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Diploma: Autoimmune disorders > Irritiable bowel diseases > Flashcards

Irritiable bowel diseases Flashcards

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1
Q

What are the primary aims of IBD management?

A
  • To induce and maintain remission (either clinical or endoscopic)
  • Reduce the risk of complications
  • Improve patient quality of life
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2
Q

What are the symptoms of Crohn’s relapse?

A

Weight loss, abdominal pain, diarrhoea and general ill-health.

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3
Q

Ulcerative Colitis vs Crohn’s?
Location
Symptoms

A
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4
Q

What are the criteria for UC to be labelled as Acute severe ulcerative colitis (ASUC)?

A

Defined by the modified Truelove and Witts criteria as:
* >6 bloody stools per day and systemic toxicity with at least one of:
* Temperature >37.8°C
* Pulse >90 bpm
* Haemoglobin <105 g/L
* C-reactive protein >30 mg/L

Adult patients with ASUC or adolescents with a Paediatric Ulcerative Colitis Activity Index (PUCAI) score of 65 or more should be admitted to hospital for assessment and intensive management

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5
Q

IBD affects how many people in the UK?

A

400 people per 100,000

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6
Q

What are the main drugs used in IBD?

A
  • Aminosalicylates (mesalazine, sulfasalazine)
  • Corticosteroids (such as prednisolone, beclomethasone and budesonide)
  • Thiopurines (azathioprine, mercaptopurine)
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7
Q

What are aminosalicylates? How do they work?

A

5-aminosalicylic acid (5-ASA) class of drugs (mesalazine and sulphasalazine) are considered safe and effective long-term treatment options for IBD

The mechanism of action of 5-ASAs is not well understood; however, they are thought to reduce inflammation by inhibiting release of interleukin-1 and preventing recruitment of leucocytes into the bowel wall

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8
Q

What are the main side effects of aminosalicylates?

A

Renal complications, drug-induced liver injury, dyspepsia, rash, urticaria and eosinophilia

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9
Q

Treatment of acute mild-moderate EXTENSIVE ulcerative colitis?

A
  1. Topical aminosalicylate + high dose oral aminosalicylate (Topical + Oral)

Studies have shown that a combination of high-dose oral and rectal mesalazine therapy is more effective at inducing remission of mild-to-moderate symptoms compared with oral therapy alone.

No improvement after 4 weeks:

  1. High dose oral aminosalicylate + 4-8 weeks oral corticosteroid (Oral + Oral)

If aminosalicylates contraindicated: 4-8 weeks oral corticosteroid

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10
Q

Maintenance treatment of mild-moderate ulcerative colitis?

A

Once in remission, 5-ASA therapy for UC should be reduced to a maintenance dose as appropriate, to limit adverse effects but still reduce the risk and frequency of flares

Ideally, all UC patients should be offered a combination of oral and enema 5-ASA

In mild-to-moderate UC, 5-ASAs are the treatment of choice and all patients should be offered a 5-ASA at a dose of 2.0-3.0g/day orally. Patients experiencing flare-ups can be escalated to 4.0–4.8 g/day

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11
Q

Methotrexate has no role in the maintenance of remission in UC.

True or False?

A

True

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12
Q

What are the monitoring and reporting requirements for Aminosalicylates?

A

Monitoring: Renal function before starting, 3 months later and then annually

Blood dyscrasias - sore throat, fever, rash, ulcers, bleeding - refer to A+E

Good practice to prescribe by brand name but not legal requirement

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13
Q

Sulfasalazine discolours bodily fluids what colour?

A

Colours body fluids orange/yellow (not harmful, avoid wearing contact lenses)

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14
Q

Treatment with 5-ASAs is not recommended for induction or maintenance treatment of Crohn’s Disease.

True or False?

A

True

Can be used if Crohn’s is mild and the patient cannot have, or decide not to have, steroids.

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15
Q

What is first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of proctitis? (present in both UC and CD)

What would be second and third line?

A
  1. Rectal + oral aminosalicylates (if mild, rectal mesalazine may suffice)
    - Foam if have difficulty retaining liquid from enemas)

If no improvement after 4 weeks or patient does not want to use rectal formulations:

  1. Oral aminosalicylate
  2. Rectal or oral steroid for 4-8 weeks
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16
Q

What can be used for maintenance of proctitis/proctosigmoiditis?

A

Rectal aminosalicylate can be started alone or in combination with oral aminisalicylate

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17
Q

What is the advantage of the newer aminosalicylates (mesalazine, balsalazide, olsalazine) over sulfasalazine?

A

Avoids the sulfonamide-related side effects of sulfasalazine

(sulphonamides are CYP inhibitors)

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18
Q

Sulfasalazine is a combination of what two compounds?

A

5-ASA and sulfapyridine

Sulfapyridine acts only as a carrier to the colonic site of action but still causes side effects

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19
Q

Which aminosalicylates have rectal preparations?

A

Mesalazine and sulfasalazine

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20
Q

Are corticosteroids suitable for maintenance treatment of UC?

A

No because of their side effects

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21
Q

What should be given in severe acute UC?

A

MEDICAL EMERGENCY

  1. IV corticosteroids (methylpred or hydrocortisone)
    - Usually 100mg hydrocortisone QDS
  2. If symptoms not improved after 72 hours:
    - IV steroid + IV ciclosporin
    - Surgery
  3. Infliximab if cannot use ciclosporin

Step down to oral prednisolone 40mg a day, with an aim to taper over six to eight weeks (usually tapered by 5mg per week)

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22
Q

In patients being treated with aminosalicylates for UC, when would you add in oral prednisolone?

A

No improvements within 4 weeks of initial therapy. If patient is on beclometasone, discontinue this

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23
Q

What is first line treatment for patients with acute exacerbation mild-moderate proctosigmoiditis or left-sided UC?

A
  1. Topical aminosalicylate (Topical)

No improvement after 4 weeks:

  1. High dose oral aminosalicylate + topical aminosalicylate OR High dose oral aminosalicylate + 4-8 weeks of topical steroid (Topical + Oral)
  2. High dose oral aminosalicylate + 4-8 weeks of ORAL steroid (Oral + Oral)
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24
Q

What are second generation corticosteroids?

A

Beclomethasone diproprionate and slow release budesonide

They have high affinity for the intracellular glucocorticoid receptor in the GI tract
- Lower systemic availability owing to extensive pre-systemic metabolism within the mucosa of the small intestine and the liver
- ‘Topically acting’ even though they are taken orally

Ensure the brand is specified as they have slightly different sites of release and licensed indications

Once remission is achieved, these should be tapered over one to two weeks

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25
Q

Rectal steroid preparations can be used to treat proctitis, proctosigmoiditis and colitis in CD. Rectal mesalazine should be used for UC owing to higher efficacy.

True or False?

A

True

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26
Q

True or false: Budesonide is licensed for inducing remission in mild to moderate UC if aminosalicylates are not suitable

A

TRUE

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27
Q

Why does oral budesonide have fewer systemic side effects than corticosteroids?

A

It exerts its action locally in the colon

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28
Q

Summary of rectal corticosteroid preparations to manage IBD

A
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29
Q

Can you use loperamide and codeine phosphate in acute UC?

A

No- contraindicated as it increases the risk of toxic megacolon

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30
Q

What can be used to MAINTANANCE of left-sided or extensive UC?

A

Low dose oral aminosalicylate

If 2 or more flare ups in 12 months:

  • Oral azathioprine or mercaptopurine
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31
Q

Which antacids can cause contipation and which can cause diarrhoea

A

Magnesium containing = laxative effects (diarrhoea)

Aluminium & Calcium containing= constipation effects

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32
Q

Within what time period during starting sulfasalazine treatment do haematological abnormalities often occur?

A

Within the first 3-6 months of starting treatment

Discontinue if these occur

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33
Q

What should patients on sulfasalazine be aware of (benign)?

A

May stain the urine and contact lenses yellow/orange

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34
Q

What type of laxative may be useful for proximal faecal loading in proctitis ulcerative colitis?

A

Macrogol

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35
Q

What is the patient counselling with aminosalicylates?

A

Report any unexplained bleeding, bruising
Salicylate hypersensitivity e.g. itching, hives
Yellow/orange bodily fluids - may stain contact lenses

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36
Q

Patient counselling points for administration of:
1. Suppositories
2. Rectal foams/enemas

A

1. Suppositories
* Insert before bed to minimise any leakage
* Wet the tip of the suppository with water or a water-based lubricant to make it easier to insert
* Try not to go to the toilet for an hour after inserting the suppository to give it time to work
* May experience leakage during the night. This is normal because the suppository starts to melt once inserted. Placing a towel on the bed may help to absorb any leaks
* If a suppository comes out within ten minutes of inserting it, do not worry. Try another suppository

2. Rectal foams/enemas
* Use enemas before bed to minimise leakage
* When administering the enema, stand with one leg raised on a chair or lie down on your side. This gently creates an opening for the enema applicator which can then be inserted into the bottom as far as possible
* If lying on your side, a pillow may help to lift the bottom up. You may also use a towel to absorb any leakage
* For sleeping, find a comfortable position that helps keep the liquid inside for as long as possible. The longer it stays in, the better chance it will work.

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37
Q

What are the red flag side effects of aminosalicylates?

A

Agranulocytosis, Bone marrow suppression, Neutropenia, Cardiac inflammation, nephrotoxicity

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38
Q

What are the monitoring requirements for aminosalicylates?

A

Renal function: before, at 3 months, and then annually

Liver function: Monthly for first 3 months

FBC: Monthly for first 3 months (drug should be stopped immediately if any indication of blood dyscrasia)

Patients should report any unexplained bleeding/bruising/fever/malaise during treatment

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39
Q

What is the interaction between lactulose and mesalazine?

A

The manufacturers of some mesalazine gastro-resistant and modified-release medicines suggest that preparations that lower stool pH (e.g. lactulose) might prevent the release of mesalazine.

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40
Q

Which GI conditions are the following drugs used for

Hyoscine butylbromide

Alverine Citrate

Mebeverine

A

(All) Gastro-intestinal smooth muscle spasms

Hyoscine: IBS, Acute spasms

Mebeverine: IBS

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41
Q

True or false: When used to maintain remission, single daily doses of oral aminosalicylates can be more effective than multiple daily dosing, but may result in more side-effects.

A

TRUE

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42
Q

Which electrolytes are affected by PPIs

A

Hyponatreamia

Long term use: Hypomagnesaemia (more common after 1 year but sometimes after 3 months)

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43
Q

What are some side effects of Loperamide and what is the MHRA alert

A

Flatulence, GI disorders, Nausea, Headache, Dizziness, Dry mouth

MHRA alert: Serious cardiovascular events (e.g. QT prolongation, TDP, cardiac arrest) with large overdose, naloxone can be given as an antidote

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44
Q

What is the MHRA saftey alert with PPIs

A

Subacute cutaneous lupus erythematosus (SCLE)

development of lesions with associated athralgia

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45
Q

When is metoclopromide contraindicated for treating sickness?

A

3 - 4 days after Gastrointestinal surgery

GI heamorrhage

GI obstruction

Under 18 years due to neurological effects

Epilepsy

Parkinsons

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46
Q

Which of the following is not a typical symptom of IBS?

A. Abdominal pain

B. Bloating

C. Constipation

D. Diarrhoa

E. Emesis (vomiting)

A

Emesis (vomiting)

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47
Q

Why can Crohns disease cause secondary osteoporosis?

A

Reduced absorption of dietary vitamins and minerals.

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48
Q

What is fistulating Crohn’s disease?

A

When there is the formation of a fistula between the intestine and adjacent structures, such as the perianal skin, bladder, and vagina. It occurs in about 1/4 patients, mostly when the disease involves the ileocolonic area.

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49
Q

What common harmful lifestyle factor can make Crohn’s worse?

A

Smoking

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50
Q

In the treatment of acute Crohn’s, what is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s in a 12-month period?

A

A corticosteroid (either prednisolone, methylprednisolone or intravenous hydrocortisone).

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51
Q

Acute Crohns: In patients with distal ileal, ileocaecal or right-sided colonic disease in whom a conventional corticosteroid is unsuitable or contra-indicated, what can be considered and why?

A

Budesonide can be considered, it is less effective but may cause fewer side-effects than other corticosteroids as the systemic exposure is limited.

Aminosalicylates (sulfasalazine and mesalazine) are an alternative option. But less effective.

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52
Q

What are immunomodulating therapies?

A

Thiopurines, methotrexate, ciclosporin and biologic or targeted cell therapies

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53
Q

When would add-on treatment be used in Acute Crohn’s?

A

If there are two or more inflammatory exacerbations in a 12-month period, or if the corticosteroid dose cannot be reduced.

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54
Q

All patients with IBD receiving immunosuppressants should also receive influenza, pneumococcal and COVID-19 vaccinations.

True or False?

A

True

But avoid live vaccines (BCG, MMR, flu nasal spray etc.)

55
Q

Acute Crohn’s: What can be added to a corticosteroid or budesonide to induce remission?

A

Thiopurines such as azathioprine or mercaptopurine can be added.

In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.

56
Q

How do thiopurines work?

A

Deactivate T-lymphocyte processes that lead to inflammation and are effective at maintaining steroid-free remission in CD and UC

Azathioprine is a pro-drug of 6-mercaptopurine

Should not be used to induce remission

57
Q

When are thiopurines started in patients with:
1. Crohn’s
2. Ulcerative Colitis

A

Crohn’s
* Thiopurines can be added to glucocorticoids or budesonide to induce remission if the patient has had ≥2 exacerbations within a 12-month period or
* If tapering of glucocorticoids has failed

Monotherapy can be continued to maintain remission

Ulcerative colitis
* Thiopurines can be initiated if ≥2 exacerbations have occurred within a 12-month window or
* If remission is not maintained by 5-ASAs or after a single episode of acute-severe UC

58
Q

Patients can be started on thiopurines in combination with biological treatment (e.g. infliximab) to minimise drug antibody development.

True or False?

A

True

59
Q

A higher immunosuppressant effect (and therefore higher doses of thiopurines) is required in patients with IBD to achieve disease remission.

True or False?

A

True

The therapeutic target for IBD patients on azathioprine is 2–2.5mg/kg, and 1–1.25mg/kg for mercaptopurine monotherapy if thiopurine
methyltransferase [TPMT] is normal

60
Q

Main side effects of thiopurines (azathioprine, mercaptopurine)?

A
  • Nausea (advise patients to take their tablets after meals)
  • Severe diarrhoea (with azathioprine, recurs on rechallenge)
  • Myelosuppression and opportunistic infections
  • Deranged liver function and hypersensitivity reactions, including pancreatitis

Long-term thiopurine use may also be associated with an increased risk of lymphoproliferative disorders and non-melanoma skin cancer. The risk of lymphoma rises markedly with increasing age

61
Q

Monitoring requirements for thiopurines (azathioprine, mercaptopurine)

A

Thiopurines are associated with a high risk of toxicity and careful monitoring is advised

62
Q

What are TPMT levels and why are they tested when taking thiopurines?

A

Individual TMPT (thiopurine S-methyltransferase) activity determines the extent of mercaptopurine metabolism

There is increased risk of severe and potentially fatal myelosuppression at standard doses in patients who have no or low levels of activity. Thiopurines should be avoided in people with zero TPMT levels

63
Q

Myelosuppression secondary to thiopurines is dose related and generally reversible.

True or False?

A

True

Commonly features leucopoenia, thrombocytopenia and transaminitis (raised LFTs)

Myelosuppression can be aggravated in those patients with low or deficient levels of TPMT.

64
Q

What are TGN levels, what is the therapeutic level and when should they checked?

A

Tests for TGN levels determine the thioguanine count in DNA structure and should ideally be requested at weeks 4 and 12 after starting therapy, thereafter bi-annually/annually, or 4 weeks after a dose change

A therapeutic TGN range of 235–450 pmol/8 x 108 red blood cells (RBCs) correlates with a sufficient clinical response

Increasing the dose by 25–50mg per day may be sufficient for TGN to reach therapeutic range, if subtherapeutic. Equally if levels are above range, reducing the dose by 25–50mg may be enough to bring it down to range

65
Q

How long should elapse between completion of cancer treatment and starting therapy for IBD with thiopurines or biologics?

A

2 years

Although this depends on the agent being considered and availability of other options to control disease

66
Q

Acute Crohn’s: Add-on treatment: In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, what can be added to a corticosteroid?

A

Methotrexate

67
Q

Under specialist supervision, what are options for the treatment of severe, active Crohn’s disease, following inadequate response to conventional therapy?

A

Adalimumab, Infliximab

68
Q

How does adalimumab work?

A

anti TNF

69
Q

How does infliximab work?

A

Anti TNF

70
Q

In the maintenance of remission in Crohn’s, which drugs can be used as unlicensed monotherapy to maintain remission?

A

Azathioprine and mercaptopurine

71
Q

Methotrexate should only be used in Crohn’s patients to maintain remission if what?

A

if they are intolerant of or not suitable for azathioprine or mercaptopurine treatment.

72
Q

What drugs should not be used for the maintenance of remission in Crohn’s?

A

Corticosteroids or budenoside.

use to induce remission only

73
Q

What drug is licensed for the relief of diarrhoea associated with Crohn’s disease?

A

Colestyramine

loperamide and codeine can also be used.

74
Q

What is diverticular disease?

A

Diverticula (sac-like protrusions of mucosa through the muscular colonic wall) cause intermittent lower abdominal pain in the absence of inflammation or infection. Can cause large rectal bleeds

40 years and over usually

Symptoms of diverticular disease: lower abdominal pain, change in bowel movements – constipation or diarrhoea, rectal bleeds, fever

75
Q

What is the treatment for diverticular disease

A

High fibre diet or bulking forming laxatives for constipation symptoms

Paracetamol for pain

Not recommended in diverticular disease – antibiotics, NSAIDs, opioids

76
Q

What is not recommended in uncomplicated diverticular disease?

A

Antibiotics unless the patient presents with signs of infection/immunocompromised

the use of NSAIDS or opioids is not recommended in uncomplicated diverticular disease

77
Q

What is the treatment for complicated diverticular disease?

A

Hospital admission required - IV antibacterials covering gram negative and anaerobes & Bowel rest

78
Q

True or false:

There is insufficient evidence to justify the role of fibre, rifaximin, antispasmodics, mesalazine, and probiotics in the prevention or treatment of diverticulitis.

A

TRUE

79
Q

Balsalazide is a pro drug of what?

A

5-ASA (Mesalamine)

80
Q

What are extraintestinal manifestations?

A

When people with IBD develop conditions affecting the joints, eyes or skin. e.g. arthritis, osteoporosis

81
Q

In a patient with a first presentation or single inflammatory Crohn’s exacerbation in a 12 month period, what drug is used?

If this is not suitable, or if the patient has right-sided colonic disease, what could be used? When would these not be appropriate and why?

A
  1. Corticosteroid - prednisolone, methylprednisolone or IV hydrocortisone
  2. Budesonide or aminosalicylates. Not appropriate if severe presentation as they are less effective (even though they have fewer side effects)
82
Q

When would you add in additional treatment (on top of steroid monotherapy) in a Crohn’s disease exacerbation?

What would you add?

A

2 or more inflammatory exacerbations in 12 months, or if the steroid dose cannot be reduced

Azathioprine or mercaptopurine

83
Q

Is mercaptopurine licensed in severe UC or CD?

A

No

84
Q

What can be added to a steroid to induce remission in a Crohn’s patient?

If these are not suitable, what could be used?

A
  1. Azathioprine, Mercaptopurine (unlicensed)
  2. Methotrexate
85
Q

What test do you need to do before starting someone on azathioprine or mercaptopurine?

A

TPMT levels. If activity is deficient, it may not be suitable

FBC weekly for 4 week, then every 3 months

Patients should be advised to monitor for signs of bone marrow suppresion

86
Q

What monoclonal antibodies are licensed for Crohn’s?

A

Adalimumab

Infliximab - can also be used for active fistulating CD

87
Q

Literature supports the use of which biologic as a first-line biologic option for UC failing conventional therapy?

A

Vedolizumab

Can be used in the induction and maintenance of remission of ulcerative colitis in patients where anti-TNF treatment has failed

88
Q

Tofacitinib as an oral agent, with no concerns about immunogenicity. True or False?

A

True

Tofacitinib can be used in the induction and maintenance of remission of ulcerative colitis in patients where anti-TNF treatment has failed

It is an attractive choice, but with little real-world experience as yet

89
Q

Tofacitinib increases the risk of what infection?
What if vaccination is required?

A

Herpes zoster

Occurred more often on active treatment

Vaccination should be considered before starting therapy in those aged over 70 years and those over 50 years considered at particularly high risk (such as recurrent shingles)
- As a live vaccination it must not be given for 3 months after stopping biologics, and tofacitinib should not be started for 4 weeks after vaccination

90
Q

Tofacitinib increases the risk of PE at what dose?

A

5-fold increase in pulmonary embolus for the group on 10 mg BD tofacitinib compared with TNF inhibitor therapy (as compared to 5mg BD)

EMA committee advises that the high dose should not be used in patients at increased risk of pulmonary embolus (heart failure, malignancy, impending/recent surgery, inherited coagulation disorders, previous thromboembolism, combined contraceptive therapy or HRT).

91
Q

Should steroids be used for the maintenance of remission for Crohn’s?

A

No- only to induce remission

92
Q

What antibiotics can be used (alone or in combination) to improve symptoms of fistulating Crohn’s?

A

No need for treatment if asymptomatic

To improve symptoms (but not fully heal):

Metronidazole and/or ciprofloxacin (unlicensed)

  • Metronidazole for 1 month but no more than 3 months (peripheral neuropathy)
93
Q

If metronidazole is given for fistulating Crohn’s, how long for and what are the associated risks?

A

1 month (no longer than 3) due to risk of peripheral neuropathy

94
Q

What is used to control the inflammation in fistulating Crohn’s disease (and continued for maintenance)? How long should they be on this for?

A

Azathioprine or mercaptopurine (unlicensed) or infliximab

For at least 1 year

95
Q

What should a patient be screened for if starting vedolizumab?

A

TB

Contraindicated in those with TB

96
Q

How are IBS patients with:

Diarrhoea

Constipation

Spasms

Pain

A

Diarrhoea - loperamide

Constipation - laxatives (avoid lactulose - bloating)

Spasms - antispasmodics (alverine, mebeverine, peppermint oil), hyoscine butylbromide (avoid in cardiac disease - antimuscarinic)

If OTC pain management is not working: amitriptyline or SSRI (unlicensed)

97
Q

Patients on colestyramine long term may need supplements of vitamins A, D, E, K, and folic acid. Why?

A

Can intefere with absorption of fat soluble vitamins

98
Q

What is the advice around taking colestyramine with other drugs?

A

Manufacturer advises take other drugs at least 1 hour before, or 4–6 hours after, colestyramine.

99
Q

Constipation red flags?

A

B - blood in stools

A - anaemia

A - abdominal pain

W - weight loss

N - New onsent constipation in over 50s

100
Q

How can people experiencing diarrhoea and high output stomas be treated?

A

Loperamide and codeine

101
Q

Arachis oil enema would be contraindicated in patients with what allergy?

A

Peanuts

102
Q

What are the warnings associated with liquid paraffin as a lubricant?

A

Anal seepage and the risks of granulomatous disease of the gastro-intestinal tract or of lipoid pneumonia on aspiration.Should not be taken immediately before going to bed

103
Q

What is 1st line for short duration constipation where dietary measures have not helped?

If stools are soft but difficult to pass, what would be more appropriate?

A
  1. BOS

Soft but difficult to pass: Stimulant laxative

104
Q

How is chronic constipation managed? (>6 months)

A

BOS

  1. Bulk forming
  2. Change to or add osmotic laxative (macrogol, lactulose second line)

If no change after 6 months:

  • Prucalopride (now also used in men)

Lactulose should be withdrawn slowly

105
Q

What is the duration of acute diarrhoea

A

Less than 14 days

106
Q

What is the maximum daily licensed dose for loperamide?

A

16mg (8 x 2mg capsules)

107
Q

What is the MHRA advice regarding loperamide?

A

Reports of serious cardiac adverse reactions with high doses associated with abuse QT prolongation, torsades de points, cardiac arrest

108
Q

What is a side effect of magnesium?

A

Laxative effect

109
Q

What is a side effect of aluminium?

A

Constipation

110
Q

Referral criteria for dyspepsia/GORD?

A

G - Gastrointestinal bleeding

A - Age over 55

U - Unexplained weight loss

D - Dysphagia

111
Q

What 2 electrolytes can drop if on PPIs?

A

Sodium and magnesium

112
Q

What is the MHRA alert associated with hyoscine butylbromide injection (IM, IV, SC)?

A

Can cause serious side effects such as tachycardia, hypotension, anaphylaxis (which is likely to be fatal in patients with CHD)

It is therefore contraindicated in patients with tachycardia and should be used in caution in those with cardiac disease

113
Q

If a patient has an aspirin sensitivity, would aminosalicylates be appropriate for them?

A

No - sulfasalazine and mesalazine are derivatives of salicylates, like aspirin.

114
Q

What colour does your urine turn if on sulfasalazine?

A

Yellow/orange

115
Q

What age is Mintec peppermint capsules licensed for?

A

> 18 years

116
Q

What age is Colpermin peppermint capsules licensed for?

A

>15 years

117
Q

What is the MHRA advice surrounding PPIs?

A

Very low risk of subacute cutaneous lupus erythematosus

Drug-induced SCLE can occur weeks, months or even yearsafter exposure to the drug.If a patient on PPIs develops lesions in sun-exposed areas
- Accompanied with arthralgia

Advise them to avoid sun exposure

Consider SCLE as a possible diagnosis

118
Q

What are long term complications of ulcerative colitis?

A

Colorectal cancer, Osteoporosis - from dietary change, corticosteroid medication,VTE,Toxic megacolon

119
Q

The use of loperamide or codeine in an acute flare up of UC increases the risk of what?

A

Toxic megacolon

120
Q

What are the complications of Crohn’s Disease?

A

Intestinal strictures, abscesses, fistulae, Malnutrition Anaemia, Colorectal and small bowel cancers, Growth failure and delayed puberty in children, Arthritis, Secondary osteoporosis - from steroid meds

121
Q

Loperamide dosing

A

1-2 tabs at first then 1 tab with each loose stool (max 8 x 2mg)

OTC: 12+

Prescription: 4+

122
Q

What are the red flag symptoms of constipation?

A

New onset in > 50 years

Anaemia

Abdominal pain

Unexplained weight loss

Change in bowel habit

123
Q

What is the advice with enteral feeds and food when taking sucralfate?

A

Administration of sucralfate and enteral feeds should be separated by 1 hour and for administration by mouth, sucralfate should be given 1 hour before meals.

124
Q

What are the side effects of antimuscarinics?

A

Blurred vision
Arrhythmias
Pupil dilation (mydriasis)
Urinary retention
Constipation
Dry mouth
Angle-closure glaucoma
Drowsiness, confusion

125
Q

What is diverculosis and treatment?

A

Asymptomatic

Forms diverticula= small pouches protruding from large intestine

Treatment: Bulking forming laxatives if they have constipation, paracetamol

126
Q

What is acute diverticulitis

A

Sudden inflammation of diverticula

Can be infected = pain, fever, rectal bleeding

Treat with antibiotics

127
Q

What is complicated acute diverticulitis

A

Access, bowel perforation, fistula, intestinal obstruction, haemorrhage, sepsis

128
Q

What is treatment for acute diverticulitis

A

Paracetamol if no systemic symptoms, antibacterials if needed and low fibre diet generally in diverticulitis

129
Q

What is treatment for complicated acute diverticulitis

A

Hospital

130
Q

What is not recommended in complicated acute diverticulitis

A

Aminosalicylates and propylactic antibacterials

131
Q

What drugs are used in IBD

A

Aminosalicylates: Sulfaslazine, sulfapyridine, mesalazine, balsalazide, olsalazine

Cytokine modulators: Infliximab, adalimumab, golimumab

132
Q

Infliximab, adalimumab and golimumab are licensed for which condition?

A

Infliximab and adalimumab are licensed for both UC and CD with comparable efficacy, while golimumab is currently licensed for UC only

133
Q

PPIs increase concentrations of what drugs?

A

Methotrexate

134
Q

Laxative abuse can lead to what?

A

Can cause hypokalaemia and lazy bowel syndrome/incontinence

Diploma: Autoimmune disorders (2 decks)

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