GI tract Flashcards
What drugs are contraindicated in an acute flare up of UC /crohns?
loperamide
codeine
increases risk of toxic megacolon
Does smoking increase the risk of relapse with crohns or UC
Crohns
What formulation should be used if UC is located:
- extensive proximal
- left sided distal
- proctosigmoiditis
- proctitis
Extensive proximal-whole colon=oral
left sided distal- enema
proctosigmoiditis - rectum and sigmoid colon= foams
proctitis- rectum= suppository
What is 1st line treatment in UC mild to moderate
aminosalicylate depending on location depends on form
What is 1st line treatment in extensive disease of UC
topical aminosalicylate and high dose oral aminosalicylate
What is treatment for severe acute UC?
Hospital admission for IV corticosteroids and assessment fo surgery
If there are 2 or more flares in 12 months that required systemic ccs then what medication is used as maintenance?
Aza or mercapto
What is used as treatment for acute flare up of crohns
Corticosteroid
If 2 or more flare ups in12 months then use of aza and mercapto as add on
What is used as maintenance of remission in crohns
aza/mercapto
What type of laxative is used if constipation is present in UC
after lifestyle advice, bulk forming used
What are key side effects of aminosalicylates to watch out for e..g mesalazine, sulfasalazine
blood dysgrasias and symptoms
Nephrotoxicity
Salicylate hypersensitivity-itch, hives
wear SPF
What is a specific side effect of mesalazine
pancreatitis
What colour does sulfasalazine turn bodily fluids
yellow/orange
may stain contact lenses
what are specific s/e of sulfasalazine
pancreatitis
decreased sperm production
sulfa allergy
need to increase folate dose in pregnancy
What is an interaction with aminosalicylates and shouldnt be used together
lactulose and mesalazine because lactulose lowers the stool pH in intestines so prevents sufficient release of active ingredient in EC /MR preps - designed to surpass acidic environment and be relased in intestines but pH lowered meaning drug released higher up
In short bowel syndrome what vitamins and electrolytes are deficient / malabsorbed?
Fat soluble DAKE and B12
Magnesium
Zinc, selenium
As there is incomplete drug absorption in short bowel syndrome, what is needed?
what cannot be used
Increased doses of e.g. warfarin, COCs, digoxin if oral
Cant use EC/MR forms
If a patient presents to pharmacy with lower abdominal spasms/cramps, bloating, constipation/diarrhoea, what do you suspect?
If they are >45 years old what is action?
Suspect IBS
refer if >45 y/o - risk cancer
What are the licensing for antispasmodics OTC for IBS?
mebeverine: 18+
Alverine: 12+
Peppermint oil colpermin: 15+
What is a counselling point for peppermint oil (colpermin IBS relief)
Swallow whole, irritates oesophagus and common S/e is heartburn
What is the licensing for OTC antimuscarinics e.g. hyoscine butylbromide and dicycloverine for IBS
Hyoscine (buscopan) = 12+
Dicycloverinee=12+
When would you avoid antimuscarinis for IBS?
Glaucoma
prostate enlargement
taking other medicines e.g. TCA, antihistamines, antipsychotics
What are red flags for constipation
>50 new onset Anaemia abdominal pain unexplained weight loss blood in stools history of colon cancer
What colour does senna turn urine/fluids?
Yellow brown
When is co-danthramer used and what colour does it change urine/fluids
Terminally ill patients
Red
What is 1st line trreatment for constipation?
Lifestyle advice!
Then bulk forming if lifestyle not effective
How long to bulk forming laxatives take to work and counselling point
72hrs ish(2-3 days) Need to maintain adequate fluid intake, lots of water but not immediately before bed du to risk of obstruction
What is fist line in children with constipation
Macrogol with diet/behaviour - diet modification alone is not recommended as 1st line
Add stimulant if inadeqeuate response
What is the licensing for
Macrogol
Lactulose
macrogol 12+ (or 2-11 movicol paeds)
Lactulose 3+ months
