3+4 Flashcards
1
Q
5 Advantages of the oral mucosal drug delivery system
A
Accessible self-administer Highly hydrated environment to dissolve Reduces chance of systemic side effects Oral mucosa repairs rapidly
2
Q
5 disadvantages of oral mucosal drug delivery system
A
Saliva washes away drug mastication/speech can dislodge it Can choke it small surface area Highly enzymatic environment
3
Q
What is oral thrush
A
Its a fungal infection by candidas albicans of the oropharynx
4
Q
Who in oral thrush common in
A
Patients with dentures, xerostyomia, DM, Taking immunosupressant drugs, anaemias
5
Q
What does oral thrush look like
A
Creamy white patches in mouth
Can be scraped off tongue leaving a red tongue
Unpleasant taste in mouth
burning sensation
6
Q
How do you treat oral thrush
A
Nystatin or miconazole- topcial application
Systemically give fluconazole
7
Q
How long does it take for a mouth ulcer to go
A
10-14 days
8
Q
List the local causes of mouth uclers
A
Mechanical trauma, chemical/thermal injury
9
Q
What are apthous ulcer
A
Most common type of mouth ulcer
10
Q
Causes of aphthous ulcers
A
May have a genetic component or due to
Oral trauma,
changes in hormone levels, ex smokers, lack of B12 and folate
11
Q
Which medications can cause mouth ulcers
A
Nicorandil, NSAID like ibuprofen and oral NRT
12
Q
Describe appearance of minor aphthous ulcer
A
less than 10mm, pale yellow but look red bc they’re swollen
Can have up to 5 at a time
7-10 days
no scarring
13
Q
Describe appearance of MAJOR aphthous ulcer
A
larger than 10mm 1/2 at a time 2 weeks-months leaves a scar v painful and difficulty eating
14
Q
Describe appearance of herpetiform ulcer
A
1-2mm
multiple at the same time- can join together
1 week-2 months
15
Q
Management advice of aphthous uclers
A
Self-limiting avoid spicy, hot, acidic foods Use a straw very soft toothbrush Change form of medication
16
Q
OTC meds for aphthous ulcer
A
Chlorhexidine mouthwash- healing and prevention
Local anaesthetic- pain relief
Analgesic oral rinse, benzydamine spray (difflam) or choline salicylate gel (bonjela- not under 16)
Hydrocortisone mucoadhesive tabs buccal tabs
17
Q
Rx meds for aphthous ulcers
A
Doxycycline/ strong steroid mouthwashes
18
Q
Which 4 meds cause dry mouth
A
Antimuscarinics, TCAs. antipsychotic, antihistamines,
19
Q
Which drugs can cause stomatitis
A
NSAIDs cause aphthous like ulcers
Methotrexate, doxorubicin- chemotherapy assocuated mucostitis
20
Q
What is gingival hyperlasia
A
Overgrown of gum tissue
21
Q
What drugs cause gingival hyperplasia
A
Phenytoin, CCB, sodium valproate, cyclosporine
22
Q
What drugs angiodema
A
ACEI
23
Q
Describe the pain of dyspepsia(indigestion)
A
epigastric pain, above umbilicus and located centrally, pain behind breast bone
24
Q
What is a sharp burning sensation in the epigastric region and behind breast bone called
A
Heartburn/acid reflux
25
What is the pain like in colic
waves of severe pain on top of a constant diuller main- occurs when organ is spasm
26
What are the symptoms of a peptic ulcer
Pain related to meals signifies a lesion on the stomach
27
What is a duodenal ulcer
pain 1-2hrs after food- worse at night
28
What is a gastric ulcer
Epigastric or central pain few mins after food
29
Pain immediately on eating
Reflux or oesphagitis
30
Which type of ulcer is relieved by food
Duodenal ulcer
31
When do you need referral in over 55s
```
Hx of gastric ulcer
Hx of gastric surgery
Family history of Gatric cancer
Pernicious anaemia
NSAID use
```
32
What are the alarm symptoms
```
Epigastric mass
Iron deficiency anaemia
Persistent vomiting
progressive dysphagia
Significant GI bleeding
```
33
Management of dyspepsia and acid reflux
```
Small frequent meals
avoid bending
don't eat before bed
reduce weight, alcohol, caffeine, chocolate and fat
Stop smoking
```
34
Why are antacids used in dyspepsia
Fast act in supressing symptoms
| Used for isolated episodes
35
What are the side effects of magnesium salts
Can cause diarrhoea
| Can increase sodium which can cause HF/hypertension
36
How are aluminium salts different to Mg
Al are longer acting
| can lead to constipation
37
Side effects of calcium salts
Fast acting, lead to constipation
| Can cause acid rebound which causes the release of gastrin causing more acid
38
Name a side effect and an give an example of a Bismuth salts
Constipation
| Pepto-bismol
39
How long does it take before relief of symptoms using a PPI
2 days
40
When are alginates used
Relief in GORD
41
How do alginates work
Form a floating viscous gel, on top of stomach contents protecting the mucous membrane of the oesophagus
42
What is domperidone
stimualtes GI peristalsis
| OTC max 1 week for nausea, hearburn and dyspepsia
43
Simeticone
Small bubbles in stomach coalese allowing gas to be eliminated
44
Treatment for uninvestigated dyspepsia
Full dose PPI for 4 weeks
if no response test for H pylori and treat infection using 2 AB and 1PP
Leave 2 week washout period after PPI- test again
45
Risk factors of GORD
Pregnancy, smoking, alcohol, obesity, large meals
46
What happens in GORD
The lower eosophageal sphincter relaxes transiently causing heartburn
47
Management of mild symptoms of GORD
Use antacids and alginates
48
Drug management for Severe cases of GORD
PPI/surgery
49
How does the surface of the esophageal mucousal act as defense mechanism
Mucous and unstirred water trap bicarbonate which acts as a weak buffer
50
What are the cardiac features of pain of GORD
Gripping/crushing pain
Radiates to neck or left arm
Worse with exercise
Accompanied by dysponea
51
How does esophageal damage occur
When drug remains on esophagus for too long
52
Which common drugs cause oesphageal injury
Doxycycline, tetracycline, clindamycin, aspirin, KCL, ferrous sulphate, quinidine NSAIDs
53
Which drugs can worsen GORD
Smooth muscle relaxants
| nitroglycerins, antimuscarins, beta agonsits, aminophyllines, benzo's
54
Which 3 biphosphonates need to be taken in caution in those with oespahgeal problems
Ibandronate, risedronate, alendronate
55
What is a peptic ulcer
Lesion in the mucosa of the digestive tract
56
Describe a H. pylori associated ulcer
Spiral-shaped, gram negative bacterium found in gastric antrum of the human stomach
57
What are the risk factors for H. Pylori associated ulcer
Low social class, overcrowding and bed sharing
58
How does a NSAID associated ulcer occur
prostaglandins produce protective mucous layer for the stomach, nsaids reduce PG, increasing risk of gastric irritation and ulceration
59
Which NSAIDs have the highest risk of uclers
Piroxicam, keoprofen and ketorolac
60
When are you most at risk of developing NSAID associated ulcer
1st month highest risk
| within the first 3 months also high risk
61
What are the 6 alarm symptoms for Ulcers/GI bleeding
```
Unexplained weight loss
Epigastric pain
Significant GI bleeding
Progressive dysphagia
Iron deficiency anaemia
Persistent vomiting
```
62
How does misoprostal prevent ulcers
Stimulates protective mechanisms and reduces acid secretion
63
Treatment of NSAID associated ulcer
Stop NSAID
Full dose PPI for 4-8 weeks
H pylori eradication +ve
Add PPI with NSAID or use a selective COX 2I e.g. celecoxib
64
Test for H pylori
c13 urea breath test: if +ve use eradication treatment
1st line,PPI, Clarithomycin, amoxicillin/metronidazole
2nd line swap amoxicillin/metronidazole, whichever wasn't used first line
65
Highest risk of NSAID associated ulcer
```
Over 65
Hx of peptic ulcer
taking other meds with GI effects
Serious co-morbidities e.g. Diabetes, CVD,
ADD IN PPI FOR THESE
```
66
Explain the mechanism of H2 receptor antagonist
Competitive inhibitors at Histamine at parietal cell
67
Mechanism of Misoprostal
Inhibits gastric acid secretion by direct action on parietal cells through binding to PG receptor
Increases bicarbonate,
reduces pepsin
68
What are the 2 main symptoms of gastroenteritis
Vomitting and diarrhoea
69
What is the name of the virus that causes gastroenteritis in
| children and older children
Children: noravirus
| Older children: rotavirus
70
Which is the common type of bacteria causing gastroenteritis
Campylobacter
71
Which parasites cause gastroenteritis
Cryptosporidium, entamoeba histolytiva, giardia
72
What bacteria is found in reheated rice
Bacilius cereus
73
Where is staphylococcus aureus found in
Cooked meat and cream products
74
What is found in reheated meat dishes
Clostridium perfringens
75
Risk factors for gastroenteritis
OVER 65S, BABIES, CHILDREN, IMMUNOCOMPROMISED
76
What is the most common and serious complication with gastroenteritis
Dehydration and electrolyte disturbances
77
What are common symptoms of UC and Crohns
Diarrhoea, abdominal pain, rectal bleeding, malnutrition an wieght loss
78
Where is the inflammation in Chrons
Affects any par of the intestine, and extends into the submucosa and deeper layers
79
Where is the inflammation in UC
Localized to the colonic mucosa
80
What is the peak age for IBD
20-40 and then again at middle age
81
In CD, which gene has a mutation
Mutation in NOD2 gene
82
which disease is more prevalent in smoker
CD is more common in smokers
83
Which part of the intestine does UC affect
Large intestine
84
What happens in UC to the mucosa
Mucosa is ulcerated, reduced goblet cells and increased paneth cells
85
What happens to the colonic crypts in UC
Become distorted and branched rather than short and straight
86
In which part of the tissue if there an increase in inflammatory cells
Lamina propia
87
in CD is the inflammation continuous
No it's interspersed
88
What is the mechanism for diarrhoea in IBD
Lack of bile salt absorption, inflammatory mediators and undigested/absorbed nutrients large intestine
89
Extra-intestinal features of IBD
Skin rashes, arthritis, inflammation of eyes
90
Treatment of IBD
Dietary manipulation, maintainance of fluid, parenteral nutrition
91
Give examples of aminosalicylates for UC
Mesalazine, sulphasalazine, Olsalazine, balsalazide
92
What corticosteroids can treat UC
Prednisolone, hydrocortisone, budenoside, beclomethasone
93
Which immunosupressives are used to treat UC
Azathioprine, mercaptopurine, methotrexate, mycopenolate mofetil, acrolimus and ciclosporin
94
Which biologics can be used to treat UC
Infliximab and Adalimumab
95
Which drugs can be given in UC to stop diarrhoea
Codeine, loperamide, diphenoxylate
96
Which laxatives are used in UC
Movicol and lactulose
97
What is diphenoxylate used for
stops diarrhoea in UC
98
What bulking agents are used in UC
Fybogel
99
Which Aminosalicylates can be used in CD
Mesalazine, Sulphasalazine and Balsalazide
100
Steroids in CD
Not beclomethasone like you do in UC
| Budesonide, Hydrocortisone and prednisolone
101
Which immunosupressive drugs are recommended in CD
Azathioprine, mercaptopurine, methotrexate and tacrolimus
102
Which antibiotics can be used in Chrons
Metronidazole and Ciprofloxacin
103
Who does IBS affect more
Young women
104
What is IBS aggravated by
food and mood
105
What are the main symptoms of IBS
abdo pain, bloating, flatulence, colic in stomach, alt in constipation + diarrhoea
106
How does constipation occur in pregnant women
Increase in progesterone, relaxes smooth muscle of bowel and baby weight in uterus causes constipation
107
Explain the mechanism of bulk forming laxatives
Retains water in large bowel increasing stool bulk
| Ispagula husk is the main one, also methylcellulose
108
How do stimulant laxatives work in IBS
Used when bulk are ineffective, increase peristalsis e.g. bisacodyl suppositries or senna
109
How are osmotic and bulk laxatives different
Osmotic are more powerful than bulk, they retain fluid and stimulate peristalsis e.g. lactylose, Mg salts
110
How do stool softners work
Reduce surface tension of hard faeces in bowel allowing water to pentrate e.g. docusate sodium
111
How many days does it take for the onset of osmotic and bulking agents
2-3 days
112
How long until relief of symptoms for stimulant
8-12 hrs
113
How long can a laxative be used for
4 days, any longer refer to GP
114
Which is the first line laxative for children
Polyethene Glycol
115
How do antimotility drugs work for diarrhoea
loperamide
| Reduce bowel motiltiy by working on the opioid receptors in the gut, increasing transit time to absoprbing more fluids
116
Give an example of an antispamodic
Mebeverine
| peppermint oil
117
How do antimuscarinics wokr in IBS
Intestinal spam e.g. buscopan
118
How does Bismuth salicylate work in IBS
Reduces intestinal motility allowing absorption of fluids
| also works to treat heartburn
119
HOw long should you take probiotics before you see an improvement of symptoms
4 weeks min
120
What is Diverticular disease
diverticula (pockets) protrude out of digestive tract
121
Causes of DD
Low fibre, drier stools so needs more pressure which pushes a small lining of the guy
122
Difference in symptoms between DD and IBS
None- but DD occurs in older people and IBS in younger
123
Treatment of Diverticular D
Increase fibre- 18g a day
124
Which drugs can cause diarrhoea
Opioids,laxatives, antacids with Mg, AB, PPI, NSAIDs
125
Describe Grade 1 hemorrhoids
Small swellings on the inside of the anal canal- can't be seen or felt
126
Describe Grade 2 hemorrhoids
PARTLY PUSHED OUT SWELLINGS, GO BACK IN WHEN U GO TOILET
127
Describe Grade 3 hemorrhoids
Pemanently hang out the anus, can push them back in with finger
128
What is a classic alarm symptom for haemorrhoids
Blood in stool
129
Treatments for haemorrhoids
Contain, bismuth salts, local aneathetics, antiseptics, antipruitic, zinc
Most eggective is hydroocortisone
130
What is threadworm
Parasite that lies for 5-6 weeks, females lay tiny eggs around back passage when youre in bed
131
How long can a threadworm survive out the body
2 weeks
132
Symptoms of threadworm
Itching around the anus
| Mild abdo pain
133
Drugs for threadworm
Mebendazole- over 2 yrs
| take second dose 2 weeks after first
134
What are the 3 main symptoms of colon caner
Abdo pain, blood in stool, change in bowel
135
Who is at risk for colon caner
Over 60, diet high in red meats and low fiber, weight, lac of exercise, smoking + alcohol and family history
136
How often are stool testing kits sent out
Every 2 yrs in 6-75 yrs olds
137
What are the different types of cancers
Squamous cell carnomas
Adenocarcinoma- start in glandular epithelium of colorectal mucosa
Sarcomas- cancer of bone/muscle
Lymphomas
Carcinoid- slow growing formed in neuroendocrine cells
138
What is stage T2
Tumour grown insdie he muscle layer
139
N2
1-3 lymph nodes cose tot he bowel congtain cancer cells
140
M1
Cancer has spread to the other organs
141
What are the treatment options for colorectal caner
Chemotherapy
radiotherapy
surgery
Bioloical therapy
142
Which drugs are used to colorectal cancer
Flourouracil with folinic acid
Capecitabine
Oxaliplatin
Irinotecan
143
What is the definition of heartburn
Pain in epigastric region after meals
144
What are the common symptoms associated with haemorrhoids
Itch
Fresh blood in stools
Discomfort when defecating
Constipation
