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PRE-REG-Thuri > GI SYSTEM- CHRONIC BOWEL DISORDERS, GORD, DYSPEPSIA, CONSITPATION, DIARRHOEA > Flashcards

GI SYSTEM- CHRONIC BOWEL DISORDERS, GORD, DYSPEPSIA, CONSITPATION, DIARRHOEA Flashcards

1
Q

What is coeliac disease?

A

Gluten allergy causes inflammation in small intestine- malabsorption.

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2
Q

What are the 5 symptoms of coeliac disease?

A

Diarrhoea

Abdominal pain

Bloating

Malnutrition

lactose intolerance

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3
Q

What is 2 treatment options for coeliac disease?

A

Gluten free diet

Vitamin supplements

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4
Q

What is diverticular disease?

A

Develop in mucosal lining of colon.

infection

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5
Q

What are 2 treatments for diverticular disease?

A

High fibre diet + bulk forming laxatives

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6
Q

What is inflammatory bowel disease?

A

Ulcerative colitis + crohn’s disease

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7
Q

What are 5 symptoms of inflammatory bowel disease?

A

Bloody diarrhoea

Abdominal pain

Weight loss

Fatigue

Mouth ulcers

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8
Q

What are 3 drug classes which help with acute flare ups + maintenance in inflammatory bowel disease?

A

Aminosalicylates

Corticosteroids

Drugs affecting immune system

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9
Q

What 2 drugs are contra-indicated in U.colitis?

A

Loperamide

Codeine

cause colonic dilation - BAD

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10
Q

List 4 aminosalicylates?

A

Balsalazide

Mesalazine

Olsalazine

Sulfasalazine

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11
Q

What is 1st line drug treatment for mild-moderate UC?

A

topical Aminosalicylates

2nd line - oral version

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12
Q

What is 1st line alternative drug for mild-moderate UC?

A

Aminosalycilates, then oral , then
corticosteroids

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13
Q

What is 1st line drug for acute Crohn’s disease (1 episode)?

A

Corticosteroids

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14
Q

List 5 corticosteroids?

A

Beclometasone

Budesonide

Hydrocortisone

Methylprednisolone

Prednisolone

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15
Q

What 6 drugs affect the immune system?

A

Azathioprine

Ciclosporin

Mercaptopurine

Methotrexate

MABs

Janus kinase inhibitors

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16
Q

What is 1st line drug for acute moderate to severe UC?

A

Immune system drugs

e.g. JAK inhibitors

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17
Q

What is 1st line for acute crohn’s disease (2 + episodes + remission)?

A

Immune system drugs

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18
Q

What is MOA of aminosalicylates?

A

Reduces cytokine + free radical formation.

inhibits prostaglandin synthesis

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19
Q

What is 1st line use of aminosalicylates?

A

Ulcerative colitis , CD

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20
Q

What are 4 main SEs of aminosalicylates?

A

Blood disorders

Nephrotoxicity

Salicylate hypersensitivity

Hepatotoxicity

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21
Q

What 3 things should be monitored on aminosalicylates? (sulfasalazine)

A

FBC + LFT - blood disorders (monthly for 3 months)

RFT- nephrotoxicity (before, 3 months, year)

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22
Q

What is patient counselling for aminosalicylates?

A

Report signs of infection or blood disorders.

e.g. sore throat, fever, mouth ulcers, bleeding or bruising.

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23
Q

What aminosalicylates stains soft contact lenses?

A

Sulfasalazine

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24
Q

What colour does sulfasalazine stain contacts and urine?

A

Yellow orange

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25
Q

What does sulfasalazine label say?

A

This med may colour urine, This is harmless.

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26
Q

What drug interacts with aminosalicylates?

A

Lactulose

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27
Q

What is the risk of if patient has G6PD deficiency?

A

neonatal haemolysis

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28
Q

How is RFT monitoring done for aminosalicylates?

A

Before treatment

At 3 months

Annually

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29
Q

How is monitoring done for sulfazalazine?

A

LFTs and FBC monthly for 1st 3 months

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30
Q

What is the risk of aminosalicylates in pregnancy?

A

Risk of haemolysis in 3rd trimester- give enough folate.

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31
Q

What is irritable bowel syndrome (IBS)?

A

Affects digestive sysyem

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32
Q

What are 3 antispasmodics for GI spasm?

A

Alverine

Mebeverine

peppermint oil

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33
Q

What are 2 SEs of peppermint oil?

A

Heartburn

Throat irritation

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34
Q

What 2 medications are used for constipation related to IBS?

A

Any class laxative except lactulose

Linoclotide

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35
Q

What are 4 antimuscarinics?

A

Atropine

Hyoscine butyl-bromide

dicycloverine

propantheline bromide

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36
Q

What antispasmodic can be used in pregnancy?

A

Peppermint oil

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37
Q

What is 1st line treatment for diarrhoea?

A

Oral rehydration therapy

Loperamide next

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38
Q

What is last resort for IBS?

A

Low dose TCA

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39
Q

What are 3 main symptoms of IBS?

A

Lower abdominal colic

Bloating

Diarrhoea - constipation

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40
Q

What are non pharmacological treatments for IBS?

A

Diet and lifestyle changes, exercise

Limit fruit to 3 portions max

Review fibre intake, if more needed, use soluble one e.g isphagula husk

8 cups water a day

Avoid sorbitol in diarrhoea

If probiotics used, continue 4 weeks + review

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41
Q

Why is lactulose NOT recommended in IBS?

A

Can cause bloating

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42
Q

When is linaclotide used for IBS constipation?

A

Patients who have not responded to laxatives from the different classes + who have had constipation for at least 12 months

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43
Q

What is Short bowel syndrome?

A

Intestinal failure after large surgical resection

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44
Q

What are 2 treatments for Short bowel syndrome?

A

Vitamins + mineral supplement - deficiency

Diarrhoea = give loperamide

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45
Q

What are 3 symptoms of Short bowel syndrome?

A

Malnutrition

Diarrhoea

Poor drug absorption

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46
Q

What 2 preparations are NOT suited for Short bowel syndrome?

A

Enteric coated or Modified release

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47
Q

What 4 drugs may need to be prescribed at a higher dose or IV due to short bowel syndrome?

A

warfarin

oral contraceptives

Digoxin

levothyroxine

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48
Q

What 3 preparations are used in short bowel syndrome?

A

Uncoated

Soluble tablets

liquid

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49
Q

What is constipation?

A

Infrequent difficult to pass or incomplete stools

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50
Q

What are 5 red flags for constipation?

A

Blood in stool

Sudden weight loss

Abdominal pain

Anaemia

New onset -50 + years

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51
Q

What are 3 symptoms of constipation?

A

Dry, hard, lumpy stools

Less than 3 times a week

Straining, abdominal pain, bloating

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52
Q

What is 1st line treatments for constipation? (BOS)

A

Bulk forming laxatives

Osmotic laxatives

Stimulant laxatives

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53
Q

What are 3 examples of bulk forming laxatives?

A

Ispagula husk

Methylcellulose - fecal softner

Sterculia

(Bran)

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54
Q

What is onset of action for bulk laxatives?

A

within 72 hrs

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55
Q

When are bulk forming laxatives used?

A

After dietary measures do not work

First line constipation

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56
Q

What are 4 main SEs of bulk forming laxatives? (BICH)

A

Bloating + flatulence

Intestinal obstruction

Cramping

Hypersensitivity

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57
Q

How to avoid intestinal obstruction with bulk forming laxatives?

A

Drink enough water

swallow tablet with lots of water, not before bed

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58
Q

List 3 osmotic laxatives?

A

Lactulose

macrogol 3350

magnesium hydroxide

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59
Q

List 5 stimulant laxatives?

A

Senna

Glycerol suppositories

Bisacodyl

Sodium picosulfate

Co-danthrusate

Co-danthramer

Docusate sodium

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60
Q

What 2 stimulant laxatives are limited to terminally ill patients due to carginogenicity?

A

co-danthramer + co-danthrusate

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61
Q

Why are Stimulant laxatives avoided in intestinal obstruction?

A

can cause abdominal cramp + increase intestinal motility

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62
Q

What 2 other properties does glycerol suppositories have?

A

Lubricant

Rectal stimulant

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63
Q

What does Docusate sodium act as?

A

BOTH stimulant laxative + faecal softener

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64
Q

How do fecal softeners act?

A

decreasing surface tension + increasing penetration of intestinal fluid into the faecal mass

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65
Q

List 4 stool softeners?

A

Liquid paraffin

Docusate (weak stimulant)

Glycerol (rectal stimulant)

Methylcellulose (bulk forming)

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66
Q

Why is Liquid paraffin cautioned?

A

Side effects e.g.

anal seepage + risks of granulomatous disease of the GI tract or of lipoid pneumonia on aspiration.

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67
Q

How do enemas with arachis oil work?

A

lubricate + soften impacted faeces + promote a bowel movement

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68
Q

Which osmotic laxative is not fully absrobed?

A

Lactulose

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69
Q

What osmotic laxative is used for hepatic encephalopathy?

A

Lactulose

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70
Q

What is Prucalopride?

A

selective serotonin 5HT4-receptor agonist

prokinetic properties

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71
Q

When is Prucalopride used?

A

Licensed for chronic constipation in adults, when other laxatives have failed.

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72
Q

What is linaclotide?

A

guanylate cyclase-C receptor agonist

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73
Q

When is linaclotide used?

A

Licensed for the treatment of moderate- severe IBS associated with constipation.

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74
Q

When is onset of osmotic laxatives?

A

2-3 days

except lactulose (48 hrs)

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75
Q

What is onset of action for lactulose?

A

48 hrs

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76
Q

When are osmotic laxatives used?

A

2nd line

+ or switch if stools still hard

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77
Q

What are some SEs of osmotic laxatives?

A

Diarrhoea, bloating, flatulence, cramps, nausea (lactulose)

Dehydration

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78
Q

When are stimulant laxatives used?

A

3rd line - if stool hard to pass

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79
Q

What are 5 SEs of stimulant laxatives? (RED DAHL)

A

Red-brown urine

Diarrhoea

Abdominal cramps

Hypokalaemia

Lazy bowel syndrome

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80
Q

What colour urine does senna cause?

A

Red brown urine

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81
Q

What colour urine does co-danthrusate cause?

A

Orange

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82
Q

What is onset of action of stimulant laxatives?

A

6-12 hrs

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83
Q

What is onset of glycerol suppositories?

A

15-30 mins

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84
Q

What is a contra-indication of stimulant laxatives?

A

NOT used in intestinal obstruction

85
Q

What is an MHRA warning for stimulant laxative pack size?

A

Smaller pack size OTC

2 short courses for 12 + years

86
Q

What electrolyte imbalance can stimulant laxatives cause?

A

Hypokalaemia

87
Q

What age can stimulant laxatives be not used in?

A

Stimulant laxatives should NOT be used in children under 12 years of age without advice from a prescriber

Children aged 12 - 17 years, products can be supplied under the supervision of a pharmacist.

88
Q

What are 4 SEs of stool softeners? (GLAM)

A

Granuloma in GI tract
Lipoid pneumonia
Anal seepage/ irritation
Malabsorption of fat soluble vitamins

89
Q

What are 4 fat soluble vitamins?

A

A, D, E + K

90
Q

When are prucalopride + linaclotide used ?

A

If pt unresponsive to 2+ laxatives in different classes after 6 months

91
Q

What 2 drugs are used for opioid- induced constipation if other laxatives do not work?

A

Methylnaltrexone

Naloxegol

92
Q

What type of laxatives should be AVOIDED in opioid- induced constipation?

A

Bulk forming - intestinal obstruction + colic

93
Q

What 2 types of laxatives are 1st line recommended in opioid induced constipation?

A

osmotic + a stimulant laxative (or docusate sodium)

94
Q

What is 1st line for constipation in children?

A

Macrogol + stimulant laxative

95
Q

What is 1st line for constipation in pregnancy + breast-feeding?

A

Bulk forming laxatives (or glycerol suppositories if response MIA)

e.g. bran/wheat

96
Q

What 2 laxatives to avoid near term pregnancy?

A

Senna

Bisacodyl

97
Q

What is treatment of faecal impaction for hard stools?

A

high dose of an oral macrogol

98
Q

What is treatment of faecal impaction for soft stools?

A

oral stimulant laxative should be started or added to the previous treatment.

99
Q

What is fecal impaction treatment if oral laxatives don’t work + stool is soft?

A

bisacodyl

100
Q

What is fecal impaction treatment if oral laxatives don’t work + stool is hard?

A

glycerol

101
Q

What is fecal impaction treatment nothing works?

A

a sodium-acid phosphate with sodium phosphate or arachis oil enema

102
Q

What is diarrhoea?

A

Passing loose stools - increase frequency + volume

103
Q

What are 7 red flags for diarrhoea?

A

Unexplained weight-loss

Rectal bleeding

Persistant diarrhoea

Systemic illness

Hospitalised

Abx

Foreign travel - except Western Europe, austrailia , North america, New zealand.

104
Q

What are 2 symptoms of diarrhoea?

A

Frequent watery stools

Dehydration

105
Q

What is 1st line treatment for diarrhoea?

A

Oral rehydration salts

106
Q

What does oral rehydration salts contain?

A

Glucose

Rice powder

Na+

K+

107
Q

What is Racecadotril used for?

A

Treatment of diarrhoea in adjunct to oral rehydration salt in people 3 months+

108
Q

List 7 anti-diarrhoeals?

A

Loperamide

Codeine

Co-phenotrope

Kaolin

Kaoline with morphine

methylcellulose

rifaximin

109
Q

What is rifaximin used in?

A

Traveller’s diarrhoea

110
Q

What abx is used as prophylaxis for traveller’s diarrhoea but not routinely recommended?

A

Ciprofloxacin

111
Q

MOA of loperamide?

A

Binds to opioid receptors in gut wall + slow motility = increases transit time

112
Q

What is co-phenotrope?

A

Opioid + antimuscarinic

Diphenoxylate + atropine

113
Q

What is loperamide used for?

A

Traveller’s diarrhoea + normal

114
Q

What is dose of loperamide in 12+?

A

4mg stat dose

2mg after loose stool for 5 days

115
Q

What is max loperamide dose a day?

A

16mg

116
Q

what age is loperamide syrup not licensed in?

A

Syrup not licensed for use in children under 4 years.

117
Q

what age is loperamide capsules not licensed in?

A

Capsules not licensed for use in children under 8 years.

118
Q

When is loperamide NOT licensed?

A

NOT licensed for use in children for chronic diarrhoea.

119
Q

What are 2 contraindications of loperamide?

A

Colitis - abx related, UC

Worsens conditions -e.g. abdominal distension

120
Q

What are 4 SEs of loperamide?

A

Dizziness

flatulence

headache

nausea

121
Q

What is an MHRA warning related to high doses of loperamide?

A

serious cardiac SEs with high doses- misuse.

Remind patient of dose

122
Q

What age is loperamide not recommended in?

A

Not recommended for children under 12 years (in children)

123
Q

Can loperamide be used in pregnancy?

A

No- no info

124
Q

What to give in loperamide overdose?

A

Naloxone

monitor 48 hrs - CNS depression

125
Q

What is dyspepsia?

A

Umbrella term - group of upper abdo symptoms

126
Q

What are 6 symptoms of dyspepsia?

A

Upper abdo pain

Heart burn

Gastric reflux

belching/gas

bloating/ feeling full

N+V

127
Q

What are 4 red flags of dyspepsia?

A

GI bleeding

unexplained weight loss

dysphagia

55+ years (cannot explain symptoms)

128
Q

What 4 things can cause dyspepsia?

A

functional - no cause

Peptic ulcer

GORD

cancer

129
Q

What 5 drugs can cause dyspepsia? (NBC)

A

NSAIDs

Nitrate

Bisphosphonate

CCB, corticosteroid

130
Q

What is 1st line treatment for uninvestigated dyspepsia?

A

PPI 4 weeks

Do H pylori test

High risk patients = elderly, NA

131
Q

What happens when clopidogrel + omeprazole given?

A

Clopidogrel conc reduced

132
Q

What is treatment for functional dyspepsia?

A

PPI or H2 receptor antagonist - 4 weeks (e.g. ranitidine)

H pylori test

132
Q

What are 2 symptoms of GORD?

A

Heartburn

unpleasant taste

132
Q

What is GORD?

A

Gastric content comes back up into oesophagus.

133
Q

What drugs may cause GORD? (TANC-B)

A

NSAID, Nitrate

Bisphosphonates, BB

CCB, corticosteroid

Alpha blocker, Antimuscarinics

TCA

134
Q

What is treatment for univestigated GORD?

A

PPI 4 weeks (same as dyspepsia)

135
Q

What is treatment for endoscopy confirmed GORD?

A

PPI (4-8 weeks)

OR

H2 receptor antagonist

136
Q

What is treatment for severe oesophagitis?

A

PPI- 8 weeks

137
Q

What is 1st line treatment of GORD in pregnancy?

A

Diet + lifestyle

138
Q

What is 1st line drug treatment of GORD in pregnancy?

A

Antacids

Omeprazole (severe syx)
OR

Ranitidine

139
Q

What are peptic ulcers?

A

Open sores in lining of stomach or duodenum

140
Q

What are 2 high risk patients of peptic ulcers?

A

history of complicated ulcer

2+ risk factors

141
Q

What are 2 main causes of peptic ulcers?

A

NSAID use

H. pylori infection

142
Q

What are other risk factors of peptic ulcer?

A

65+ years
High dose + long termuse

SSRIs - GI bleeding

Serious co-morbidity e.g CVD, HT, DM

Smoking

143
Q

What are 7 symptoms of peptic ulcers?

A

Burning pain

Dyspepsia

Heartburn

Nausea

Bloating

Appetite loss

Weight loss

144
Q

Wha ti is treatment for NSAID-induced ulcer?

A

PPI or H2 antagonist - 8 weeks

H pylori test
Stop NSAID

145
Q

What to give if NSAID needs to be continued but patient has ulceration?

A

Consider COX-2 inhibitor instead + PPI

146
Q

What is treatment for GORD if patient has NO NSAID history and No h, pylori?

A

PPI or H2-receptor antagonist should be used

for 4–8 weeks

147
Q

What to do if patient with GORD H. pylori positive?

A

Treat infection first

148
Q

What 2 tests to diagnose H. pylori?

A

C13 urea breath test

Stool Helicobacter antigen.

149
Q

When to not do H pylori test?

A

Within 2 weeks PPI or 4 weeks of abx

150
Q

what is h pylori treatment?

A

PPI (BD) + 2 antibiotics (amoxicillin, clarithromycin or Metronidaxole)

151
Q

How many times is PPI taken a day for H. pylori treatment?

A

BD

152
Q

What is 1st line H pylori treatment if penicillin allergy?

A

PPI

Metro

Clarithromycin

153
Q

MOA of antacids?

A

Neutralises gastric acid

Symptomatic relief within 15-30 mins.

154
Q

What is 2nd line H pylori tx if penicillin allergy?

A

PPI
Metro

Levofloxacin *

155
Q

MOA of alginate?

A

Forms viscous gel raft on top of stomach contents to prevent reflux.

156
Q

List 4 antacids?

A

Aluminium salt

Magnesium salt

Calcium salt

Sodium salt

157
Q

What are 2 long acting antacids?

A

Aluminium salt

Magnesium salt

158
Q

What is a constipating antacid?

A

Aluminium salt

159
Q

What is a laxative antacid?

A

Magnesium salt

160
Q

List 2 alginates?

A

Alginic acid

Sodium alginate

161
Q

What antacid formulation is more effective than tablets?

A

Liquid

162
Q

When is low Na+ preparations useful in ?

A

Patients with HTN, HF, Kidney failure + fluid retention.

163
Q

What are 2 uses for antacids/alginates?

A

Dyspepsia

GORD

164
Q

How to take antacids/alginates?

A

After each main meal, at bedtime or PRN.

165
Q

What 3 drugs/classes drug absorption is reduced by antacids/alginates absorption?

A

Bisphosphonates

tetracyclines

quinolone (cipro)

166
Q

What can antacids/alginates damage?

A

Enteric coating of other tablet

167
Q

How to prevent antacids/alginates from reducing absorption of other drugs?

A

Give other drugs 2 hrs apart

168
Q

MOA of PPI?

A

Blocks gastric acid secretion - blocks H+/K+ ATPase in parietal cells

Most effective

169
Q

What PPI is taken 30-60 mins before food?

A

Lansoprazole

169
Q

What PPI is safe in pregnancy?

A

Omeprazole

169
Q

What are 3 uses for PPI?

A

Peptic ulcer

Dyspepsia

GORD

170
Q

What is dose for PPIs?

A

Lowest effective dose for shortest period

171
Q

How to take PPI?

A

Swallow whole. Leave 2 hr gap between indigestion remedies.

172
Q

List 5 SEs with PPIs? (G-CASH)

A

GI disturbances

Clearance reduced (methotrexate toxicity)
Antiplatelet effect - clopidogrel
SCLE
Hypomagnesaemia +fractures

173
Q

What does PPI mask?

A

Gastric cancer

174
Q

What does PPI do to bones?

A

Cause increase in fractures + GI infections

175
Q

What does Omeprazole do to clopidogrel?

A

Reduces antiplatelet effect

176
Q

Omeprazole + Methotrexate?

A

Reduces MTX clearance = builds up = toxic

177
Q

MOA of H2 receptor antagonists?

A

Blocks gastric acid secretion - blocks H2 receptors in parietal cells.

178
Q

3 uses of H2 antagonists?

A

Peptic ulcer

GORD
DyspepsiaW

179
Q

What are 4 H2 antagonists?

A

Cimetidine

Famotidine

Nizatidine

Ranitidine

180
Q

What H2 antagonist is enzyme inhibitor?

A

Cimetidine

181
Q

What H2 antagonist is discontinued (MHRA)?

A

Ranitidine - stopped due to safety, No new patients should be started on it.

182
Q

What are 4 main SEs of H2 antagonists?

A

Headaches

Rashes

Dizziness + diarrhoeaq

183
Q

What does H2 antagonist mask?

A

Gastric cancer

184
Q

What is contra-indicated in aminosalicylates?

A

Salicilate hypersensitivity

185
Q

What age is ulcerative colitis most common in?

A

15-25 years

186
Q

What is proctitis?

A

Inflammation of rectum

187
Q

What is proctosigmoiditis?

A

Inflammation rectum + sigmoid colon

188
Q

What is left- sided colitis?

A

Colon distal to the splenic flexure

(my right)

189
Q

What is extensive colitis?

A

Colon close to the splenic flexure and includes pan-colitis

More is affected

190
Q

What are 3 main symptoms of UC?

A

Bloody diarrhoea

Urgent need to poo

Abdo pain

191
Q

What are 4 complications of UC?

A

Colorectal cancer

secondary osteoporosis

VTE

toxic megacolon

192
Q

When to consider adding topical or oral corticosteroid in proctitis?

A

If taking aminosalicylates for 4 weeks not working.

193
Q

How long to try oral steroids for proctitis?

A

4-8 weeks

194
Q

What is 1st line for proctosigmoiditis + left-sided UC?

A

Topical aminosalicylates as well.

195
Q

What is used as 1st line for mild-moderate extensive UC?

A

Topical aminosalicylate + high dose oral aminosalicylate

196
Q

What is given in life threatening severe UC?

A

IV steroid methylpred or HC.

assess surgery

197
Q

What is given in life threatening severe UC if steroids contra-indicated?

A

Ciclosporin or surgery.

198
Q

What is licensed for relief of diarrhoea linked to crohn’s disease?

A

Colestyramine

199
Q

What 6 drugs can cause peptic ulcers and should be stopped if suspected?

A

NSAIDs
aspirin
bisphosphonates,
immunosuppressive agents (e.g. corticosteroids),
potassium chloride, selective (SSRIs) recreational drugs

200
Q

Patient with peptic ulcers testing positive for H-pylori should be reviewed when after starting treatment?

A

Reviewed 6–8 weeks after starting eradication treatment + re-tested, depending on the size of the lesion

201
Q

What is an MHRA alert about PPis?

A

Proton pump inhibitors (PPIs): very low risk of subacute cutaneous lupus erythematosus.

can occur weeks, months or even years after exposure to the drug

consider discontinue use + avoid sunlight if developing lesions

202
Q

Who is IBS more common in?

A

Women

203
Q

What age group does IBS affect?

A

20-30 years

204
Q
A
205
Q

When should patients with peptic ulcer need to be reviewed again for H. Pylori?

A

Patients with peptic ulcers (gastric or duodenal) who tested positive for H. pylori should be reviewed 6–8 weeks after starting eradication treatment and re-tested, depending on the size of the lesion.

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