GI tract

Question 1

What are the symptoms of indigestion (dyspepsia)?

Answer 1

• Discomfort of pain in the stomach
• Bloating; Burping; Nausea
• Heartburn

Question 2

What are the ain causes of dyspepsia/indigestion?

Answer 2

• Over eating; spicy foods, smoking, alcohol
• pregnancy
• ulcers
• anxiety/ stress

Question 3

What are the symptoms of gastro-oesophageal reflux disorder?

Answer 3

• Heartburn - pain in the middle of the chest

- Sour mouth - contents of stomach coming back up

Question 4

What are the main causes of gastro-oesophageal reflux disorder?

Answer 4

• Over eating; spicy foods, smoking, alcohol
• Pregnancy
• Certain drugs
• Ulcers
• Anxiety/ stress

Question 5

What are ulcers?

Answer 5

Areas where damage has occurred to the mucosal membrane of the oesophagus, stomach or duodenum

Question 6

What are the symptoms of an ulcer?

Answer 6

• pain

- bleeding

Question 7

What are the causes of an ulcer?

Answer 7

• Bacterial infection H. pylori
• NSAIDS
• Smoking
• Zollinger-ellison syndrome
• Anxiety/ stress

Question 8

Which drugs are used for ulcers, GORD and indigestion?

Answer 8

• antacids
• antisecretory drugs & mucosal protectants:
  
  • histamine H2 antagonist
  • proton pump inhibitor
  • chelates & complexes
  • prostaglandin analogues
• Antibiotics ( for ulcers only !)

Question 9

What are the actions of antacids?

Answer 9

• Act locally to neutralise acid in the stomach

- As pH now less acidic, this also decreases pepsin activity

Question 10

What is the preparation of antacids?

Answer 10

• They can come as liquids or tablets
• They contain calcium, aluminium and magnesium salts
  Examples are: Rennies, Maalox, Gaviscon

Question 11

what are the 2 types of antacids?

Answer 11

• simeticone

- alginates

Question 12

how do simeticone antacids work?

Answer 12

• alters surface tension of small bubbles of gas to allow formation of large bubbles which can then be got rid of

Question 13

how do alginates antacids work?

Answer 13

– react with gastric juices to form a raft that floats on top and protects oesophagus from stomach contents

Question 14

aluminium may cause ______

Answer 14

constipation

Question 15

magnesium may cause ______

Answer 15

diarrhoea

Question 16

take ___ hour after or before food

Answer 16

1

Question 17

leave a ____ hour gap between other oral medication and antacids

Answer 17

2

Question 18

can cause electrolyte imbalance so always monitor….

Answer 18

for calcium, phosphate, magnesium and aluminium levels

Question 19

this position can help…

Answer 19

Sleep on left side or with head/shoulders propped up with pillows

Question 20

H2 Receptor Antagonists examples are…

Answer 20

Cimetidine (Tagamet®); famotidine (Pepcid®); nizatidine (Axid®); ranitidine (Zantac®)

Question 21

H2 Receptor Antagonist actions…

Answer 21

Block H2 receptors on parietal cells in stomach

Reduce acid production in the stomach

Question 22

Proton pump inhibitors examples…

Answer 22

Lansoprazole (Zoton®), Esomeprazole (Nexium®) Omeprazole (Losec®), Pantoprazole (Protium®), Rabeprazole (Pariet®)

Question 23

Proton pump inhibitor actions …

Answer 23

In acidic pH form two reactive molecules
Binds permanently to proton pump
Proton pump never pumps acid again!

Question 24

Helicobactor Pylori Infection is …

Answer 24

• H. pylori is a gram negative bacteria that causes inflammation of the stomach lining
• Routine treatment of ulcers includes treatment for H. pylori

Question 25

Helicobactor Pylori Infection treatment is ..

Answer 25

-2 Antibiotics + reduction in acid secretion
- know as “triple therapy” for 7-14 days
-Antibiotics:
Clarythromycin; Amoxycillin; Metronidazole; tetracycline

Question 26

If patient has a penicillin allergy do not give …

Answer 26

amoxicillin

Question 27

NSAIDS induce..

Answer 27

NSAID induced ulcers – NSAIDs inhibit Cox-1 which produces prostaglandins

Question 28

Antispasmodics site of action is

Answer 28

the intestine

Question 29

Antispasmodics reduce …

Answer 29

Reduce gut motility

Relax smooth muscle

Question 30

Antispasmodic drugs are used to treat …

Answer 30

Irritable bowel syndrome

Diverticular disease

Question 31

Side effects of antispasmodic drugs are ..

Answer 31

• Dry mouth
• Constipation
• Caution when using in elderly patients as may cause confusion

Question 32

what are the 3 Different Classes of Laxative?

Answer 32

Bulk forming

Stimulant

Osmotic

Question 33

Bulk forming laxatives actions are…

Answer 33

Increase of faecal mass, stimulating peristalsis

take a few days to work
a patient needs to maintain / increase fluid intake

Question 34

Examples of bulk forming laxatives are …

Answer 34

Ispaghula husk (Fybogel® ;Regulan®), methylcellulose (Celevac®), sterculia (Normacol®)

Question 35

Stimulant Laxatives actions are

Answer 35

Increase peristalsis, moving stool through large intestine

For acute use – can cause lazy bowel

Question 36

Examples of stimulant laxatives are

Answer 36

Bisacodyl, dantron, senna (Sennokot®), sodium picosulfate

Question 37

How do osmotic laxatives work ?

Answer 37

Poorly soluble, not absorbed, draw water into gut
Makes stools softer and easier to pass

Lactulose & Macrogols – takes a couple of days to work

Question 38

Examples of osmotic laxatives are…

Answer 38

Lactulose, macrogols (Movicol®),
Magnesium salts
Phosphates (Carbolox®) / Sodium Salts (Microlax®) (Rectal Use)

Question 39

Side effects of osmotic laxatives are …

Answer 39

Abdominal cramps
Wind
Diarrhoea

Question 40

Female, 25 has symptoms of burning in the middle of her chest and acute pains in the stomach. She is on phenytoin for epilepsy but otherwise healthy what drug is she likely to be on?

Answer 40

Gaviscon (antacid + alginate)

Question 41

A 45 year old man has abdominal cramps and has been going to the toilet every 30mins-1hr.  He has no nausea and vomiting but is feeling very faint
What is the man likely to receive
A. proton pump inhibitor
B. lactulose + fluids
C. loperamide + oral rehydration

Answer 41

c.