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Pharmacy > GI > Flashcards

GI Flashcards

1
Q

what is coeliac disease?

A

chronic inflammation of the small intestine

Symptoms:
diarrhoea, bloating, abdo pain

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2
Q

what is coeliac disease caused by?

A

adverse reaction to gluten

Gluten is found in cereals, wheat, barley, rye

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3
Q

what are the treatment options for coeliac disease?

A

gluten-free diet
vitamin and mineral supplementation
assess for risk of osteoporosis and treat

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4
Q

what are people with coeliacs disease at risk of develpoing?

A

malabsorption of key nutrients (vitamin D and calcium) leading to osteoporosis

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5
Q

what are diverticula?

A

small pockets/ bulges that develop on the lining of the intestine?

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6
Q

what is diverticular disease?

A

diverticula present

symptoms:
abdo pain, constipation, diarrhoea, rectal bleeds

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7
Q

what is acute diverticulitis and what can this lead to?

A

diverticula become inflamed/ infected
symptoms include sever abdo pain, fever, rectal bleeding

can lead to complicated acute diverticulitis:
abscess, perforation, fistula, obstruction, haemorrhage, sepsis

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8
Q

how can you treat diverticular disease?

A

high fibre diet
bulk forming laxatives
paracetamol
ABX - diverticulitis

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9
Q

what are the two types of IDB?

A

crohn’s & UC

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10
Q

what is crohn’s?

A

inflammation of the GI tract from mouth to anus

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11
Q

what are the symptoms of crohn’s?

A

abdo pain, diarrhoea, rectal bleeding, weight loss, low grade fever, fatigue

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12
Q

what are the complications of crohn’s?

A

malnutrition, anaemia, cancers, arhritis, intestinal strictures/ abscesses/ fissures

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13
Q

what lifestyle advice can be given to patients with crohn’s?

A

high fibre diet
smoking cessation - reduces risk of relapse

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14
Q

what options are available to treat diarrhoea associated with crohn’s?

A

loperamide
codeine
cholestyramine

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15
Q

what is the treatment options for a patient with crohn’s who presents with their first flare up in 12 months?

A

prednisolone, methylprednisolone, IV hydrocortisone

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16
Q

what is the treatment options for a patient with crohn’s who has had 2 or more flare ups in the past 12 months?

A

1st azathioprine/ mercaptopurine
2nd methotrexate
if severe - MABs

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17
Q

what treatments can be used to manage maintenance of remission in crohn’s?

A

1st azathioprine/ mercaptopurine
2nd methotrexate

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18
Q

what medications should be initiated for maintenance of remission of crohn’s following surgery?

A

azathioprine + metronidazole

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19
Q

what is UC?

A

inflammation and ulcers affecting colon/ rectum

symptoms:
bloody diarrhoea (mucus or pus), abdo pain, urgent need to defecate
Acute flare up: mouth ulcers, arthritis, sore skin, weight loss, fatigue

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20
Q

what are the complications of UC?

A

colorectal cancer, osteoporosis, VTE, toxic megacolon

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21
Q

can loperamide and codeine be used to treat diarrhoea in acute flare up of UC?

A

No

can cause paralytic ileus - increased risk of toxic megacolon

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22
Q

what are the different types of UC?

A

extensive (proximal) - affects entire colon
left sided (distal) - inflammation up to distal colon
proctosigmoiditis - inflammation of rectum and sigmoid colon
proctitis - inflammation of rectum

*treatment depends on area affected

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23
Q

how would you treat an acute mild/ moderate flare up of UC?

A

proctitis:
1st topical aminosalicylate for 4 weeks, if not improved THEN
2nd oral aminosalicylate
3rd corticosteroid for 4-8 weeks

proctosigmoiditis:
1st topical aminosalicylate for 4 weeks, if not improved THEN
2nd + oral aminosalicylate
3rd + corticosteroid for 4-8 weeks

extensive (proximal and distal):
1st topical + oral aminosalicylate
2nd + corticosteroid for 4-8 weeks

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24
Q

how do you treat a severe acute flare up of UC?

A

IV corticosteroid

if symptoms don’t improve/ worsen in 72 hour:
IV ciclosporin + IV corticosteroids
OR surgery

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25
Q

what are the side effects of the aminosalicylates?

A

blood dyscrasias
nephrotoxicity
hypersensitivity

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26
Q

what colour does sulfasalazine turn bodily fluids?

A

yellow/ orange

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27
Q

how does lactulose interact with mesalazine?

A

lactulose lowers stool pH preventing sufficient release of drug in EC or MR preparations

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28
Q

what are the side effects of azathioprine/ mercaptopurine?

A

hypersensitivity
bone marrow suppression

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29
Q

what pre-test must be done prior to treatment with azathioprine/ mercaptopurine?

A

TPMT

low enzyme activity increases risk of myelosuppression

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30
Q

how does azathioprine and allopurinol interact?

A

inhibits metabolism of purines, leading to toxicity

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31
Q

what are the symptoms of IBS?

A

lower abdo pain, bloating, alternating constipation and diarrhoea

32
Q

what types of food exacerbates IBS?

A

coffee, alcohol, milk, fried food, stress

33
Q

what are the treatment options for IBS?

A

antisposmodics: alverine, mebeverine, peppermint oil
antimuscarinics: hyoscine butylbromide, atropine
laxatives: NOT LACTULOSE (causes bloating)
loperamide

2nd line for abdo pain:
TCAs and SSRIs

34
Q

what are the complications of short bowel syndrome?

A

deficiency of vitamins A,D,E,K and B12

35
Q

what treatment can be used for short bowel?

A

loperamide

36
Q

what are the red flags for constipation?

A

blood in stool, anaemia, abdo pain, weight loss, new onset, age > 50

37
Q

what are the different classes of laxatives?

A

stimulant
osmotic
bulk forming
stool softener

38
Q

what are the bulk forming laxatives?

A

isphagula husk
methylcellulose
stercula

39
Q

what is the mechanism of action of bulk forming laxatives?

A

increase faecal mass to stimulate peristalsis

40
Q

when should bulk forming laxatives be used?

A

ideal for small, hard, stools
works within 2-3 days
swallow with plenty of water and not immediately before bed

41
Q

what are the osmotic laxatives?

A

macrogol
lactulose

42
Q

what is the mechanism of action of osmotic laxatives?

A

increase water in the colon

lactulose - osmotic diarrhoea of low faecal pH
macrogol - sequester fluid in bowel

43
Q

when should osmotic laxatives be used?

A

second line if stools remain hard
works within 2-3 days
side effects: flatulence, cramps, nausea (reduced when administered with liquid/ meals)

44
Q

what is the MHRA alert for macrogol?

A

do not take with starch base thickeners (increased risk of aspiration)

45
Q

name the stimulant laxatives?

A

senna
bisacodyl
glycerol suppositories
co-danthramer
docusate

46
Q

what is the mechanism of action of stimulant laxatives?

A

increases gut motility

47
Q

when should stimulant laxatives be used?

A

stools soft but difficult to pass
short term use (~ 1 week)
6-12 hours to work (glycerol 15-30 mins)
side effects: abdo cramps, hypokalaemia, diarrhoea, lazy bowel

avoid in obstruction

48
Q

what colour can senna colour urine?

A

yellow/ brown

49
Q

when should co-danthremer be used?

A

in palliative patients

*carcinogenic

colours urine red

50
Q

name the stool softeners?

A

liquid paraffin, docusate, glycerol

51
Q

what laxatives should be used in patients with opioid induced constipation?

A

osmotic + stimulant
naloxegol when not responding to other laxatives

  • AVOID bulk forming
52
Q

what laxatives should be used in patients with chronic constipation?

A

1st bulk forming
2nd + macrogol
after 6 months prucalopride

53
Q

what laxatives should be used in pregnant patients?

A

1st bulk forming

osmotic
bisacodyl or senna (avoid senna near term)

54
Q

what are the red flag symptoms for diarrhoea?

A

weight loss, rectal bleeding, persistent diarrhoea, systemic illness, recent hospital treatment, following foreign travel

55
Q

what is first line for diarrhoea?

A

oral rehydration (diarolyte)

56
Q

what is the age limit for loperamide?

A

> 12

57
Q

what is the dose of loperamide?

A

take 2 tablets, then one tablet after each loose stool for up to 5 days

*max 8 tablets (16mg) per day

58
Q

what is the MHRA alert for loperamide?

A

QT prolongation

59
Q

what is the reversal agent in loperamide overdose?

A

naloxone

60
Q

what are the symptoms and causes of dyspepsia?

A

symptoms: upper abdo pain, fullness, early satiety, bloating, belching, nausea

causes: indigestion, GORD, gastritis, gastric/ duodenal ulcer

61
Q

what are the red flags of dyspepsia requiring urgent endoscopy?

A

anaemia
loss of weight
anorexia
recently changed (unexplained, new dyspepsia in >55)
malaena

62
Q

what can be used to treat dyspepsia?

A

antacids - neutralise stomach pH
alginates - form viscous gel raft to prevent reflux

63
Q

what are the PPIs?

A

omeprazole
esomeprazole
lansoprazole

64
Q

which of the PPIs interact with clopidogrel?

A

omeprazole & esomeprazole

65
Q

what are the side effects of PPIs?

A

GI upset
increased fracture risk
c.diff risk
hypomagnesaemia

66
Q

what is the MHRA alert for PPIs?

A

subacute cutaneous lupus erythematosus

67
Q

how do you test for h.pylori infection?

A

c-urea breath test

do not perform within 4 weeks of abx or 2 weeks of PPIs

68
Q

how do you treat h.pylori infection?

A

triple therapy for 7 days

PPI BD +

one of:
amoxicillin
clarithromycin
metronidazole

69
Q

how do you treat GORD?

A

Mild:
antacids + alginates
H2 receptor antagonists/ PPI

Severe:
PPI for 4-6 weeks

70
Q

how do you treat GORD in pregnancy?

A

antacids/ alginates
ranitidine
omeprazole

71
Q

how do you treat GORD in children?

A

common in infants, resolves after 12-18 months

thickened feeds or alginates

72
Q

what is the MHRA alert for hyoscine butylbromide?

A

risk of adverse events in patients with underlying cardiac disease

contraindicated in tachycardia

73
Q

how should you treat acute anal fissure?

A

bulk forming/ osmotic laxative
topical local anaesthetic

74
Q

how should you treat chronic anal fissure?

A

1st GTN rectal ointment

or nifedipine, diltiazem

75
Q

how can you manage pruritis associated with cholestasis?

A

cholestyramine
ursodeoxycholic acid
rifampicin

76
Q

how can you manage pain associated with gall stones?

A

mild/ moderate:
paracetamol/ NSAID

severe:
IM diclofenac

77
Q

how do you manage stoma care?

A

EC/ MR preparations unsuitable
vulnerable to GI side effects (avoid NSAIDs)
PPI to reduce gastric acid secretion
use K sparing diuretics (risk of hypoK)
high doses of loperamide/ codeine

Pharmacy (20 decks)

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