PPT

Question 1

Definitive investigation and treatment for Upper GI bleed

Answer 1

OGD - Upper GI endoscopy

Question 2

What score is used to work out whether endoscopic intervention is needed

Answer 2

Blatchford score

Blood urea
Hb
Systolic BP
Melaena, syncope, hepatic disease,HF

Question 3

Acute upper GI bleed treatment

Answer 3

IV fluids

Blood transfusion

Question 4

What reduces the rate of bleeding in someone with an active upper GI bleed (bleeding ulcers)

Answer 4

PPI - Pantoprazole

Suppresses gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump.

Question 5

Risk factors for bleeding peptic ulcers

Answer 5

H pylori
NSAIDS
Physiologic stress
Excess gastric acid

Question 6

How do NSAIDS cause ulcers

Answer 6

Mucosal damage

Due to inhibition of COX1 -> reduced production of protective PGE2 (prostaglandin)

Question 7

Why is celecoxib (selective COX2 inhibitor) not used?

Answer 7

Serious risk of CV disease

Question 8

Triple therapy for H pylori eradication

Answer 8

Lansoprazole
Clarithromycin
Metronidazole

Question 9

Contraindication: Simvastatin and claruthromycin

Answer 9

Increased risk of rabdo

Question 10

Avoid alcohol with…

Answer 10

Metronidazole

Question 11

What is the initial definitive investigation for UC

Answer 11

Flexible sigmoidoscopy and biopsy

Question 12

Management of acute UC

Answer 12

Oral mesalazine (5ASA) or oral steroid
Rectal mesalazine or steroid
IV steroids
Broad sprectrum ABX
LMWH

Question 13

Long term steroid use complications

Answer 13

Cushing’s syndrome

Question 14

Why do we gradually reduce steroids

Answer 14

To avoid an Addisonian crisis

Question 15

Infliximab MOA

Answer 15

Monoclonal Ab
Inhibits TNFalpha activity
Reduces inflammation (in Crohns and UC)

Question 16

Perioperative pain comes from

Answer 16

Inflammation caused by tissue trauma (i.e., surgical incision, dissection, burns) or direct nerve injury (i.e., nerve transection, stretching, or compression)

Question 17

Side effects of opioids

Answer 17

Somnolence
Respiratory depression
Hypotension
Urinary retention
NandV (stimulation of CTZ)

Question 18

Opioids can cause histamine release.. what are the effects of this

Answer 18

Flushing, tachycardia, hypotension, pruritus, and bronchospasm.

Question 19

Antagonist of opioids

Answer 19

Naloxone (Reversible Competitive antagonist)

Question 20

How to treat opioid induced constipation

Answer 20

Methylnaltrexone (opioid antagonist)

Question 21

If there is concern over breakthrough pain then what can you add?

Answer 21

IV opiate

Question 22

What is the main anti-emetic used in PONV (Post op NandV)

Answer 22

Ondansetron (Serotonin antagonist)

Does not have sedative effect

Note: chronic use can cause constipation then leading to potential nausea

Question 23

Alternative treatments for PONV

Answer 23

Anticholinergics – Hyoscine (Sedative effect)
Glucocorticoids (prophylaxis) – dexamethasone -
Antihistamines – cyclizine (H1 antagonist)

Question 24

Dopamine receptor antagonists

Prochlorperazine and Metoclopramide side effects

Answer 24

Hypotension

Extrapyramidal SE

Question 25

Treatment of acute dystonic reaction

Answer 25

Procyclidine (if its doesnt work consider diazepam)

Question 26

Drugs that can cause constipation

Answer 26

``` Opioids Anticholinergic drugs Tricyclic antidepressants Antihistamines Neuroleptic drugs Antispasmodics ```

Question 27

Suportive intervention for bowel obstruction

Answer 27

IV fluids and anti-emetics

Question 28

Opioid constipation via

Answer 28

Delayed gastric emptying

Question 29

Volume distribution calculation

Answer 29

Amount of drug in body/Plasma concentration of drug EXAMPLE: Drugs A given as 100mg IV bolus Measured plasma concentrations are 10mg/L The corresponding Vd would be 10L (100/10=10L)

Question 30

What is anastrozole

Answer 30

Aromatase inhibitor

Question 31

Anastrozole side effects

Answer 31

hot flushes, vaginal dryness, vaginal bleeding, hair thinning, anorexia, nausea, vomiting, diarrhoea, headache, arthralgia, arthritis, bone fractures, bone pain, rash

Question 32

Tamoxifen MOA

Answer 32

Oestrogen receptor antagonist

Question 33

Tamoxifen interactions

Answer 33

SSRIs (Fluoxetine, Paroxetine) - Inhibits tamoxifen metabolism Warfarin - Tamoxifen inhibits CYP3A4 (increased risk of bleeding)

Question 34

Treatment of Acute lymphoblastic leukaemia (Hyper CVAD)

Answer 34

Cyclophosphamide Vincristine Doxorubicin Dexamethasone

Question 35

Cyclophosphamide MOA

Answer 35

Alkylating agent Cause intrastrand crosslinking -> present DNA synthesis

Question 36

Side effects of chemo

Answer 36

Impaired fertility Bone marrow suppression (neutropaenia) Development of other malignancies

Question 37

Vincristine (Vinca alkaloids) MOA

Answer 37

Miotic inhibitors

Question 38

Doxorubicin side effect

Answer 38

Cardiotoxic - Dilated cardiomyopathy

Question 39

Methotrexate MOA

Answer 39

Folic acid antagonist

Question 40

Methotrexate used in

Answer 40

DMARD - RA, psoriasis, lupus | Abortion

Question 41

How is methotrexate excreted and how is it monitored

Answer 41

Excreted renally Monitoring via LFTs (hepatotoxic), UnE, FBC (platelet count as can affect)

Question 42

Consequences of Chemo

Answer 42

Gastrointestinal tract – Diarrhoea, sore mouth, nausea and vomiting Bone marrow – Myelosuppression; can lead to anaemia, neutropenia and thrombocytopenia Loss of hair Reproductivity – can affect both men and women Tumour Lysis syndrome – Rapid breakdown of malignant cells can cause hyperuricaemia, hyperkalaemia, hypophosphataemia, hypocalcaemia with consequent renal damage / arrhythmias.

Question 43

Anti-metabolite examples

Answer 43

6 mercaptopurine 5-fluorouracil Capecitabine MOA - interferes with DN synthesis

Question 44

Which chemo drug is mainly used for solid tumours

Answer 44

Cisplatin Carboplatin Ovarian and lung tumours Side effect: Ototoxic, nephrotoxic, peripheral neuropathy and myelosuppresion