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PMP 103 - Clinical Pharmacy > Symptoms In Pharmacy - Gastrointestinal (w20) > Flashcards

Symptoms In Pharmacy - Gastrointestinal (w20) Flashcards

1
Q

What questions should you ask when dealing with a patient who has mouth ulcers ?

A
  • is the ulceration painful ?
  • how many ulcers do you have ?
  • how long have you had the ulcer(s) ?
  • which sites in your mouth are affected ?
  • do you have any concurrent signs or symptoms ?
  • have you recently started any new medicines ?
  • have you had a similar episodes of ulceration previously ?
    If so, how long did the ulcers take to heal ?
    Are you aware of any factors that predispose to your ulcers ?
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2
Q

What is an aphthous minor mouth ulcer (about 80% of cases) ?

A
  • Often in groups of up to five
  • Small ulcers (<1cm)
  • “uncomfortable”
  • Heal within 10-14 days
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3
Q

What if a aphthous major mouth ulcer (about 10% of cases) ?

A
  • Usually 1-3 ulcers
  • Larger than 1cm
  • Painful and may affect eating
  • Can take weeks to heal
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4
Q

What is a herpetiform mouth ulcer (about 10% of cases) ?

A
  • Groups of 10-50 small ulcers
  • Very painful
  • Heal within 10-14 days
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5
Q

What is a traumatic ulcer ?
And how are these typically caused ?

A
  • usually a single, irregularly shaped ulcer.

caused by :
- burn- hot/ cold/ chemical
- biting lining of mouth
- sharp surface of tooth/denture

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6
Q

What can cause mouth ulcers ?

A
  • Iron deficiency anaemia
    Vegetarian/vegan diet often implicated
    Heavy menstrual loss
  • Hypersensitivity
    Preservatives in food (benzoic acid/benzoates)
    Foods (chocolate, tomatoes)
    Sodium lauryl sulfate
  • Psychological stress
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7
Q

What are some treatments given to patients with mouth ulcers ?

A

Saline
Half a teaspoon of salt in a glass of warm water
Rinse frequently until ulcers subside
Any age

Antiseptic (chlorhexidine)
Rinse (or spray) twice a day
Not within 30 minutes of toothpaste
Can cause temporary yellow staining of teeth
Can be used OTC from age 12

Anti-inflammatory (benzydamine)
Use every 1.5-3 hours
Can be used OTC from age 6

Steroid (hydrocortisone)
One tablet dissolved on ulcer four times a day
Can be used OTC from age12

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8
Q

When do you refer a patient with a mouth ulcer ?

A
  • if it lasts longer than 3 weeks.
  • keeps coming back.
  • painless and persistent.
  • grows bigger than usual.
  • at back of throat.
  • bleeds or gets red and painful.
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9
Q

What is dyspepsia ?

A

A complex of upper gastrointestinal tract symptoms typically present for 4 or more weeks

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10
Q

What are the symptoms of dyspepsia ?

A

Symptoms
- Severity varies from patient to patient (most: mild + intermittent)
- Upper abdominal pain or discomfort
- Burning sensation starting in stomach, passing upwards to behind the breastbone
- Gastric acid reflux
- Nausea or vomiting

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11
Q

List the common causes of dyspepsia …

A
  • Gastro-oesophageal reflux disease (GORD)
  • Peptic ulcer disease (gastric or duodenal ulcers)
  • Functional dyspepsia
    Epigastric Pain Syndrome
    Post-prandial distress syndrome (fullness and early satiety)
  • Barrett’s oesophagus
    A premalignant condition
  • Upper GI malignancy
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12
Q

What mechanisms cause gastric-oesophageal reflux disease (GORD) ?

A

Caused be a range of mechanisms:
1) Transient relaxation of lower oesophageal sphincter
2) Increased intra-gastric pressure
3) Delayed gastric emptying
4) Impaired oesophageal clearance of acid

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13
Q

What are some triggers/ risk factors of GORD ?

A
  • Smoking
  • Alcohol
  • Coffee
  • Chocolate
  • Fatty foods
  • Being overweight
  • Stress
  • Medicines (calcium channel blockers, nitrates, NSAIDs)
  • Tight clothing
  • Pregnancy
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14
Q

What causes Peptic ulcer disease (PUD) ?

A
  • Helicobacter pylori infection
  • Medication, mainly NSAIDs (others can cause them)
  • Zollinger-Ellison syndrome (rare condition causing high acid secretion)
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15
Q

How is dyspepsia managed ?
Give some options for management ….

A
  • Most patients have mild or intermittent symptoms which may be managed through non-pharmacological means and OTC treatments

Options :
- Non-pharmacological
- Antacids
- Alginates
- H2 receptor antagonists
- Proton pump inhibitors

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16
Q

What are non-pharmacological treatments to treat dyspepsia ?

A
  • Lose weight if overweight
  • Eating small, frequent meals rather than large meals
  • Eat several hours before bedtime
  • Cut down on tea/coffee/cola/alcohol
  • Avoid triggers, e.g. rich/spicy/fatty foods
  • If symptoms worse when lying down, raise head of bed (do not prop up head with pillows)
  • Avoid tight waistbands and belts, or tight clothing
  • Stop smoking
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17
Q

What are antacids ?
(Used in treatment of dyspepsia)

A

Compound that neutralise stomach acid
E.g. sodium bicarbonate, calcium carbonate, magnesium hydroxide

18
Q

What’s are alginates ?
(Used in treatment of dyspepsia)

A

They form a ‘raft’ on top of stomach contents, creating a physical barrier to prevent reflux
Example: sodium alginate
Usually contain sodium bicarbonate to help ‘raft’ to float to top of stomach

19
Q

What is the point of H2 receptor antagonists ?

A
  • Longer duration of action and longer onset of action than antacids
  • Block H2 receptors in stomach to prevent acid production
  • For the short-term symptomatic relief of dyspepsia
  • Also to prevent symptoms arising if associated with food or drink consumption when they cause sleep disturbances
20
Q

Esomepraole is a proton pump inhibitor (PPI) what is its function ?

A
  • PPIs block proton pumps in stomach wall to prevent gastric acid production
  • Takes 1-4 days to work fully, so may need to cover with antacids until it kicks in
21
Q

When to refer patients with dyspepsia >?

A

Beware of patients frequently attending for dyspepsia remedies
Dyspepsia remedies may mask signs of gastric cancer

22
Q

What’s red flag signs of dyspepsia ?

A

55 -years or over, especially with new onset
Dyspepsia hasn’t responded to treatment
Features including bleeding, dysphagia, recurrent vomiting or unintentional weight loss

23
Q

What are three associated symptoms to nausea and vomiting ?

A
  • diarrhoea – may be gastroenteritis, question about food intake, could be rotavirus in children
  • blood in vomit – differentiate fresh blood from that of gastric/duodenal origin
    -faecal smell – GI tract obstruction
24
Q

What are some medications given to patients with nausea/ vomiting ?

A

Medication: opioids, NSAIDs/aspirin, antibiotics, oestrogens, steroids, digoxin, lithium, etc.

25
Q

How can you help identify constipation ?

A
  • bowel movement less than three times a week
  • difficult to pass stools
  • hard, dehydrated stools
26
Q

Who is mainly affected by constipation ?

A
  • women and older people (esp. >70yrs) more frequently affected
27
Q

What are some symptoms of constipation ?

A
  • abdominal discomfort
  • cramping
  • bloating
  • nausea
  • straining
28
Q

What are some red flags symptoms of constipation which may lead to referral ?

A
  • unexplained weight loss
  • rectal bleeding
  • family history of colon cancer or inflammatory bowel disease
  • signs of obstruction
  • co-existing diarrhoea
  • long-term laxative use
  • failed OTC > 1 week
29
Q

What are some medications that can cause constipation ?

A

Opioid analgesics
Antacids – aluminium
Antimuscarinics (anticholinergics)
Anti-epileptics
Anti-depressants
Anti-histamines
Anti-psychotics
Parkinson’s medication
Calcium-channel blockers
Calcium supplements
Diuretics
Iron
Laxatives (!)

30
Q

What are some non-pharmacological treatment options fro constipation ?

A
  • increase fibre intake
  • increase fluid intake
  • increase exercise
31
Q

What are some pharmacological treatment options for constipation ?

A
  • bulk forming e.g. methylcellulose, ispaghula husk
  • osmotic e.g. lactulose, macrogols
  • stimulates e.g. senna, glycerin, bisacodyl
  • faecal softener
32
Q

What is classed as chronic diarrhoea ?

A

Symptoms more than 4 weeks

33
Q

What is acute diarrhoea ?

A

When symptoms last less than 14 days

34
Q

What is persistent diarrhoea ?

A

Symptoms last more than 14 days

35
Q

What are some symptoms of diarrhoea ?

A
  • Three or more lose, watery stools in 24 hours
  • Faecal urgency
  • Abdominal cramps
  • Abdominal pain
  • +/- nausea and vomiting
36
Q

What are some treatment options for diarrhoea ?

A
  • oral re-hydration therapy e.g. dioralyte (first lien of therapy even when referring)
  • loperamide e.g. Imodium - 12 + only
  • kaolin +/- morphine
37
Q

When do you refer a patient with diarrhoea ?

A
  • Duration longer than:
    1 day in < 1year old
    2 days in < 3 year old or in older adults
    3 days in older children and adults
  • Pregnancy
  • Severe vomiting
  • Fever
  • Blood or mucous in stools
  • Suspected reaction to prescribed medicine
  • Suspected outbreak of “food poisoning”
  • Recent foreign travel
  • Persistent diarrhoea following antibiotic treatment
38
Q

What are heamorrhoids ?

A

Haemorrhoids are clusters of vascular tissue, smooth muscle and connective tissue arranged in three columns along the anal canal​

39
Q

What risk factors are there surrounding haemorrhoids ?

A
  • Constipation and poor diet
  • Increased incidence between ages 45-65yrs
  • Pregnancy
  • Heavy lifting
  • Chronic cough
  • Certain toilet behaviours, such as straining or spending more time on a seated toilet than on a squat toilet
40
Q

What are symptoms of internal and external haemorrhoids ?

A

External haemorrhoids
lumps and bumps around the anus
itchy (irritation from faecal matter not being fully removed by wiping)
not usually painful unless severely swollen

Internal haemorrhoids
discomfort/pain
feeling of fullness in rectum
when prolapsed, itchy and irritating
not usually painful unless prolapsed and strangulated

Both may bleed (especially after passing stools)

41
Q

What is the treatment for haemorrhoids ?

A

Usually self-limiting and heal within a week or so
Life-style measure in relation to diet and fluid intake
Analgesia as needed

Topical preparation may contain astringents, local anaesthetics, corticosteroids or a combination
Can be internal (creams, suppositories) or external (creams, gels, ointments)

PMP 103 - Clinical Pharmacy (24 decks)

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