Pooping Flashcards
Drugs causing diarrhoea
Anti virals, bacterial, fungal (capsofungin), antimalarial
Anti psychotic
Metformin
Ace inhibitors and ARB-I
Antacids
Alpha blockers
NSAIDs, cytokine blockers, ulcer healing meds
Use of opioids?
Treat diarrhoea, particularly when uncontrolled or w stoma
Best drug to treat diarrhoea where there is visceral pain and intestinal fluids
Avoid in whom?
Linaclotide guanylate Cyclase C receptor agonist
Avoid in obstruction
Anti motility drugs?
Avoid in dysentery
Loperamide
Avoid
What are synthetic opioids?
Careful with?
Atropine
Careful w dependence issues
Avoid co prescribing w MAO-I
Causes of constipation
Anti-viral, psychotics, cholinergics, epileptics
Antacids
Biphosphonates Beta blockers Opioids NSAIDs Calcium channel blockers
Patient with hepatic encephalopathy who is constipated?
Osmotic laxative- lactulose
Constipated patient w fecal haemorrhoids, avoid what?
Avoid rectal prescription of fecal softener (docusate)
Patient with constipation and suspected bowel obstruction- avoid what?
Bulk forming laxatives
What are the simulant laxatives?
Bisocydol, senna
FODMAP=?
Fermentable oligosaccharides disaccharides, monosaccharides and polyols
Limit this w issues of over activity of bowel
Dietary recommendation to reduce diarrhoea frequency
Increase fibre- non fermenting fibre, psyllium e.g.
Smoking and IBD?
Bad for UC
Good for Crohns
What key questions would you ask in a IBD Hx?
Genetics: 15% patients have first degreee relative w condition Anti microbial or NSAIDs can exacerbate Loss of intestinal flora Stress? Smoking Infection and UC symptoms
Pathological feature of UC?
Loss of haustra Depleted goblet cells Cryptic abscesses Distorted atrophic glandular architecture Uniformly heavy lymphocytic infiltrate No granulomas Thickened muscularis mucosa
Pathological features of crohns ?
Normal goblet cells Scanty crypt abscesses Preserved glandular architecture Patchy, heavy in places,. Lymphocytic infiltrate Granulomas Normal muscularis mucosae Lots of submucosal inflammation
Drug therapy options for IBD?
Why is the route of administration important?
Aminoacylates
Immunosuppression- azathioprine
Immunomodulators-MABs
Antibiotics
Minimisé systemic absorption and maximise intestinal absorption
Drugs be mindful to prescribe by brand?
Amino salicylates
Immunosuppressants
Thioguanines; azothioprine; methotrexate; cyclosporate; mycophenolate
Use in those non reps nice to steroids of amino salicylates
What are Thioguanines?
Side effects
Caution
Immunosuppressants - azathioprine or 6-mercaptopurine
Métabolised on the liver to the active
Inhibit purine synthesis
Hepatotoxic
Pancreatitis
immunosuppressive , so avoid active vaccines
Methotrexate
Prescribing points
Induce or maintain remission esp in Crohns
Inhibits DHFR
GI related SE, hepatotoxic
Prescribe every week but not on day you co prescribe with folic acid
Avoid active vaccines
Biological agents for IBD
Target B and T
iL1 and TNF
Drug likely to be cause of Peptic ulcer
NSAIDs
Treating Peptic ulcer disease (H Pyolori -)
Endoscopy to ID high risk patients (active bleeding,. Adhérent clôt)
Adrenaline with human thrombin and fibrin flue
Acid suppression with ppi
Check medications patient might be taking for interaction, like clopidogrel or omeprazole
