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OTC MEdicines: Minor Ailments > Gastro-Intestinal system > Flashcards

Gastro-Intestinal system Flashcards

1
Q

What is dyspepsia?

A

A collection of symptoms:
1. upper abdominal discomfort and pain,
2. heartburn
3. acid reflux (with or without bloating),
4. nausea and vomiting related to eating

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2
Q

Causes of dyspepsia

A
  1. non-ulcer dyspepsia (diagnosis made by endoscopy),
  2. GORD,
  3. peptic ulcer disease (gastric or
    duodenal)
  4. hiatus hernia (when part of stomach squeezes into chest through opening in diaphragm)
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3
Q

Dyspepsia Alarm Symtoms

A
  1. gastro-intestinal bleeding (may present as ‘coffee grounds’ in vomit or malaena)
  2. dysphagia (difficulty swallowing) - urgent referral to GP
  3. progressive unintentional weight loss
  4. persistent vomiting
  5. GP examination: iron deficiency anaemia; an epigastric mass; swallowing difficulties,
    anaemia or suspicious barium meal

NOTE: Symptom severity is a poor indicator of an underlying disease. In the presence of such symptoms investigations would be performed to exclude oesophageal and gastric carcinoma. Anyone describing the danger
symptoms listed should make an urgent appointment with their GP

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4
Q

How do you differentiate between cardiac pain and dyspepsia?

A
  1. Pain travelling down the arm which is not relieved by antacids
  2. Accompanying symptoms: pale/cold/clammy/breathing difficulties

If there is any doubt about whether it is cardiac pain, refer urgently,emergency 999 if required. The principal distinguishing feature is periodicity, ie relating to eating, exercise etc. Patients reporting first episode of dyspepsia at the age of 40 or over should be referred because of the possibility of gastric cancer.

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5
Q

What medicines might cause dyspepsia as a side-effect?

A
  1. Bisphosphonates
  2. Iron
  3. NSAIDs
  4. Corticosteroids
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6
Q

What other conditions may present like dyspesia?

A
  1. Irritable bowel syndrome - accompanied by bloating, and abnormal bowel habits reported.
  2. Motility disorders - require referral to the GP.
  3. Biliary colic - present as epigastric pain precipitated by eating.
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7
Q

4 meds

What is the OTC treatment for Dyspepsia and how do they work?

A
  1. Antacids - neutralize acid
  2. Alganiates - form a raft on top of stomach contents
  3. H2 antagonists (Ranitidine) - Prevent acid secretion by blocking the H2 receptor.
  4. PPI (proton-pump-inhibitor:Omeprazole) - inhibits acids secretion by blocking proton pump.

.

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8
Q

Information to be given with antacids and alginates

A
  1. Take after meals and at bedtime (they remain in the stomach for longer at these times).
  2. Antacids not to be taken at the same time as other drugs as they may impair absorption.
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9
Q

Side effects of antacids?

A
  1. Aluminium containing - constipation
  2. Magnesium containing - diarehoea
  3. Combination products can balance out effects
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10
Q

Dose of Ranitidine for OTC dyspepsia?

Ranitidine contains low levels of NDMA which can cause cancer. It was withdrawn from the market in 2019

A

Maximum single dose for OTC use is 75mg

Not licensed for OTC sale to:
* children aged under 16 years or to
* patients who are pregnant or breastfeeding

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11
Q

3 points

What practical advise would you give for someone with dyspepsia?

A

The following will reduce symptoms:
* Weight loss
* Smoking cessation
* Avoid trigger foods: chocolate, alcohol, caffeine, rich, spicy or fatty foods

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12
Q

How does Orlistat work and who can it be sold to?

A

Inhibits gastric and pancreatic lipases and thus limits dietary fat absorption
Can be sold to adults over 18 with a BMI of > 28 Kg/m2

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13
Q

4 (FOSS)

What are the side effects of Orlistat?

A
  • flatulence
  • oily stools (with or without spotting),
  • sudden bowel movements
  • steatorrhoea.
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14
Q

What advise should be given to people Orlistat?

A
  • Maintain a low fat low calorie diet
  • Combine with exercise to see best results
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15
Q

What are the OTC restrictions for the following:
1. All products for dyspepsia
2. Gaviscon
3. Gaviscon infant
4. Esomeprazole and Pantoprazole
5. Ranitidine

A
    • All products
      * Pregnancy, breastfeeding,
      * jaundice or liver disease
    • Gaviscon®
      * Children under 12 years,
      * renal failure or kidney disease
      * hypercalcaemia
    • **Gaviscon® Infant **
      * Children under 12 months,
      * babies born before 37 weeks,
      * children over 2 years and renal impairment
    • Esomeprazole and pantoprazole
      * children under 18 years
      * adults over 55 years with new or recently changed symptoms
    • Ranitidine (withdrawn 2019)
      children under 12 years,
      peptic ulceration
      elderly taking NSAIDS

Ranitidine contains low levels of NDMA which can cause cancer. It has therefore been withdrawn from the market

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16
Q

What active ingredients are in the following OTC medicines:
1. Rennie
1. Andrews salts
1. Gastrisoothe
1. Gaviscon double action
1. GaviNatura
1. Nexium (generic available - boots own; Guardium)
2. Pantaloc
3. Zantac/Gavilast/Ranicalm

A
  1. Calcium carbonate & Magnesium carbonate
  2. Magnesium sulphate, sodium hydrogen carbonate
  3. Aloe vera, sodium alginate, antacids
  4. Sodium alginate, sodium bicarbonate, calcium carbonate
  5. Aloe vera and Limestone - can be used in pregnancy if necessary
  6. Esomeprazole 20mg
  7. Pantoprazole (P)
  8. Ranitidine

Gaviscon can be used in pregnancy. Gaviscon double action says consult health professional before using in pregnancy.

17
Q

What is GORD?
What are the symptoms?

A
  1. Gastroduodenal reflux disease is a chronic condition that is caused by gastric juices flowing back into oesophagus.
  2. Unpleasant burning feeling, felt behind the breastbone (heartburn)
    sour or bitter taste in the throat may also be present
18
Q

GORD alarm symptoms

A
  1. gastro-intestinal bleeding (may present as ‘coffee grounds’ in vomit or malaena)
  2. dysphagia (difficulty swallowing) - urgent referral to GP
  3. progressive unintentional weight loss
  4. persistent vomiting
  5. GP examination: iron deficiency anaemia; an epigastric mass; swallowing difficulties,
    anaemia or suspicious barium meal

NOTE: Symptom severity is a poor indicator of an underlying disease. In the presence of such symptoms investigations would be performed to exclude oesophageal and gastric carcinoma. Anyone describing the danger
symptoms listed should make an urgent appointment with their GP

19
Q

What are the long-term complications of GORD

A
  1. **Oesophagitis **
  2. Oesophageal stricture (narrowing of tube)
  3. Barrett’s oesophagus - cube shaped cells lining gullet become elongated.
  4. Untreated Barrett’s oesophagus may lead to ulcer and a higher tendency to undergo malignant change.
20
Q

FDA SOG

What are potential trigger/risk factors for GORD?

A
  1. Foods: fatty foods, citrus fruits, onions, coffee
  2. Drugs which relax oesophageal sphincter,
    e.g. calcium channel, blockers, theophylline, nitrates
  3. Alcohol
  4. Smoking
  5. Obesity
  6. Genetic factors
21
Q

What are the treatment options for GORD?

A

PPI - heals any ulcers present but does not relieve symptoms of GORD
H2 antagonist- provide symptomatic relief and more effective than antacids or alginates
Antacids - provide some symptomatic relief
Alginates - protect mucosa

22
Q

Age and duration

What are the sale restrictions for Omeprazole and Esomeprazole?

A
  1. Both for adults over 18.
  2. Omeprazole 10mg for use upto 28 days.
  3. Esomeprazole licenced for use for 2 weeks

Ask patients if they have a referral for endoscopy as PPI should not be taken two weeks before since they may mask pathology.

23
Q

Lifestyle advice for patients with GORD

A

Not known whether changing modifiable risk factors will improve GORD although this will be beneficial to health.
Raising the head of the bed may provide some relief at bedtime.

24
Q

FRAID

Symptoms of GORD in young children (under 18 months)

A
  1. Failure to thrive
  2. Recurrent vomiting
  3. Abdominal pain
  4. Irritability
  5. Difficulty feeding,
25
Q

Treatment options for GORD in infants

A

On the advise of health visitor or GP:I

Instant Carobel - feed thickner made from carob seed.
Gaviscon Infant sachets - sodium alginate. Consult GP if child under 1. Not for child over 2 or adults.

Not for preterm children
Check if other meds are being used

26
Q

What is colic?

A

Unexplained irratibility/crying (3 hours+/day) for 3+ days per week for atleast 3 weeks in baby between 0-5 months.

27
Q

Advise for colic

A

Hold the baby in an upright position, to help any wind to pass.
 Try a dummy (not recommended by some health professionals).
 If breastfeeding, avoid products in the diet that may upset the baby, suchn as caffeine, alcohol, spicy foods, chocolate or dairy products.
 If bottle-feeding, ensure that the hole in the teat is the correct size, e.g. if it is too large, the baby may feed too quickly and gulp in a lot of air.
 Let friends or family help look after the baby.

28
Q

Treatment options for colic

A
  1. Anti-foaming agents, e.g. simethicone, contained in Dentinox® and Infacol®.
    * little evidence of effectiveness.
    * It is not systemically absorbed and therefore is safe from birth.
  2. Gripe water, containing sodium bicarbonate and herbal aromatic oils may also be tried, but once again, evidence for its effectiveness is lacking.
29
Q

Define constipation

A

Reduced frequency of defecation compared to norml for that person, often accompanied by straining
and the passage of small, hard stools

30
Q

Symptoms of constipation

A

Passing of hard stools
Reduced frequency
Abdominal discomfort
Cramps
Feeling of incomplete emptying

31
Q

Causes of constipation

A

Poor fibre intake
Poor fluid intake
Sedentary lifestyle.
Drugs
Pregnancy

32
Q

Danger symptoms of constipation

A
  1. Adults with new or worsening unexplained constipation
  2. ** Blood** in the stools (unless explained by haemorhhoids)
  3. **Weight loss **(unexplained)
  4. Nausea and vomiting.

1.Faecal impaction should be referred to the GP for manual evacuation.

Symtoms that may indicate colorectal cancer

33
Q

Lifestyle changes for constipation management

A

Preference over medication use. Increase :
* Fluid
* Fibre
* Exercise

34
Q

Treatment options for constipation

A

When straining needs to be avoided e.g. angina or haemorrhoids:
1. Bulk forming laxative
2. Stimulant laxative
3. Osmotic laxatives
4. Stool softeners
5. Glycerol supposotories

35
Q

Osmotic laxatives
1. names
1. mechanism
1. advise

A
  • lactulose
  • Increases absorption of water in large bowel.
  • Takes 48 hours to work and can cause cramps/bloating
36
Q

Bulk forming laxatives
1. names
1. mechanism
1. advise

A
  1. Ispaghula and Sterculia
  2. Stimulates peristalsis by increasing faecal mass by retaining water in the gut.
  3. Delayed onset, take with adequate fluid to avoid obstruction, may cause bloating/flatuence/distension (settles with regular use)
37
Q

Stimulant laxative
1. names
1. mechanism
1. advise

A

senna and bisacodyl
stimulating colonic nerves
to increase intestinal motility.

OTC MEdicines: Minor Ailments (3 decks)

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