Azathioprine
Mercaptopurine

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12
Q

Example of biological drugs

A

Infliximab

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13
Q

Antibiotics used in IBD

A

Ciclosporin - UC

Metronidazole / ciprofloxacin - CD

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14
Q

What type of IBD may require surgery

A

Crohn’s disease
fistulae

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15
Q

What pain killer can be given in IBD
what one is avoided

A

Paracetamol

Avoid NSAIDS - risk of bleeding

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16
Q

What is giving to patient with UC and constipation?

A

Bulk forming laxative

Avoid all other types of laxative

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17
Q

What laxative is beneficial in proximal proctitis

A

Macrogol- containing osmotic laxative

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18
Q

What area of the bowel does proctitis affect?

Choice of drug form

A

Rectum

*Suppositories**

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19
Q

What area of the bowel does left-sided colitis (distal) affect?

Choice of drug form

A

Descending colon

Enema

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20
Q

What area of the bowel does proctosigmoiditis affect?

Choice of drug form

A

Rectum and sigmoid colon

Foam preparation

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21
Q

What area of the bowel does extensive colitis (proximal) affect?

Choice of drug form

A

Most of ascending colon

Oral drug

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22
Q

What is used in acute mild- moderate UC first line?

A

Pricititis / Proctosigmoiditis
Aminosalicylate (rectal or oral or both)
Alt: Rectal/oral corticosteroids

Extensive colitis / Left-sided colitis
High dose oral aminosalicylate
+rectal aminosalicylate or oral beclometasonse
Alt: oral prednisolone

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23
Q

What is used in acute mild- moderate UC second line?

A
  • Add oral prednisolone (after 4 weeks with aminosalicylate)
  • Add oral tacrolimus (if no response after 2-4 weeks)
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24
Q

What is used in acute moderate to severe UC first line?

A

Oral prednisolone
Alt: monoclonal antibodies

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25
Q

Treatment of acute sever UC

A

First line: IV Corticosteroid + assess need for surgery
- Alt: IV Ciclosporin or surgery

Second line: IV Ciclosporin + IV Corticosteroids or Surgery
- Alt to Ciclosporin: infiximab

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26
Q

Maintenance of remission in UC

A

Aminosalicylate

  • oral azathioprine/ mercaptopurine - if 2+ acute flare-ups in 12 months that required systemic corticosteroids
  • Monoclonal antibodies - continued if effective/tolerated during acute flare up
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27
Q

What needs to be monitored in UC

A

Bone health

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28
Q

Treatment of CD (monotherapy)

A

Corticosteroid - prednisolone, methyl prednisolone, IV hydrocortisone

Alt: budesonide (1st) or aminosalicylate

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29
Q

When to introduce add on treatment for CD

A
  • If 2 or more inflammatory exacerbations in 12 months
  • Corticosteroids dose cannot be reduced
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30
Q

What are the add on treatments for CD

A

1st: Azathioprine / Mercaptopurine
2nd: Methotrexate

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31
Q

What to be monitoring with CD treatment

A

Neutropenia

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32
Q

Maintaining remission in CD

A
  1. Azathioprine or Mercaptopurine
  2. Methotrexate, if worked previously

Corticosteroids or budesonide should NOT be used

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33
Q

Remission of CD post surgery

A

1st: Azathioprine or Mercaptopurine
If had >1 resection or complex/debilitating disease

2nd: Aminosalicylate

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34
Q

Side effects of aminosalicylate

A
  • Blood dyscrasia
  • Nephrotoxicity
  • Agranulocytosis
  • Renal impairment
  • Salicylate hypersensitivity (itching and hives)
  • yellow/orange bodily fluids with sulfasalazine
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35
Q

Counselling with aminosalicylate

A
  • Avoid bright sunlight/ sun beds and use sun scream (SPF >15)
  • Preps with granules should be placed under tongue and washed down without chewing
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36
Q

Interaction with mesalazine

A

Lactulose

Prevents sufficient release of the active ingredient in E/C or M/R preparations

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37
Q

Counselling with methotrexate

A

Give with folic acid
OW on a different day of methotrexate

Reduce toxicity

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38
Q

What can be used to decrease acid stimulation

A

H2 - antagonists
PPI

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39
Q

Examples of H2 - receptor antagonist

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

40
Q

Difference between UC and CD

A

UC - only in colon and rectum
continuous inflammation

CD - anywhere from mouth to anus

41
Q

What is the mechanism of action of aminosalicylates

A

Decrease inflammation

42
Q

Side effect of sulfasalazine

A

Yellow/orange urine
Warning: soft contact lenses may be stained

43
Q

Why is given in a specific formulation

A

E/C or M/R

  • so it’s not absorbed in the upper GIT
44
Q

Antibiotics used in IBS

A
  • Metronidazole
  • Clarithromycin
  • Ciprofloxacin
45
Q

What are the classes of drugs used in IBS

A
  • Antispasmodic (GI spasms)
  • Antimuscaranics (GI spasms)
  • Laxatives (Constipation)
  • Antimotility (Diarrhoea)
  • Antidepressants (Second line for abdominal pain/ discomfort)
46
Q

Examples of antispasmodics

A

Alverine
Mebeverine
Peppermint oil

47
Q

Examples of antimuscarincs

A

Hyoscine butylbromide
Atropine
Duct clover one
Propantheline bromide

48
Q

What do you give to a patient with IBS who is unresponsive to different laxative classes and have had constipation for 12 months

A

Linoclotide

49
Q

What laxative is not recommended in IBS

A

Lactulose - causes bloating

50
Q

What is used first choice in IBS with diarrhoea

A

Loperamide

51
Q

What antidepressants are used in IBS for second line abdominal pain/ discomfort

52
Q

Main symptom of short bowel disorders

A

Malabsorption and Malnutrition

Deficiency of vitamin A, B12, D, E & K, Essentially fatty acids, Zinc, Selenium, Hypomagnesaemia - supplementation

53
Q

What drugs are impacted by short bowel syndrome

A

Increase dose

  • Warfarin
  • Oral contraceptives
  • Digoxin
54
Q

What triggers coeliac disease?

A

Gluten

  • Wheat
  • Barley
  • Rye
  • Pasta, cakes, cereals, bread
55
Q

Symptoms of coeliac disease

A

‘ABCD’

  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhoea
56
Q

Treatment of coeliac acid

A
  • Supplementation with calcium, vit D and folic acid
  • DO NOT self medicate with OTC supplements
  • Treat osteoporosis & bone disease
  • Prednisolone (initial management while awaiting specialist advice)
57
Q

Can coeliac disease be treated OTC with supplements?

A

No

Refer for specialist advice with supplements

58
Q

What causes Diverticulitis

A

Poor fibre diet

59
Q

Difference between Diverticulosis and Diverticular disease/ diverticulitis

A

Diverticulosis - No symptoms

Diverticulitis/ diverticular disease - symptoms/ severe symptoms

60
Q

What age is at high risk of diverticulosis

61
Q

What symptom does diverticular disease NOT cause?

A

Inflammation or infection

62
Q

Main Symptoms of diverticulitis

A
  • Constant lower abdominal pain
  • Sudden inflammation and infection
63
Q

Do you give antibiotics in diverticular disease

64
Q

What type of pain killers are used in diverticulitis

A

Paracetamol

NOT NSAIDS OR OPIOIDS

65
Q

Risk factors of IBD

A
  • Stress
  • Smoking
  • Infection
  • Air pollution
  • Drugs
66
Q

What is used in pt with Crohn’s disease experiencing diarrhoea

A

Loperamide / Codeine phosphate
Colestyramine

67
Q

What is associated with long term steroid therapy

A

Increased risk of shingles
(red blotchy rash, painful to touch)

68
Q

What is used to treat procitis

A

First line: Topical aminosalicylate

If remission not achieved within 4 weeks, add on oral aminosalicylate
If response remains inadequate add topical or oral corticosteroid for 4-8 weeks

69
Q

Red flag symptoms of constipation

A
  • New onset 50+
  • Anaemia
  • Abdominal pain
  • Unexplained weight loss
  • Blood in stool (could be cancer or GI bleed)
70
Q

What are the different classes of laxatives

A
  • Stimulants
  • Opioid receptors antagonist
  • Osmotic
  • Bulk forming
  • Stool softener
  • Chloride-channel agonist
  • Selective 5HT-4 agonist
71
Q

What to use in short duration constipation

A

Bulk forming

Eg. Ispagula husk

72
Q

What to use if stool remains hard after using bulk forming laxative

A

Switch to or add osmotic laxative

73
Q

If stool is soft but difficult to pass or the person complains of inadequate emptying

A

Add a stimulant laxative

74
Q

Side effect of laxative abuse

A

Hypokalaemia

75
Q

Examples of bulk forming laxatives

A
  • Isphagula husk
  • Methylcellulose (can be used in both constipation and diarrhoea)
  • Sterculia (fybogel)
76
Q

bulk forming laxative onset of action

A

72 hours
Not ideal for patients who haven’t visited the toilet in a few days (consider stimulant)

77
Q

When are bulk forming laxatives contraindicated

A
  • faecal impaction
  • intestinal obstruction
  • reduced gut motility
78
Q

Risk associated with bulk forming laxatives

A

Hypersensitivity
Risk of obstruction of GI - don’t take before going to bed

79
Q

Examples of stimulant laxatives

A
  • Bisacadoyl
  • Docusate sodium
  • Sodium picosulfate
  • Senna
  • Glycerol
  • Co-danthromer / co-danthrusate
80
Q

Which stimulant laxative is only used in palliative care

A

Co-danthromer
Co- danthrusate

Colours urine red

81
Q

When to avoid stimulant laxative

A

Intestinal obstruction
- causes abdominal cramps

82
Q

stimulant laxative onset of action

A

8-12 hours
bedtime dose recommended

Suppositories quicker - 20-60 minutes

83
Q

Side effects of stimulant laxative

A
  • abdominal cramps
  • rash
  • risk of abuse
  • prolonged use; lazy bowel syndrome
84
Q

Mechanism of glycerol suppositories

A

Lubricant
Rectal stimulants

85
Q

Onset of action of Docusate sodium

A

1 to 2 days

Rectal: 20 minutes

caution in pregnancy and breast feeding

86
Q

Properties of senna

A
  • suitable in pregnancy and breastfeeding
  • suitable for children above 1 month
  • discolouration of urine
87
Q

Counselling with bisacodyl

A
  • suitable in pregnancy
  • do not take indigestion remedies 2 hours before and after
88
Q

Stimulant laxatives OTC

A
  • Smaller packs available OTC for short-term ocassional constipation in ADULTS ONLY >12 years
  • 20 standard tabs, 10 max strength and 100ml solutions
  • for children 12-17 years; supervision of a pharmacist
  • Bisacodyl (5mg) may be used in children but higher doses not licensed
89
Q

Examples of osmotic laxatives

A
  • Lactulose
  • Macrogol
  • Magnesium hydroxide
  • Sodium acid phosphate with sodium phosphate enema
90
Q

Onset of action of osmotic laxatives

A

48-72 hours

91
Q

Which acts faster between Macrogol and Lactulose

A

Macrogol

Lactulose may take up to 2 days for max effect - not suitable for immediate relief

92
Q

Which osmotic laxatives are used to clear vowels quickly

A
  • magnesium hydroxide
  • sodium acid phosphate with sodium phosphate enema
93
Q

Which laxative can be used in hepatic encephalopathy

A

Lactulose

Not absorbed by GI tract and produces osmotic diarrhoea of low pH which discourages the proliferation of ammonia producing organisms

94
Q

Lactulose dose by mouth

A

• 1 - 11 months : 2.5mL BD
• 1 - 4 years : 2.5-10mL BD
• 5-17 years : 5-20mL BD
• Adult : initially 15mL BD, adjusted according to response

95
Q

Lactulose dose in hepatic encephalopathy

A

30-50mL TDS

96
Q

MHRA warning with Macrogol

A

Potential interactive effect when mixed with starch based thickeners leading to increased risk of aspiration

Careful in elderly

Random Pre Reg Questions (12 decks)

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