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Pre-reg Exam 2021 > OTC GI > Flashcards

OTC GI Flashcards

1
Q

What is the BMI needed for orlistat to be supplied?

A

28 or above

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2
Q

When do you refer patients who want orlistat?

A 
Levothyroxine 
Amiodarone
Ciclosporin
Warfarin and DOACS
Acarbose
Anti epileptics

Take caution if oral contraceptives, ADEK vitamin deficiency

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3
Q

What conditions need to be referred if a patient wants orlistat?

A

Diabetes
Hypertension
High cholesterol

Chronic malabsorption syndrome
Cholestasis 
Pregnancy or breastfeeding
Kidney disease
Failure to lose weight after 3 months
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4
Q

How do you take orlistat?

A

1 capsule TDS

Prevents absorption of dietary fat

18+

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5
Q

What is the advice needed for orlistat?

A 
Not substitute for healthy diet
5 portions fruit and veg
18-30g fibre
2.5L fluids
Exercise 30mins/day 5 days a week
Alcohol, 2-3 units a day if interspersed with several alcohol free days
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6
Q

What are the symptoms of constipation?

A

Small hard stools passed less frequently than normal

Straining
Incomplete emptying
Abdominal cramps/bloating
Nausea

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7
Q

When do you refer constipation?

A 
Blood in stools
Unexplained weight loss, appetite loss
Patients over 40 with sudden change in bowel habit
Medication ADR 
Constipation and lethargy, weight gain , coarse, thinning hair, dry skin
Stimulant laxatives abuse
Obstruction 
> 2 weeks
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8
Q

What are the OTC products for constipation?

A

BOSS laxatives

Bulk forming
Osmotic
Stimulant
Stool softeners

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9
Q

What are the bulk forming laxatives OTC?

A

Isphagula husk 6+
Sterculia 6+
Methylcellulose

2-3 days
Oesophageal or intestinal obstruction

Swallow with water and not immediately before bed

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10
Q

What are the osmotic laxatives used OTC?

A

Macrogol 12+/2-11 movicol
Lactulose 3 months +
Magnesium sulphate 12+

2-3 days

Discomfort, flatulence, cramps

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11
Q

What are the stimulant laxatives used OTC?

A

Senna 6+/12+
Bisacodyl 10+
Sodium picosulfate 10+
Docusate 18+

6-13 hours

Glycerin suppositories, 15-30 mins

Hypokalaemia, diarrhoea, lazy bowel
Take at night

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12
Q

What is used otc for pregnant women constipation?

A

Bulk forming or lactulose

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13
Q

What is the caution for elderly patients with constipation?

A

Caution recommending bulk forming as risk of obstruction

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14
Q

What is used for children OTC constipation?

A

Lactulose

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15
Q

What is used for opioid induced constipation otc?

A

Lactulose and stimulant laxative

Avoid bulk forming

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16
Q

What is the advice for constipation?

A

Lifestyle advice

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17
Q

What causes dyspepsia?

A

Indigestion
GORD
Gastritis
Gastric or duodenal ulcers

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18
Q

What are the symptoms of dyspepsia?

A

Vague abdominal pain above the belly button
Bloating, belching, flatulence, early satiety
Fullness
Nausea
Vomiting
Heartburn

19
Q

What are the referral criteria for dyspepsia?

A

ALARM

Anaemia 
Loss of weight
Anorexia
Recently changed or new, over 55 
Malaena
20
Q

How do you rule out peptic ulcers in dyspepsia?

A

Persistent gnawing,boring pain from one point in the abdomen

21
Q

How do you rule out cardiovascular problems?

A

Pain radiating to jaw, back and arms

Pain precipitated by exercise and not relieved by antacids

22
Q

When else should dyspepsia be referred?

A

Symptomatic treatment > 4 weeks

Medication ADR

Refuse PPI if due for endoscopy in 14 days

Previous ulcer

Children

Regurgitation

Jaundice

23
Q

What are the OTC products for dyspepsia?

A

Antacids

Alginates - gaviscon suitable in pregnancy

Take after each main meal and at bedtime or when required

24
Q

What are the antacid interactions?

A

Impairs absorption of other drugs, leave 2 hour gap

Tetracyclines, quinolones, bisphosphonates

High sodium content - fluid retention

Damage enteric coatings by increasing stomach pH

25
Q

What are the PPIs used OTC?

A

Omeprazole
Esomeprazole
Pantoprazole

18+, max supply 14 days. Max use 4 weeks

Once daily, swallow whole

Omeprazole interacts with warfarin, phenytoin, clopidogrel

26
Q

What is the advice for dyspepsia?

A 
Stop smoking
Avoid excess alcohol
Caffeine, chocolate
Avoid bending over
Raise head of bed
Weight reduction
27
Q

What are the symptoms of haemorrhoids?

A 
Swollen veins
Protrude into anal canal or prolapses outside anus
Dull pain on defaecation 
Slight rectal bleeding
Perianal itching and burning
Swelling and soreness in perineum
28
Q

When should you refer haemorrhoids?

A 
Blood in stools
Abdominal pain, nausea, vomiting, fever, malaise, loss of appetite
Altered bowel habit
Tenesmus
Severe sharp pain on defaecation 
Symptoms > 3 weeks
Unresponsive > 1 week OTC failure
Constipating medication
29
Q

What are the OTC products used for haemorrhoids?

A

Soothing agents
Mild astringents
Local anaesthetics, 12+
Products with hydrocortisone 18+, avoid in pregnancy/breastfeeding

30
Q

What is the advice for haemorrhoids?

A

Increase dietary fibre
Treat constipation if present
Clean with attention to minor faecal soiling
Pregnancy increases risk of haemorrhoids

31
Q

What are the symptoms of diarrhoea?

A

Frequent, loose water stools

Abdominal cramps
Nausea
Flatulence
Dehydration

32
Q

What are the referral criteria for diarrhoea?

A

Babies < 3 months
< 1 year, diabetic, elderly > 1 day
< 3 years > 2 days

Refer everyone > 3 days
ALARM
Faecal impaction
Recent travel abroad
Severe vomiting, high grade fever
Chronic diarrhoea > 3 weeks
33
Q

What medication needs referral when diarrhoea occurs?

A 
Magnesium antacids
NSAIDs
Iron
Laxatives
Antibiotics 
Digoxin
PPI
Diuretics
SSRI
34
Q

What are the OTC products for diarrhoea?

A

ORT all ages

1-2 sachets after each loose motion

Loperamide 12+, 2 caps after each loose motion maximum 8 in a day
Not recommended in pregnancy or breastfeeding

Kaolin and morphine 12+
Bismuth 16+

35
Q

What is the advice for diarrhoea?

A 
Stay hydrated
Eat plain, bland foods
Babies - dilute formula feeds to quarter strength, more frequently than normal
Avoid drinks with high sugar
Avoid milk
36
Q

What is advice for people travelling abroad with regards to diarrhoea?

A

Drink bottled water
Avoid uncooked fish, meat, poultry
Wash hands regularly and use clean towels

37
Q

What are the symptoms of IBS?

A

Lower abdominal spasms
Bloating
Alternating constipation and diarrhoea

38
Q

When should IBS be referred?

A

Children
> 45 first time symptoms
Blood in stools
Bowel obstruction

ALARM

Pregnant women
Depression

39
Q

What are the OTC products are the antispasmodics used in IBS?

A

Mebeverine 18+
Alverine 12+
Peppermint oil 15+

Swallow capsules whole, irritates mouth and oesophagus
Heartburn

40
Q

What OTC antimuscarinics are used for IBS?

A

Hyoscine 12+
Dicycloverine 12+

Additive anticholinergic effect with antihistamines, TCAs, antipsychotics, avoid in glaucoma and prostatic enlargement

41
Q

What is used for constipation in IBS?

A

Bulk forming

42
Q

What is used for diarrhoea in IBS?

A

Loperamide 18+

43
Q

What is the advice for IBS?

A 
Limit to 3 portions fruit and veg
Increase soluble fibre
Avoid insoluble fibre
Eat regularly and avoid missing meals
8 glasses water
Limit stress
Probiotics

Pre-reg Exam 2021 (79 decks)

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