Bowel

Question 1

what antibiotics cause c diff (5)

Answer 1

quinilones
clindamycin
cephlasporins (second and third gen)
ampicillin/ amoxicillin
co-amox

Question 2

antispasmodics which slow gut transit e.g. codeine are contrainditcated in diverticular disease because

Answer 2

they can exacerbate symptoms

Question 3

what sort of fiber should people with IBS use

Answer 3

soluble - e.g. ispagula husk

not insoluble like bran

Question 4

what sort of laxative is preffered in IBS

Answer 4

osmotic such as macrogol

but lactulose may cause bloating

Question 5

in IBS patients who have not responded to antispasmodic drugs for abdo pain what can be tried

Answer 5

TCA

or later SSRI

Question 6

what type of drug is mesalazine

Answer 6

aminosalicylate

Question 7

is cuclosporin used for crohns or UC

Answer 7

UC

Question 8

what is the connection between smoking and chrons

Answer 8

smoking cessation reduces the risk of relapse

Question 9

What two antibiotics are used for fistulating crohns disease

Answer 9

metronidazole and cirpofloxacin

Question 10

what is the risk of metronidazole use in fistulating crohns

what duration do we limit it to

Answer 10

peripheral neuropathy

usually 1 month, at most 3 months

Question 11

do we use antispasmodic or antimotility drugs in IBD

Answer 11

no - may percipitate mega colon (includes loperamide, codeine etc) treatment of the inflamation is more logical

Question 12

what is colestyramine used for in IBD

Answer 12

diarrhoea resulting from loss of bile salt absorption (as cholestytamine binds bile salts)

Question 13

which aminosalicylate is older, activates further up the bowel and therefore has more sulfonamide like side-effects

Answer 13

sulfasalazine

as opposed to new ones: mesalazine, besalazine, osalazine

Question 14

what significant 2 side-effectds are common to all aminosalycilates

Answer 14

blood disorders and lupus like syndrome

Question 15

what are the sulfonamide like sideeffects of aminosalycilates

Answer 15

Diarrhea.
dizziness.
loss of appetite.
nausea or vomiting.
tiredness

Question 16

what should always be given with methotrexate in IBD

Answer 16

folic acid on a differenty day

Question 17

patients taking aminosalicylates should be councelled to report signs of blood disorders such as

Answer 17

sore throat
fever
malaise
bruising
bleeding

Question 18

how often should renal function be monitored for aminosalicylates

Answer 18

at 3 month and then annually

Question 19

what is the caution with using lactulose with mesalazine

Answer 19

preparations that lower ph may prevent the release of drug

Question 20

which aminosalycilate has high monitoring requirements

LFTs, renal and FBC

Answer 20

sulfasalazine

Question 21

what drugs should be withheld on the day of bowel prep (3)

Answer 21

ACEi/ARB
NSAIDs
duiretics

Question 22

what class of drug is mebevarine

Answer 22

antimuscarinic

Question 23

when should mebevarine be taken

Answer 23

20 mins before meals

Question 24

what is ursodexycholic acid used for ?

Answer 24

dissolution/prophylaxis of galls stones and billary cirhosis

Question 25

how lond can orlistat be used for

Answer 25

12 months

Question 26

what is methycellulose used for but there is little evidence of benifit

Answer 26

increase satiety in obesity

Question 27

What are phentermine and diethylpropion what are the risks

Answer 27

central stimulants NOT recommended for obesity phentermine - pulmonary hypertension

Question 28

what would be the local aneasthetic of choice for anal fissure what are two associated risks

Answer 28

lidocaine - others are more irritant - caution excessive use as absorbed through anal mucosa - local sensitisation after more than a few days use

Question 29

what are zinc oxide, bismuth subgallate, hamamelis used for in haemerroids

Answer 29

soothing ans astringent

Question 30

when should you use oily phenol for haemoerroids and what is the mode of administration

Answer 30

injection | mainly for unprolapsed haemerrhoids

Question 31

if you are mixing your pancreatic enzymes with food what should you do to avoid them breaking down

Answer 31

admin within the hour | avoid excessive heat

Question 32

what should you mix gastro resistant pancreatic enzymes with

Answer 32

milk, slightly acidic soft food swallow imediately without chewing

Question 33

when should pancreatic enzymes be taken in relation to food and why what else could you use for this effect (2 drugs)

Answer 33

with or just after as inactivated by acid you can also give cemetidine and ranitidine with them

Question 34

why are EC and MR preps not suitable in stoma

Answer 34

not sufficient release of active ingrediant

Question 35

why should you not give enemas and washouts to patient with a stoma

Answer 35

severe loss of electrolytes and water

Question 36

if constipated what laxatives would be ok in stoma patient

Answer 36

``` bulk forming (can also use this to treat diahorrea weirdly) senna ```

Question 37

what is the caution with antacids in stoma patients

Answer 37

tendancy increased for Mg - diahorreah Aluminium - constipation

Question 38

diuretics should usually be avoided in stoma but if you had to use one what would you choice

Answer 38

K sparing

Question 39

what is the risk of digoxin in stoma

Answer 39

particularly suceptable to hypokalaemia