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### > Week 11: GI OTC > Flashcards

Week 11: GI OTC Flashcards

1
Q

What are the red flag symptoms of the chest? (10)

A

Chest Pain
SOB
Wheezing
Swollen Ankles
Blood in sputum
Palpitations
Persistent Cough
Whooping Cough
Croup
Sputum mucoid, coloured?

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2
Q

What are the red flag symptoms for the gut? (6)

A

Difficulty swallowing
Blood in vomit
Bloody diarrhoea
Vomiting with constipation
Weight loss
Sustained alteration of bowel habit.

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3
Q

What are the red flag symptoms of the eyes? (3)

A

Painful red eye
Loss of vision
Double vision

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4
Q

What are the red flags symptoms for the ear? (6)

A

Pain
Discharge
Deafness
Irritation
Tinnitus
Vertigo

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5
Q

What are the red flags symptoms of the genitourinary? (6)

A

Difficulty in passing urine.
Blood in urine.
Abdominal/loin/back pain with cystitis.
Urethral discharge
Vaginal discharge
Vaginal bleeding in pregnancy.

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6
Q

What other red flag symptoms do you need to consider? (3)

A

Neck Stiffness
Rigidity with temp.
Persistent Vomiting

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7
Q

What other factors do you need to consider? (6)

A

Drug Interactions
Contraindications
Px’s Age
License restrictions
Legal Issues
Confidentiality

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8
Q

What Qs do you need to ask for px’s presenting with abdominal pain? (7)

A

Where is the pain?
When did it start?
Is it constant/intermittent?
Has it moved +/or spread?
Have you had it before?
Is the area tender?
Have you taken anything which helps?

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9
Q

What symptoms would be considered as a referral in patients presenting with abdominal pain? (8)

A

Continuous severe pain lasting > 1hr.
Mild/moderate lasting intermittent for 7 days.
Swelling - ass. with hernias.
Over 45yrs v 55yrs and suffering persistent dyspepsia.
Recent unexplained weight loss.
Vomiting/constipation/diarrhoea + persistent abdomen.
Blood in vomit/stools (red/coffee grounds)
Ab. pain + chronic back pain

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10
Q

What symptoms would be considered as a referral in babies presenting with abdominal pain? (3)

A

Projectile vomiting
Constipation
Diarrhoea
(Gastroenteritis)

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11
Q

What medication(s) can cause gastric pain? (1)

A

NSAIDs

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12
Q

What medication(s) can cause constipation? (3)

A

Opioids
TCAs
Iron

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13
Q

What medication(s) can cause oesophageal ulceration? (3)

A

KCl
Alendronic Acid
Doxycycline

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14
Q

What are the main causes of oral thrush? (6)

A

Antibiotic therapy
Diabetes
Pregnancy
Immunocompromised
Ill-fitting dentures
ICS

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15
Q

What are the symptoms of oral thrush? (3)

A

White raised patches
Tendency to bleed
Painful (baby refusing to feed, ass. with nappy rash)

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16
Q

What are the treatment options available for oral thrush? (3)

A

Antifungals:
- Miconazole 20mg/g (Daktarin Oral Gel)
- Tx from 4 months
- Dose age related

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17
Q

What counselling points should be given to patients taking antifungal treatment for oral thrush? (4)

A

Maintain good oral hygiene.
Apply after food
Keep in mouth for as long as possible before swallowing.
Continue tx for 7 days after symptoms.

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17
Q

Which patients need referral when they present with oral thrush? (2)

A

Pregnant
Breastfeeding

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17
Q

Which drugs are contraindicated with Miconazole? (3)

A

Warfarin
Sulphonylureas
Phenytoin

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18
Q

What are the main causes of mouth ulcers? (6)

A

Deficiency? Vit. B, Folic Acid
Stress
Physical Illness (CD, IBD)
Nutrition
Trauma
Carcinoma

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19
Q
A
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20
Q

What are the common symptoms for mouth ulcers? (4)

A

Shallow yellow/white ulcers on tongue, cheek and lip mucosa.
Painful, can look swollen
Single/in clusters
Can be recurrent

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21
Q

What are the available treatment options for mouth ulcers? (4)

A

Topical local anaesthetics/analgesics: Anbesol liquid, bonjela, iglu pastilles (limited use, short duration of action, taken after food)

Antiseptic mouth washes: Chlorhexidine (Corsodyl mouthwash) - reduces risk of secondary infection + accelerates healing process.

Topical local anti-inflammatory/analgesics:
Benzydamine HCl (Difflam Oral Rinse) - can numb +/or sting, dilute with equal amount of water if stings. Use every 1.5 to 3hrs prn, max 7 days. Not to be used on children < 13 yrs.

Hydrocortisone 2.5mg Muco-adhesive buccal tablets:
Reduces inflammation and ulcer size, used only in prev. diagnosed ulceration. > 12 yrs only. Keep in mouth and allow to dissolve slowly close to the ulcers QDS.

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22
Q

When would it be appropriate to refer a patient with mouth ulcers? (6)

A

Recurrent ulcers
Ulcer > 3 weeks old
Pregnant
Breastfeeding
Diabetes
Ulcers due to infection

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23
Q

What are the common symptoms of oral cancer? (3)

A

White patch +/or red patches on gums, tongue, mouth lining.

Small sore that looks like a common mouth ulcer that fails to heal.

Lump/mass that can be felt on the lip/mouth/throat.

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24
Q

What is dyspepsia also known for? (3)

A

Indigestion
Heartburn
Trapped Wind

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25
Q

What are the common causes for dyspepsia? (9)

A

Hurried meals
Overindulgence
Spicy food
Smoking
Overweight
Pregnancy
Medication (NSAIDs, Digoxin, Iron)
HF
H. Pylori

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26
Q

What are the common symptoms of indigestion? (5)

A

Epigastric discomfort shortly after eating/drinking.
Felling of fullness
Heartburn
Trapped wind
N+V

27
Q

What are the treatment options for indigestion? (9)

A

Antacids:
- Mg Salts (Milk of Magnesia) = can cause diarrhoea.
- Al Salts (now only in combo. products) = can cause constipation.
- Bismuth salts (Pepto-Bismol) = supply issues (UK), avoid if aspirin sensitive, avoid if pregnant, unsuitable < 16yrs
- Co-magaldrox (combo. prep.)

Activated Simeticone:
- Antifoaming agent
- Refuces surface tension of gas bubbles (Windsetlers)

Alginates:
- Useful to treat acid reflux
- ‘raft’ effect
- Usually in combo. with antacid(s)
- Gaviscon/Peptac

28
Q

What drugs can interact with antacids? (8)

A

Digoxin
Enteric coated tablets
Lithium (serum level reduced by NaHCO3-)
Tetracyclines
Warfarin
Iron
Alendronic Acid

(Avoid concomitant administration 2-4 hrs either side of dose.)

29
Q

What is the treatment option for indigestion? (4)

A

PPI:
Omeprazole 20mg OD:
- no improvement after 2 weeks = refer
- Can use for up to 4 weeks at 10mg dose
- use at lowest effective dose
- Available as GSL (esomeprazole)

30
Q

What counselling should you give to patients presenting with indigestion? (7)

A

Small regular meals.
Avoid meals late at night.
Avoid highly spiced foods
Avoid bending/stooping.
Don’t wear tight clothing.
Raise the head of the bed.
Take antacid about 1 hr after food.

31
Q

When would you need to refer a patient presenting with indigestion? (8)

A

1st time dyspepsia 45+ (GP referral)

Endoscopy Referral:
> 55yrs and with:
- Persistent vomiting
- Appetite Loss
- Difficulty Swallowing
- Feeling lump in throat
- GI bleeding

32
Q

What are the common causes of IBS? (3)

A

Emotion/stress
Food intolerance
Disturbance to normal bowel movement.

33
Q

Which patients are most likely to suffer from IBS? (3)

A

F>M
Adolescence
Young Adults

34
Q

What are the colonic symptoms of IBS? (5)

A

Young adults:
- bloating
- alt. diarrhoea/constipation
- Ab. pain

Rectal fullness
Incomplete Evacuation

35
Q

What are the non-colonic symptoms of IBS? (3)

A

Nausea
Back Pain
Urinary Frequency/urgency

36
Q

What do you need to consider before offering IBS treatment? (1)

A

Only offer IBS tx OTC if the condition has been previously diagnosed by a Dr.

37
Q

What are the major symptoms that indicate IBS? (3)

A

Ab. bloating
Diarrhoea OR Constipation

38
Q

What are the treatment options for IBS? (10)

A

Anti-spasmodic:
- Intestinal smooth muscle relaxants.
- C/i in paralytic ileus
- Mebeverine (Colofac IBS)
- Hyoscine Butylbromide (Buscopan IBS)
- Peppermint Oil (Colpermin = contains arachis oil)

Anti-diarrhoeal:
- Loperamide (Imodium)
- Decreases bowel motility
- Reduces stool frequency + urgency.
- Poor penetration of blood/brain barrier.

Bulking agent:
- Improves constipation + diarrhoea.
- Ispaghula husk (Senokot High Fibre)

39
Q

What counselling points should be given to patient presenting with IBS? (6)

A

Food diary - identify triggers.
Ask if taking other medicines.
Try not to rush meals.
Eat balanced diet and plenty fluids.
Take regular exercise.
Relaxation.

40
Q

When would you refer a patient presenting with IBS? (5)

A

Persistent symptoms > 2 weeks despire tx or if symptoms have changed.
Bloody stools
Not had IBS diagnosed by Dr.
Fever
Unexplained weight loss.

41
Q

What are the causes of constipation? (11)

A

Change in lifestyle
Change in eating habits
Reduced fluid intake
Lack of exercise
Medication (e.g. Iron)
Depression
IBS
Anal Fissures
Haemorrhoids
Pregnancy
Refusal to obey urge to pass stool.

42
Q

What are the symptoms of constipation? (4)

A

Decreased bowel movement frequency.
Hard stools
Straining

(What is their normal bowel habit?)

43
Q

What are the treatment options available for constipation? (6)

A

1st line: Alter diet + lifestyle + increase fluids.

2nd line: Bulk-forming laxatives (Ispaghula Husk)
- Closest to natural process.
- Slow Action (24-72hrs)
- Take with plenty of H2O.
- Not taken at bedtime.
- Not for elderly/bed bound
- Can alter medication absorption.

3rd line: Stimulant Laxatives:
- Stimulates nerve endings in the bowel wall.
- Anthraquinones (Senokit, Ex-lax) = Acts within 8-12 hrs.
- Diphenylmethane derivates (Bisacodyl = Dulcolax tablets + supps, Sodium picosulphate = Dulcolax-pico, Dulcolax perles)

4th line: Osmotic Laxatives:
- Retain fluid in the bowel = stimulating peristalsis and forming a loose stool
- More powerful than the bulk laxatives
- Magnesium salts: magnesium sulphate (EpsomSalts);magnesium hydroxide (Milk of Magnesia)
- effective within 3 hrs

Lactulose/macrogol (polyethyleneglycol’3350’)
- longer action; up to 72hrs of regular dosing
- sweet tasting
- C/I in patients’ lactose/galactose intolerant
- use with caution in diabetes

5th line: Glycerol (Glycerin Supps. 1g, 2g, 4g)
- 1-2 hrs effect

6th Line: Faecal softeners (Docusate sodium = Dioctyl caps)
- Little if straining required.
- Effect within 1-3 days.

44
Q

What precautions do you need to consider when giving laxatives to a px? (2)

A

Babies and children < 14yrs can take lactulose if their doctor recommends it.

Don’t give lactulose to a child < 14 yrs unless their doctor has said it’s ok.

45
Q

What are the restrictions associated with laxatives? (3)

A

GSL = 18+, P = 12+

Pack sizes = standard strength (pack of 20), max. strength tabs (pack of 10) and syrups (pack size of 100ml)

For short term occasional relief only.

46
Q

What type of laxative(s) is appropriate/inappropriate for pregnant px suffering from constipation? (3)

A

Osmotic/bulk-forming = safe
Stimulant = C/I

47
Q

What type of laxative(s) is appropriate/inappropriate for breastfeeding px suffering from constipation? (1)

A

Stimulant laxative = c/i

48
Q

What counselling points should be given to babies who are suffering from constipation? (2)

A

Breast-fed: may need extra water from bottle.

Bottle-fed: are they making feed with sufficient water.

49
Q

What counselling points in given to elderly px suffering from constipation? (2)

A

Increase fluids = dehydration
Bulk laxatives = care in bed bound / inactive px.

50
Q

What are the symptoms that indicate referral when px is suffering from constipation? (10)

A

Constipation +:
- Illness + unable to work
- Children/babies who show ill symptoms.
- Blood in stools
- Continuous severe pain
- Weight loss
- Diarrhoea *unless diagnosed with IBS
- Self-medication ineffective after 4-5 days.
- Fever/night sweats
- N+V

51
Q

What are haemorrhoids? (1)

A

Varicose vein dilatations in the lower part of the large intestine +/or anus.

52
Q

What are the causes of haemorrhoids? (7)

A

Anal infections - STI/Scratching
Sports e.g. cycling (sitting in the same position)
Pregnancy
Constipation
Pelvic area lesions
Laxative abuse

53
Q

What are the symptoms of haemorrhoids? (4)

A

Itching in the ‘down there’ region.
Can be painful
Sharp pain on defaecation.
Bright red blood on stool + toilet paper.

54
Q

What factors can contribute to developing haemorrhoids? (5)

A

Increased in intra-abdominal pressure.
Elderly
Dehydration
Low fibre intake
Medicines

55
Q

What are the treatment options for Haemorrhoids? (9)

A

1st line: Topical Prep (Creams/Ointments/Suppositories)
- Anusol
- Preparation H
- Germoloids

2nd line: Hydrocortisone
- No more than 7 days
- Not used in pregnancy/BF
- Adults > 18yrs only
- Not used if broken skin/infection

56
Q

What counselling points should you give to patients presenting with haemorrhoids? (6)

A

Hygiene
Diet
Don’t scratch area
Avoid straining
Increase activity
Laxatives (faecal softeners)

57
Q

What symptoms would consider a referral for patient presenting with haemorrhoids? (5)

A

> 3 weeks
Internal anal pain
Rectal bleeding
Suspected drug-induced constipation
Recurrent piles (regular recurrence)

58
Q

What are the common causes of nausea + vomiting? (7)

A

Viral/Bacteria/Bacterial toxins
Inner ear disorders
Migraine
Motion sickness
Meningitis
Medications - Digoxin, theophylline, NSAIDs
Pregnancy

59
Q

What counselling should be given to patient presenting with N + V? (4)

A

Ensure px doesn’t become dehydrated = offer electrolyte replacement.
Sip water little + often.
Avoid dairy products + greasy foods for 24 hrs.
Re-introduce light diet when hungry.

60
Q

What treatment options/counselling should be given to pregnancy px presenting with N+V? (3)

A

Frequent small meals
Ginger
Sea-bands

61
Q

What px symptoms would indicate referral when presenting with N+V? (8)

A

Projectile vomiting (babies/adults)
Bloody vomit
Vomiting ass. with weight loss.
Babies < 12 months + symptoms for 24hrs
Children <3 yrs/
Elderly
Symptoms for 48 hrs
Diabetic px (if persistent)

62
Q

What are the common symptoms of diarrhoea? (2)

A

Increased frequency
Change in frequency

63
Q

What are the common causes of diarrhoea? (6)

A

Bacterial/Viral
Diet changes/overindulgence
Medication
Food allergies
Secondary to medical condition (e.g. diabetes, hyperthyroidism, IBS)
Stress

64
Q

What are the treatment options for diarrhoea? (16)

A

1st line: Usually self-limiting
- Maintain fluid intake
- Oral rehydration sachets (Dioralyte)
- Mix with recommended amount of water
- Keep for 1hr or 24 hrs in the fridge
- Sip little + often

2nd line: Anti-diarrhoeals
- Loperamide (Imodium caps)
- Decreased bowel motility
- Adults + children > 12 yrs

3rd line: Morphine-containing products (Kaolin + Morphine; Diocalm)
- Used with adsorbent
- Dependence issue
- Not recommended

4th Line: Bismuth Salicylate (Pepto-Bismol)
- C/i if allergic to aspirin

65
Q

What counselling points are given to patients presenting with diarrhoea? (3)

A

Ensure high fluid intake.

If recommending OTC product, emphasise how to take correctly.

If symptoms don’t improve after OTC tx or symptoms worsen - see GP.

66
Q

What main counselling point is given to babies suffering from diarrhoea? (1)

A

Ensure bottle is properly sterilised + making feeds properly.

67
Q

What symptoms would indicate referral when px present with diarrhoea? (12)

A

Elderly: Persistent symptoms for 48 hrs

Refer if:
- Chronic/Recurrent Diarrhoea
- Fatigue/pain lasting > 2 days

Refer ALL px if:
- Weight loss
- Bloody stool
- Persistent mucous in stool
- Symptom change/worsens
- Alt. diarrhoea/constipation

< 12 months+ symptoms > 24hrs
<3 yrs, elderly and symptoms > 48 hrs
Older adults + children > 72 hrs.

### (57 decks)

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