GI treatments Flashcards
1
Q
H.pylori (no penicillin allergy) (5)
A
- PPI + amoxicillin + clarithromycin/metronidazole 7 days
- if tried already = PPI + amoxicillin + tetracycline/levofloxacin 7 days
- Specialist = PPI + Bismuth + 2 drugs mentioned above/rifabutin/furazolidone 10 days
2
Q
H.pylori (penicillin allergy) (5)
A
- PPI + + clarithromycin + metronidazole 7 days
- if clari. tried already = PPI + bismuth + metronidazole + tetracycline 7 days
- not had fluroquinolone = PPI + metronidazole + levofloaxin 7 days
- had fluroquinolone = PPI + bismuth + metronidazole + tetracycline 7 days
- Specialist = PPI + Bismuth + rifabutin/furazolidone 10 days
3
Q
C.difficile (3)
A
- Review meds: Withdraw causative Abx, avoid PPI
- Oral metronidazole or Vancomycin
- Faecal transplant if not working
4
Q
Aphthous ulcers (6)
A
- Protectorants (gelatine, pectin, carmellose)
- Local anaesthetic (benzocaine, lidocaine)
- Choline salicylate
- Benzydamine (difflam)
- Antibacterials (chlorhexidine (Corsodyl mouthwash))
- Corticosteroids (hydrocortisone)
5
Q
Oral thrush (2)
A
- Miconazole gel (Daktarin 2% ether 1.25ml QDS or 2.5ml QDS after food)
- Nystatin (1ml QDS for 7 days and 48 hours after resolved
6
Q
Dyspepsia (4)
A
- Antacids (rennies, aluminium hydroxide salts, etc…)
- Alginates (gaviscon)
- PPIs (omeprazole, etc..)
- H2 receptor antagonists (famotidine)
7
Q
GORD (no oesophagitis) (3)
A
- Full dose PPI 4-8 weeks
- If not effective, switch PPI and add H2 receptor antagonist
- If effective switch to low dose - symptom management when needed
8
Q
GORD (with oesophagitis) (3)
A
- Full dose PPI 8 weeks
- If effective, continue at full dose
- If not effective different full dose PPI + refer to specialist + treat underlying cause
9
Q
GORD mucosal protectors (3)
A
- Bismuth subsalicylate (antacid) - 525mg 4 times a day for 7 days
- Sucralfate (sucrose-aluminium complex) - 2g twice daily or 1g 4 times daily for 4-6 weeks
- Misoprostol (synthetic prostaglandin E2, useful to counter NSAIDs) - 400mg twice daily or 200mg 4 times daily for at least 4 weeks
10
Q
GORD sphincter strengtheners (3)
A
- Improve tone of the lower oesophagus sphincter muscle
- dopamine antagonists
- metoclopramide
11
Q
eosinophilic oesophagitis (3)
A
- dietary changes - six food elimination diet
- Swallowed corticosteroids - soluble beclomethasone tablets
- oesophageal dilation
12
Q
Faecal impaction (3)
A
- High-dose osmotic laxative
- Bisacodyl suppository
- Sodium citrate enema
13
Q
Constipation (8)
A
- increase fibre (soluble and insoluble)
- increase fluid
- gentle exercise
- Stimulant laxatives - Senna
- Bulk-forming laxatives - Ispaghula husk
- Osmotic Laxatives - lactulose
- Bowel Cleansing Preparations
- Peripheral Opioid-receptor antagonists
14
Q
Diarrhoea (6)
A
- Oral rehydration
- Food and Physical hygiene
- Antimotility drugs - opiates, loperamide
- co-phenotrope
- codeine morphine (not generally recommended, holding back bacteria)
- Adsorbents- kaolin- no longer recommended (harbours bacteria)
15
Q
Mild ulcerative colitis (2)
A
- topical aminosalicylate
- after 4 weeks = oral aminosalicylate then if required + topical/oral corticosteroid
16
Q
Mild Crohn’s (3)
A
- Oral corticosteroid (prednisolone/methylpred.
- Or budesonide if lower SE needed)
- If Corticosteroid is contraindicated aminosalicylate
17
Q
Moderate ulcerative colitis (3)
A
- Topical aminosalicylate,
- after 4 weeks = Topical aminosalicylate + high-dose oral aminosalicylate or switch to a high-dose oral aminosalicylate and time-limited topical corticosteroid
- If more needed switch to oral aminosalicylate + oral corticosteroid
18
Q
Moderate Crohn’s (2)
A
- Oral corticosteroid (do not offer budesonide or aminosalicylate as less effective)
- If ≥ 2 exacerbations in 1 year or glucocorticoid dose cannot be tapered, consider (+Azathioprine or mercaptopurine) or +Methotrexate
19
Q
Severe ulcerative colitis (2)
A
- IV corticosteroid (IV ciclosporin as alternative)
- After 72 hours + IV ciclosporin (+ infliximab if ciclosporin not tolerated)
20
Q
Chronic proctitis/ proctosigmoiditis (rectal inflammation) (3)
A
- Topical aminosalicylate
- Topical + oral aminosalicylate (oral ideally OD)
- Oral aminosalicylate alone- explaining not as effective
21
Q
Chronic left-sided and extensive UC
A
Oral aminosalicylate (ideally OD)
22
Q
Chronic all extents of UC (3)
A
- If oral aminosalicylate not effective, not tolerated or ≥ 2 exacerbations in a year
- Oral azathioprine
- or mercaptopurine
23
Q
Chronic Crohn’s disease (3)
A
- Azathioprine or mercaptopurine monotherapy
- Methotrexate where Aza/MCP not tolerated
- Do NOT offer corticosteroid
24
Q
Severe Crohn’s
A
If unresponsive to conventional therapy + infliximab or adalimumab
25
Q
IBS abdominal pain (3)
A
- Mebeverine - 135 mg TDS, 20 minutes before food
- Hyoscine BUTYLbromide (Buscopan) - 10 mg TDS
- Peppermint oil Colpermin - 1-2 capsules TDS (swallow whole)
26
Q
IBS constipation (3)
A
- Senna (S laxative) - 7.5-15 mg ON
- Movicol (O laxative) - 1 sachet up to three times a day
- Ispaghula husk (BF laxative) - 1 sachet BD
27
Q
IBS diarrhoea
A
Loperamide - 4-8 mg in divided doses (max 16 mg/24hours)
28
Q
IBS second line (4)
A
- Tricyclic antidepressants (TCAs) e.g. Amitriptyline 5-10mg ON and increase to 30mg ON
- Selective serotonin reuptake inhibitors (SSRIs) e.g. Citalopram, Fluoxetine, paroxetine
- cognitive behavioural therapy (CBT) or/ & hypnotherapy for people with IBS who do not respond to pharmacological treatments after 12months and who develop a continuing symptom profile
- probiotics minimum 4 weeks
29
Q
Haemorrhoids (4)
A
- Local anaesthetic
- Bismuth, zinc, allantoin, peru balsam - Anusol
- Hydrocorticon - Anusol plus HC
- Shark liver oil, lauromacrogol, yeast cell extract.
30
Q
vestibular (ears and balance) N&V (5)
A
- Hyoscine hydrobromide - 30 mins before a journey
- Antihistamines - less effective but have fewer side effects
- Cinnarazine (antihistamine) - 2 hrs before journey
- Promethazine - VERY SEDATIVE, not often used now
- For Meniere’s Disease Hyoscine hydrobromide or antihistamines are used plus phenothiazines
31
Q
pregnancy N&V (2)
A
- Avoid ALL drug treatment in first trimester
- In severe cases: 24-48 hours of promethazine or metoclopramide: REFER to SPECIALIST
32
Q
Cancer N&V (3)
A
- Prevent pre-exposure: phenothiazine, domperidone, dexamethasone
- Highly emetogenic: as on a 5HT3 antagonist (ondansetron)
- Second line: dexamethasone, phenothiazines, aprepitant, cannabinoids
33
Q
Parkinson’s N&V (2)
A
- Domperidone (not centrally acting, but risk of QT prolongation)
- Cannabinoids
34
Q
Post-operative N&V (2)
A
- Often local guidelines
- 5HT antagonists and Cyclizine common
35
Q
OTC travel sickness N&V (3)
A
- Hyoscine bromide - 30 mins before travelling then every 6 hrs
- Cinnarazine - 2 hrs before driving then every 8 hrs as needed
- Promethazine - very drowsy, often abused - avoid
36
Q
OTC migraine nausea (4)
A
- Promethazine - 18+
- placed on top gum under lip to dissolve
- Likely to cause drowsiness (aggravated with alcohol, opioids and antidepressants)
- Avoid use: Parkinson’s, epilepsy, glaucoma
