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PharmEducate Notes > GI System > Flashcards

GI System Flashcards

1
Q

What is coeliac disease?

A

Autoimmune condition associated with chronic inflammation of the small intestine, restricting nutrient absorption.

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2
Q

What is the cause of coeliac diseases?

A

Gluten intolerance

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3
Q

Symptoms of coeliac disease?

A

Diarrhoea
Abdominal pain
Bloating
Malabsorption of key nutrients e.g. Ca and vit. D

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4
Q

Can coeliacs disease cause osteoporosis?

A

Yes due to reduced absorption of vit D and Ca

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5
Q

How is coeliacs disease treated?

A

Gluten-free diet
Vitamin and mineral supplements following discussion with a HCP
Prednisolone for initial management while awaiting specialist advice

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6
Q

What is diverticulitis?

A

Small bulges or pockets in the lining of the intestine

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7
Q

What are the symptoms of diverticulitis?

A

Lower abdominal pain
Constipation and diarrhoea

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8
Q

Treatment of diverticulitis?

A

High fibre diet
Bulk forming laxatives E.g. methyl cellulose to treat diarrhoea and constipation
Uncomplicated can be treated with simple analgesics such as paracetamol

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9
Q

Does diverticulitis require antibiotics?

A

Yes when presenting with symptoms of infection or immunocompromised

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10
Q

What is inflammatory bowel disease?

A

Umbrella term for ulcerative colitis and Crohn’s disease

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11
Q

What is ulcerative colitis?

A

Inflammation and ulcers in the colon or rectum

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12
Q

Symptoms of IBD?

A

Bloody diarrhoea, abdominal pain, weight loss, fatigue and mouth ulcers

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13
Q

True or false:
During a flare up of UC, symptoms can be seen elsewhere such as mouth ulcers, arthritis, sore skin, weight gain and fatigue

A

True

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14
Q

What are the long-term complications of UC?

A

Colorectal cancer
Secondary osteoporosis
VTE

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15
Q

What is Crohn’s disease?

A

Inflammation of the GI tract (anywhere from mouth to anus)

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16
Q

First line treatment for mild-moderate UC?

A

Aminosalicylates
Or corticosteroids as alternative

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17
Q

Examples of aninosalicylates?

A

Mesalazine
Sulfasalazine

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18
Q

First line treatment for 1 acute CD flare up per year?

A

Corticosteroids
Alternatively can use aminosalicylates

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19
Q

First line treatment for 2+ acute CD flare ups per year or to maintain remission?

A

Immunosuppressant
E.g. azathioprine or methotrexate

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20
Q

First line treatment for moderate - severe UC?

A

Immunosuppressant
E.g. azathioprine or methotrexate

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21
Q

Can loperamide and codeine be used in IBD related diarrhoea?

A

NO. Only for CD as it can cause paralytic ileum in UC PTs

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22
Q

Can corticosteroids be used for long-term remission of CD?

A

No due to side effects such as osteoporosis and diabetes

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23
Q

Side effects of aminosalicylates?

A

Blood disorders - STOP and report signs of infection or blood disorders - do a FBC
Nephrotoxicity
Salicylate hypersensitivity

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24
Q

What is the main side effect of sulfasalazine?

A

Colours body fluids yellow - orange

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25
Q

Interaction between lactulose and MR mesalazine?

A

Lactulose decreases pH of the intestines meaning MR preparations may not be released

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26
Q

Symptoms of irritable bowel syndrome?

A

Lower abdominal colic
Bloating
Diarrhoea or constipation

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27
Q

Treatment of abdominal colic in IBS?

A

Antispasmodics
E.g. Alverine, mebeverine and peppermint oil

or Antimuscarinics
E.g. atropine, Hyoscine butylbromide

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28
Q

Which laxative can not be used in IBS?

A

Lactulose - can cause bloating which can worsen IBS symptoms

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29
Q

First line treatment for diarrhoea in IBS?

A

Loperamide

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30
Q

Red flag constipation symptoms?

A

New onset in someone >50
Anaemia
Abdominal pain
Weight loss
Blood in stool

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31
Q

Treatment for constipation?

A

1st line = lifestyle advice
2nd line = laxatives - “BOS”
Bulk-forming, osmotic then stimulant laxative

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32
Q

Examples of bulk-forming laxatives?

A

Isphagula husk
Methylcellulose

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33
Q

Onset of bulk-forming laxatives?

A

Can start working in 24 hours but can take up to 72 hours for full effect

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34
Q

Side effects of bulk forming laxatives?

A

Intestinal obstruction
Bloating and flatulence
Cramping
Hypersensitivity - isphagula husk

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35
Q

Important counselling for bulk-forming laxatives?

A

Maintain adequate fluid intake, take with water and not before bed.

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36
Q

Example of an osmotic laxative?

A

Lactulose
Macrogol
Magnesium hydroxide

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37
Q

Onset of action for osmotic laxatives?

A

2-3 days
48hours for lactulose

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38
Q

Side effects of osmotic laxatives?

A

Diarrhoea, bloating, flatulence, cramps, nausea and dehydration.
Does settle over time, maintain fluid levels to minimise risk of dehydration.

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39
Q

Examples of stimulant laxatives?

A

Senna
Docusate
Bisacodyl
Glycerol suppositories

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40
Q

Onset of stimulant laxatives?

A

6-12 hours
15-30mins for glycerol suppositories

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41
Q

Side effects of stimulant laxatives?

A

Abdominal cramps
Diarrhoea
Hypokalaemia
Lazy bowel syndrome
Red-brown urine with senna

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42
Q

What colour does senna change your urine?

A

Red-brown
Not harmful

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43
Q

OTC stimulant laxatives pack size and age?

A

Each PT limited to 2 short courses for PTs > 12 years old

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44
Q

What can be given to a PT unresponsive to 2+ laxatives from different classes?

A

Prucalopride
Linaclotide

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45
Q

Which laxatives can be given in opioid-induced constipation?

A

Lactulose + senna

46
Q

If first line laxatives for opioid induced constipation don’t work what can be given?

A

Methylnaltrexone
Naloxegol

47
Q

Is lifestyle advice first line for children with constipation?

A

No
Offer “OS”

48
Q

When is senna contraindicated for patients?

A

At term in pregnancy or if history of unstable pregnancy as can stimulate uterine contractions

49
Q

1st line treatment for diarrhoea?

A

Oral rehydration salts (Diarolyte)

50
Q

What is Rifaximin?

A

Antidiarrhoeal used for travellers diarrhoea

51
Q

Can codeine be used for diarrhoea?

A

Yes

52
Q

Age restriction for loperamide?

A

12+

53
Q

Loperamide dose?

A

4mg STAT followed by 2mg after each loose motion for 5 days. Max 16mg in a day

54
Q

Contraindications for loperamide?

A

Antibiotic associated colitis
Peristalsis and abdominal distension

55
Q

MHRA alert for loperamide?

A

Serious cardiac effects with high doses such as a prolonged QT interval, cardiac arrest or death

56
Q

Loperamide antidote?

A

Naloxone

57
Q

Red flag symptoms in dyspepsia?

A

GI bleeding
Weight loss
Dysphagia (difficulty swallowing)
55+ years old

58
Q

Treatment of uninvestigated dyspepsia?

A

PPI for 4 weeks
Test for h. Pylori

59
Q

Treatment of diagnosed functional dyspepsia?

A

PPI or H2 receptor antagonist for 4 weeks
Test for h. Pylori infection

60
Q

Counselling for lansoprazole?

A

30-60mins before food

61
Q

Which PPI is safest in pregnancy?

A

Omeprazole

62
Q

PPI counselling?

A

Swallow whole, do NOT take indigestion remedies 2 hours before or after.
Can take up to 2-3 days to work so can use antacid to bridge

63
Q

What complications can PPIs lead to?

A

Can increase osteoporosis and c. Diff infections - stop

64
Q

MHRA alert with PPIs?

A

Lupus erythematosis - lesions on sun-exposed areas

Counsel PTs to avoid sunlight exposure and consider stopping PPI

65
Q

Which electrolyte disturbance caused by PPIs predisposes to digoxin toxicity?

A

Hypomagnesaemia

66
Q

Omeprazole interactions?

A

Clopidogrel - decreases antiplatelet effect
Methotrexate - decreases clearance of methotrexate causing toxicity

67
Q

Example of a h2 receptor antagonist?

A

Cimetidine
Famotidine
Ranitidine

68
Q

Which h2 receptor antagonist is safest in pregnancy?

A

Ranitidine

69
Q

Drugs which can cause GORD?

A

NSAIDs
Nitrates
Bisphosphonates
CCBs
Corticosteroids
Beta blockers
TCAs

70
Q

Treatment of uninvestigated GORD?

A

Same as dyspepsia

PPI for 4 weeks

71
Q

Treatment of diagnosed GORD?

A

PPI for 4-8 weeks OR h2 receptor antagonist

72
Q

Treatment of severe oesophagitis?

A

PPI for 8 weeks

73
Q

Treatment of GORD in pregnancy?

A

1st line = Diet and lifestyle
2nd line = antacids
3rd line or symptoms are severe = Omeprazole or ranitidine

74
Q

What are the 2 main causes of peptic ulcers?

A

H. Pylori and NSAIDs

75
Q

Main symptom of a peptic ulcer?

A

Burning upper abdominal pain

76
Q

Treatment of NSAID induced ulcer?

A

PPI or H2 receptor antagonist for 8 weeks
H. Pylori test
Stop NSAID or offer a selective cox-2 inhibitor + gastric protection.

Misoprostal also an option but colic and diarrhoea are dose-limiting side effects therefore limiting use.

77
Q

Non NSAID or non H. Pylori induced ulcer treatment?

A

PPI or H2 receptor antagonist for 4-8 weeks

78
Q

Which test is used to diagnose H. Pylori?

A

Urea breath test and stool helicobacter antigen test.

Do not perform test within 2 weeks of PPI or 4 weeks of antibiotic treatment

79
Q

1st line H. Pylori eradication therapy?

A

7 days of PPI (BD) + 2 antibiotics from:
Amoxicillin, Clarithromycin and metronidazole
1st line = PAC
Avoid A if penicillin allergic
Avoid C if recent treated with a macrolide

80
Q

2nd line H. Pylori eradication therapy if patient has penicillin allergy?

A

PML = PPI (BD) + Metronidazole + Levofloxacin

81
Q

Why do antacids contain both aluminium and magnesium salts?

A

Aluminium is constipating and magnesium is laxative therefore cancel each other out

82
Q

When should high sodium containing antacids be cautioned?

A

Hypertension, heart, liver or kidney failure or PTs taking lithium

83
Q

Which medications interact with antacids therefore requiring a 2H gap before and after?

A

Bisphosphonates
Tetracyclines
Quinolones
PPI

84
Q

How to take antacids?

A

After each meal, at bedtime or PRN

85
Q

Treatment for food allergy?

A

Avoid food items
Chlorphenamine - can be used to treat allergic symptoms such as hives
Sodium chromoglicate

86
Q

GI spasms treatment?

A

Antimuscarinics or antispasmodics

87
Q

Examples of antimuscarinics?

A

Propantheline
Hyoscine butylbromide (buscopan)

88
Q

Antimuscarinic side effects?

A

“Can’t see, can’t pee, can’t spit, can’t shit”

Opposite to cholinergic side effects

89
Q

MHRA alert for Hyoscine butylbromide injections?

A

Serious side effects which are more likely to effect patients with underlying coronary heart disease.

Side effects include tachycardia, hypotension and anaphylaxis.

90
Q

Examples of antispasmodics?

A

Alverine, mebeverine and peppermint oil

91
Q

Contraindication for antispasmodics?

A

Paralytic ileus

92
Q

Counselling for peppermint oil?

A

Swallow capsules whole due to irritation of mouth and oesophagus

93
Q

Anal fissure symptoms?

A

Linear split
Sharp pain on defecation
Bleeding (bright red)

94
Q

Treatment of acute anal fissure?

A

Constipation - Tx = bulk forming laxative or osmotic as alternative

Pain relief - Tx = simple analgesic or local anaesthetic (max a few days)

95
Q

How many weeks is considered chronic for an anal fissure?

A

6+ weeks

96
Q

Treatment of chronic anal fissure?

A

GTN rectal ointment inserted into the anal canal.

Increases blood supply to area to improve healing

97
Q

Symptoms of haemorrhoids?

A

Swelling
Pain and bleeding after defecation
Bright red blood
Itchy

98
Q

Treatment of haemorrhoids?

A

Constipation - Tx = bulk forming laxative

Pain relief - Tx = simple analgesic (avoid NSAIDs in bleeding)

Topical - Tx = local anaesthetic (max a few days) or corticosteroids (max 7 days)

99
Q

What is exocrine pancreatic insufficiency?

A

Reduced pancreatic enzyme secretion

100
Q

Treatment of pancreatic insufficiency?

A

Replacement therapy and vitamin supplements if deficient

101
Q

Dietary advice for pancreatic insufficiency?

A

Distribute food intake into 3 meals and 2-3 snacks
Avoid foods hard to digest E.g. high fibres foods
Avoid reduced fat diets
Avoid alcohol

102
Q

How to take pancreatin?

A

Take with meals and snacks
Do not mix with excessively hot food or drink and discard mixture after 1H
Maintain adequate hydration at all times

103
Q

What options are there if pancreatic levels still low with pancreatin?

A

May require an acid suppressor as enzymes may be denatured in the stomach making them less effective.

Enteric coated pancreatin is also an option.

104
Q

Pancreatin side effects?

A

GI effects
Irritation of the perioral skin and buccal mucosa - excessive doses can effect the perianal area
Can cause hypersensitivity reactions when handling powders
Fibrosing colonopathy (colon wall forms thick scar tissue) can occur in cystic fibrosis PTs with high doses

105
Q

Contraindications for pancreatin?

A

Children < 15 years old with cystic fibrosis as it is associated with colon strictures

106
Q

Which medical forms are unsuitable in stoma patients?

A

EC and MR

107
Q

Which formulations are preferred in stoma patients?

A

Fast acting medications E.g. soluble, uncoated, liquids and capsules

108
Q

Are stoma patients at increased or decreased risk of GI side effects with drugs?

A

Increased

109
Q

Which medications increase GI effects in stoma patients?

A

NSAIDs, opioids, iron, magnesium and aluminium antacids

110
Q

Which electrolyte imbalance is caused by stomas?

A

Hypokalaemia - due to increased water depletion in stoma which predisposes to digoxin toxicity

Consider potassium sparing diuretic or potassium supplement to counter this

111
Q

Which laxative can be given to colostomy stoma patient?

A

Bulk forming if necessary

PharmEducate Notes (8 decks)

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