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Pharmacy year 2 > TREATMENT OF UPPER GI DISEASE > Flashcards

TREATMENT OF UPPER GI DISEASE Flashcards

pharmacy year 2

1
Q

What is dyspepsia?

A

had or difficult digestion
subjective feeling of pain or discomfort located primarily in the upper abdomen

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2
Q

what group of symptoms may indicate disease in the upper GI tract ?

A

feeling full too soon
feeling of discomfort around the abdomen

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3
Q

name a few causes of dyspepsia

A

h-pylori
stress
smoking
alcohol
medicines such as NSAIDS
iron or potassium supplements
fried foods

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4
Q

what are the different types of dyspepsia

A

acute dyspepsia
chronic dyspepsia
invested dyspepsia
uninvestigated dyspepsia

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5
Q

acute dyspepsia

A

every ow and again

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6
Q

chronic dyspepsia

A

a period of more than 4 weeks

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7
Q

investigated dyspepsia

A

use of an endoscope to take pictures
the camera is swallowed by the person and it takes photographs of the inside of the stomach and abdomen

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8
Q

when to investigate?

A

if there are alarm symptoms present
such as dysphagia haematemis
in patients aged 55 years and over with weight loss and upper abdominal pain
reflux
dyspepsia
in people aged 55 years or over with
treatment -resistent dyspepsia
upper abdominal pain with low haemoglobin levels
raised platelet count with any of the following , nausea vomiting weight loss, reflux, dyspepsia upper abdominal pain
nausea and vomiting with any of the following weight loss, reflux, dyspepsia , upper abdominal pain

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8
Q

what is haematemis?

A

throwing up darker blood

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9
Q

what is a barium swallow?

A

when an endoscope cannot be done so liquid full of barium sulphate is used which is radioactive so an x-ray can be done

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10
Q

investigated dyspepsia

A

treat any underlying pathology PUD or malignancy

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11
Q

what is functional idiopathic dyspepsia?

A

many investigations don’t reveal any problems

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12
Q

if there is no known cause of dyspepsia

A

treat and test for H-pylori
offer low dose
offer low dose PPI or H2RA for 4 weeks
if symptoms re-start the PPI over H2RA at lowest dose possible
avoid long-term frequent use of antacids

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13
Q

what is PPI

A

proton pump inhibitor

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14
Q

name examples of proton pump inhibitors

A

omeprazole pantoprazole, lansoprazole, rabeprazole,

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15
Q

which 2 PPI’s are most common

A

omeprazole and lansoprazole

16
Q

which H2RA used to be used but was stopped due to cancer warning?

A

ranitidine

17
Q

name the H2RAs

A

Famotidine, histamine , ranitidine, cimetidine

18
Q

H.pylori testing

A

h.pylori has an enzyme unique to it
blood test to detect h.pylori antigens
stool test-antigens in patients stool

19
Q

uninvestigated dyspepsia

A

offer h.pylori test and treat to people making sure to leave an appropriate wash out period

offer full-dose PPI therapy for 4 weeks

if symptoms return, step down PPI to the lowest dose needed to control symptoms even PRN therapy ?

offer H2RA therapy if there is an inadequate response to a PPI

20
Q

Do antacids/alginates have a role?

A

too much acid in the stomach stop acid from being secreted

20
Q

examples of antacids

A

gaviscon-contains lots of potassium which can causes dehydration
long term- large doses of magnesium causes diarrhoea

antacids can have aluminium which causes constipation

asinine antacid- works straight away doesn’t last very long

Rennie- takes 12hours for it to work

21
Q

causes of GORD

A

Being overweight,
certain drugs can cause gord

22
Q

management of gord

A

routine h.Pylori testing is not required
for proven GORD
Lifestyle advice
a full dose ppi for 4-8 weeks depending on severity
in severe diseases consider a full dose PPI long-term as maintenance step down where possible

if symptoms reoccur after initial treatment , offer a PPI at the lowest possible dose to control symptoms even PRN

in refractory cases a double dose of PPI or the addition of H2RA usually at night to a PPI can be tried on a short-term basis

23
Q

name 3 prokinetic agents

A

metoclopramide
bethanechol
cisapride

24
Q

what are prokinetic agents

A

used to given to increase sphincter pressure

25
Q

what do pro kinetic agents do?

A

increase LOS pressure
stimulate the motility of GI tract without altering gastric acid secretion
ineffective at healing erosive oesophagus
now seldom used in treatment of GORD

26
Q

what is gastro oesophageal reflux disease

A

in the retrograde passage of gastric contents from the stomach into the oesophagus

26
Q

Barrett oesophagus

A

30 times more likely to develop oesophageal cancer

27
Q

symptoms of oesophageal reflux disease

A

include heartburn pyrosis, regurgitation of gastric contents into the throat , early satiety , belching , hiccups and nausea and vomiting

28
Q

what are therapeutic goals?

A

to relieve symptoms promote oesophageal healing and avoid long-term complications

29
Q

safety of long-term PPI use

A

rebound hypersection
osteoporotic fractures
hypomagnesaemia
community and hospital acquired pneumonia

30
Q

drug interactions

A

metabolic drug interactions
enzymes
PPI’s can interact with digoxin and citalopram and escitalopram

31
Q

Clostridium difficile colitis

A

anaerobic bacteria releases bad toxins which release really bad toxins
kept in check by other bacteria in the colon. if good bacteria is destroyed this may cause problems

32
Q

dyspepsia treatment PPI

A

esomeprazole
lansoprazole
omeprazole
pantoprazole
rabeprozole

33
Q

summary

A

dyspepsia and good are relatively common conditions we see in primary care

a number of medications can cause dyspepsia as well as contributing to good
important to think about H.pylori eradication therapy , as well as possible alarm symptoms

the proton pump inhibitors as well as the histamine-2 receptor antagonists are important therapies for these conditions

Pharmacy year 2 (5 decks)

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