OTC GI Flashcards
What is the BMI needed for orlistat to be supplied?
28 or above
When do you refer patients who want orlistat?
Levothyroxine Amiodarone Ciclosporin Warfarin and DOACS Acarbose Anti epileptics
Take caution if oral contraceptives, ADEK vitamin deficiency
What conditions need to be referred if a patient wants orlistat?
Diabetes
Hypertension
High cholesterol
Chronic malabsorption syndrome Cholestasis Pregnancy or breastfeeding Kidney disease Failure to lose weight after 3 months
How do you take orlistat?
1 capsule TDS
Prevents absorption of dietary fat
18+
What is the advice needed for orlistat?
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
What are the symptoms of constipation?
Small hard stools passed less frequently than normal
Straining
Incomplete emptying
Abdominal cramps/bloating
Nausea
When do you refer constipation?
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
What are the OTC products for constipation?
BOSS laxatives
Bulk forming
Osmotic
Stimulant
Stool softeners
What are the bulk forming laxatives OTC?
Isphagula husk 6+
Sterculia 6+
Methylcellulose
2-3 days
Oesophageal or intestinal obstruction
Swallow with water and not immediately before bed
What are the osmotic laxatives used OTC?
Macrogol 12+/2-11 movicol
Lactulose 3 months +
Magnesium sulphate 12+
2-3 days
Discomfort, flatulence, cramps
What are the stimulant laxatives used OTC?
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
What is used otc for pregnant women constipation?
Bulk forming or lactulose
What is the caution for elderly patients with constipation?
Caution recommending bulk forming as risk of obstruction
What is used for children OTC constipation?
Lactulose
What is used for opioid induced constipation otc?
Lactulose and stimulant laxative
Avoid bulk forming
What is the advice for constipation?
Lifestyle advice
What causes dyspepsia?
Indigestion
GORD
Gastritis
Gastric or duodenal ulcers
What are the symptoms of dyspepsia?
Vague abdominal pain above the belly button
Bloating, belching, flatulence, early satiety
Fullness
Nausea
Vomiting
Heartburn
What are the referral criteria for dyspepsia?
ALARM
Anaemia Loss of weight Anorexia Recently changed or new, over 55 Malaena
How do you rule out peptic ulcers in dyspepsia?
Persistent gnawing,boring pain from one point in the abdomen
How do you rule out cardiovascular problems?
Pain radiating to jaw, back and arms
Pain precipitated by exercise and not relieved by antacids
When else should dyspepsia be referred?
Symptomatic treatment > 4 weeks
Medication ADR
Refuse PPI if due for endoscopy in 14 days
Previous ulcer
Children
Regurgitation
Jaundice
What are the OTC products for dyspepsia?
Antacids
Alginates - gaviscon suitable in pregnancy
Take after each main meal and at bedtime or when required
What are the antacid interactions?
Impairs absorption of other drugs, leave 2 hour gap
Tetracyclines, quinolones, bisphosphonates
High sodium content - fluid retention
Damage enteric coatings by increasing stomach pH
What are the PPIs used OTC?
Omeprazole
Esomeprazole
Pantoprazole
18+, max supply 14 days. Max use 4 weeks
Once daily, swallow whole
Omeprazole interacts with warfarin, phenytoin, clopidogrel
What is the advice for dyspepsia?
Stop smoking Avoid excess alcohol Caffeine, chocolate Avoid bending over Raise head of bed Weight reduction
What are the symptoms of haemorrhoids?
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
When should you refer haemorrhoids?
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
What are the OTC products used for haemorrhoids?
Soothing agents
Mild astringents
Local anaesthetics, 12+
Products with hydrocortisone 18+, avoid in pregnancy/breastfeeding
What is the advice for haemorrhoids?
Increase dietary fibre
Treat constipation if present
Clean with attention to minor faecal soiling
Pregnancy increases risk of haemorrhoids
What are the symptoms of diarrhoea?
Frequent, loose water stools
Abdominal cramps
Nausea
Flatulence
Dehydration
What are the referral criteria for diarrhoea?
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
What medication needs referral when diarrhoea occurs?
Magnesium antacids NSAIDs Iron Laxatives Antibiotics Digoxin PPI Diuretics SSRI
What are the OTC products for diarrhoea?
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+
What is the advice for diarrhoea?
Stay hydrated Eat plain, bland foods Babies - dilute formula feeds to quarter strength, more frequently than normal Avoid drinks with high sugar Avoid milk
What is advice for people travelling abroad with regards to diarrhoea?
Drink bottled water
Avoid uncooked fish, meat, poultry
Wash hands regularly and use clean towels
What are the symptoms of IBS?
Lower abdominal spasms
Bloating
Alternating constipation and diarrhoea
When should IBS be referred?
Children
> 45 first time symptoms
Blood in stools
Bowel obstruction
ALARM
Pregnant women
Depression
What are the OTC products are the antispasmodics used in IBS?
Mebeverine 18+
Alverine 12+
Peppermint oil 15+
Swallow capsules whole, irritates mouth and oesophagus
Heartburn
What OTC antimuscarinics are used for IBS?
Hyoscine 12+
Dicycloverine 12+
Additive anticholinergic effect with antihistamines, TCAs, antipsychotics, avoid in glaucoma and prostatic enlargement
What is used for constipation in IBS?
Bulk forming
What is used for diarrhoea in IBS?
Loperamide 18+
What is the advice for IBS?
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
