PH2113 - GI Flashcards
What drugs cause gastric bleeding?
SSRIs, NSAIDs and anti-platlets.
Why do NSAIDs cause gastric bleeding?
COX-1 inhibition disrupts production of prostaglandins and disrupts barrier methods in mucosa.
What are drugs causing dyspepsia?
Anti-biotics, biophosphates, CCBs, corticosteriods, tricyclic anti-depressants, nitrates, theophylline and potassium chloride.
Commonly used medications associated with dyspepsia include aspirin, NSAIDs, corticosteroids, bisphosphonates, iron, selective serotonin reuptake inhibitors, erythromycin, acarbose, metformin, orlistat, potassium (particularly modified-release forms) and nicorandil.
What are alarm symptoms of dyspepsia?
Dysphagia, weight loss, anaemia, persistent vomitting, mass somewhere.
What are signs of constipation?
Not having bowel movement for > 3days to a week. Difficulty with bowel movement, stool is dry hard and lumpy.
What are some lifestyle advice you can give to patients with dyspepsia?
- Avoid eating large meals, especially late at night
- Raise the head of the bed 10-20cm, using blocks rather than pillows (only for patients with nocturnal symptoms)
- Reduce bodyweight if obese
- Tight clothing should not be worn
- Avoid heavy lifting, stooping and bending from the waist
- Avoid fatty or spicy foods, caffeine, mint, chocolate and alcohol
- Discourage smoking
What are antacids?
Most antacids contain aluminium salts, magnesium salts, or both.
Combinations may be preferable to magnesium salts alone (which may cause diarrhoea) or aluminium salts alone (which may cause constipation).
magnesium trisilicate. magnesium hydroxide. magnesium carbonate. - in rennies calcium carbonate. in rennies sodium bicarbonate.
other antacid types:
Bismuth salts: similar to AL and Mg salts. Neutralising acid and coating the gastric mucosa, acting as a mechanical barrier against acid.
Why is Dimeethicone added to some antacids?
- Anti foaming agent used to reduce flatulence
How are Antacids formulated?
Liquids and powders have a higher neutralising capacity than tablets but empty from the stomach quicker than tablets and thus have a shorter duration of action. Tablets should not be swallowed whole but either chewed or sucked to provide a slow but sustained delivery to the stomach.
What should look you out for in patients taking antacids with high sodium content?
Patients with:
- hypertension
- chronic kidney disease
- Heart failure and those on lithium therapy or a salt-restricted diet or pregnant women
- Due to interactions with other drugs, a two-hour gap should be left between antacids and other medicines.
What are H2RA?
- H2-receptor antagonist
Examples:
- Famotidine (Pepcid AC, Pepcid Oral)
- Cimetidine (Tagamet, Tagamet HB)
- Ranitidine (Zantac, Zantac 75, Zantac Efferdose, Zantac injection, and Zantac Syrup)
- Nizatidine Capsules (Axid AR, Axid Capsules, Nizatidine Capsules)
-licensed for the short-term treatment of dyspepsia, indigestion, hyperacidity and heartburn.
What are some restrictions of H2RA use?
- Restricted to use in adults and children over 16 years.
- Not be sold to patients taking NSAIDs or to pregnant or breastfeeding women.
What are PPIs?
Examples: Omperazole Gastro-resistant Capsules Pantoprazole 20mg tablets Esomeprazole (Nexium) - OTC Lansoprazole Rabeprazole -For people aged 18-45 or the relief of reflux-like symptoms. - More effective than antacids o H2RA in reducing dyspeptic symptoms.
When should patients be advised to take PPIs?
- 30 minutes before a meal
- Why? theoretically this will block meal-induced activation of the acid pumps most effectively
What are some interactation or concerns relating to ppi?
-Possible interaction between PPIs and clopidogrel with a consequent loss of antiplatelet protection.
Concerns about PPI:
- Serious hypomagnesaemia with long-term use (low level of magnesium in the blood)
- Increased risk of osteoporosis ( bones become brittle and fragile)in postmenopausal women
- Increased risk of Clostridium difficile infection, particularly in patients receiving antibiotics
- Increased risk of community-acquired pneumonia