GI Tract

Question 1

Laxatives medication recommendation

Answer 1

1) Bulk-forming laxatives (isphagula husk)
2) If stool still difficult to pass switch to an osmotic (macrogol) or stool softener (dulcoease)
- If stool is soft but feels difficult to pass or inadequate emptying switch to a stimulant (senna - avoided in pregancy)
- Use osmotic + stimulant lax for opioid-induced constipation
- Take occasionally for only up to a week and gradually reduce use once stool is soft/easy to pass 3 times a week

Question 2

Advice for those with constipation

Answer 2

• Eat more fibre: cereals, vegetables, grain foods + whole meal bread
• Healthy balanced diet with whole foods
• Avoid a sedentary lifestyle “ do you think you could incorporate more movement into your life?”
• Increasing fluid intake at least 2L a day especially when on lax
• Ask them how they feel if constipation is due to stress

Question 3

Safety netting for constipation

Answer 3

• If an effect does not happen within 3 days of taking laxatives (osmotics, bulk forming, stimulant) then please return to the pharmacy for further advice

Question 4

IBS medication recommendation

Answer 4

• Antipasmodic= for abdominal pain/spasm: peppermint oil
• Loperamide hydrochloride (imodium) = for IBS D
• Probiotics: lactobacillus or Bifidobacterium
• Lax for IBS-C

Question 5

Advice for those with IBS

Answer 5

• Dietary and lifestyle changes
• Discuss if it psychological due to stress before issuing medication
• Regular meals, do not skip meals
• Reduce alcohol + fizzy + caffeinated drinks

Question 6

Haemorrhoids treatment recommendation

Answer 6

• Simple analgesia: paracetamol 500mg tablet
• Lidocaine suppositories, ointment, cream
• Anusol cream, ointment, suppositories
• Lax if constipation is a contributing factor

Question 7

Advice for haemorrhoids

Answer 7

• Same dietary and lifestyle advice as constipation
• Warm bath or applying ice pack wrapped in towel to ease discomfort
• External haemorrhoids can be pushed back inside
• Perianal hygeine: Damp wipes instead of dry wipes
• Do not avoid going to the toilet
• Avoid painkillers causing constipation e.g co-codamol

Question 8

Treatment for mouth ulcers

Answer 8

• Analgesics: Bonjela, Difflam 0.15 spray
• Antiseptic/antimicrobia chlorhexidine gluconate mouthwash (corsodyl)
• Hydrocortisone muco-adhesive tablets for second line
• Salt water rinse

Question 9

Treatment for Dyspepsia

Answer 9

• Rennie + other antacids for indigestion
• Gaviscon – suspension + tablet

Question 10

Patient advice for dyspepsia

Answer 10

• Change to lower fat diet
• Reduce alcohol intake to recommended levels
• Stop smoking, lose weight, reduce caffeine intake, eat less spicy food
• Raise head and shoulders when in bed (stops stomach acid from coming up in sleep)
• Don’t eat less than 2 hours before going bed

Question 11

Patient advice for travel sickness

Answer 11

• Chew ginger before going on travel
• Avoid eating heavy meal before travelling
• Close your eyes
• Stay hydrated
• Avoid strong odours

Question 12

Treatment for travel sickness

Answer 12

• First line: Kwells hyoscine hydrobromide
• Antihistamines: Phenergan, Sturgeon 15