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Pre-reg revision > Gastro-intestinal system > Flashcards

Gastro-intestinal system Flashcards

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1
Q

‘Ulcerative colitis increases your chances of developing venous thromboembolism and colorectal Ca’
True or False?

A

True

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2
Q

Name some aminosalicylates

A

Mesalazine, sulfasalazine, olsalazine, balsalazide

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3
Q

Why should mesalazine be prescribed by brand?

A

Oral preparations may have different delivery characteristics

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4
Q

How is a flare of UC usually treated?

A
  1. Topical/oral aminosalicylate
  2. Oral prednisolone
  3. Tacrolimus or budesonide multimatrix
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5
Q

How is diarrhoea in UC treated?

A

With loperamide/codeine during remission

This is CONTRA-INDICATED during active UC as there is a risk of toxic megacolon

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6
Q

What is usual maintenance treatment for Crohns disease?

A
  1. No treatment, patients must be aware of signs of relapse
    OR
  2. Azathioprine/mercaptorine monotherapy
  3. Methotrexate

Do not offer a steroid for maintenance treatment

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7
Q

Can loperamide/codeine be used to manage diarrhoea in Crohns?

A

Yes- if no colitis

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8
Q

What abx are used to treat fistulating Crohns?

A

Metronidazole/ ciprofloxacin

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9
Q

What lifestyle factors can reduce the risk of relapse in Crohns?

A
  • Smoking cessation

- High fibre diet

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10
Q

What is first line treatment for an acute flare of Crohns?

A

Corticosteroids

Prednisolone, methylpred or IV hydrocortisone

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11
Q

How should patients on aminosalicylates be counselled?

A

Risk of blood disorders/dyscrasia

Report any unexplained bleeding, bruising, sore throat etc

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12
Q

What monitoring is required for patients on aminosalicylates?

A
  • FBC if signs of blood disorders

- Renal function, risk of neprotoxicity

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13
Q

Why should aminosalicylates be avoided during breast feeding?

A

Risk of diarrhoea in the newborn

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14
Q

Which aminosalicylate can turn bodily fluids including contact lenses orange?

A

Sulfasalazine

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15
Q

Why should mesalazine not be given with lactulose?

A

Lactulose lowers pH of stools, can prevent sufficient release of MR/EC preparations of mesalazine

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16
Q

Which lifestyle advice can be offered to patients suffering with IBS?

A
  • Increase exercise
  • Eat regular meals
  • Limit fresh fruit to 3 portions per day
  • Increase fibre and fluid intake
  • Reduce caffeine, alcohol and fizzy drinks
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17
Q

Why should lactulose not be recommended in IBS?

A

Can cause bloating

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18
Q

How does NICE define constipation?

A

Defecation less than 3 times per week

Differs for each person

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19
Q

Which ‘red flags’ would ean you referred a patient presenting with constipation?

A
  • New onset constipation aged over 50
  • Anaemia
  • Abdo pain/vomiting/bloating
  • Unintentional weight loss
  • Blood/mucus in stools
  • Painful defecation
  • Secondary caused by drug, drug should be reviewed
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20
Q

Which patient would you NOT refer?

  • Woman in her late 50s presenting with 3 weeks of constipation and this is the first time she has had these symptoms
  • Man aged 23 with new constipation after being prescribed co-drydamol for an injury
  • Man aged 47 with constipation and a 2 month history of weight loss
  • Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past
  • Woman aged 60 with constipation, abdominal pain and blood in stools
A

Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past - if no new/unusual bowel habits or other red flags

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21
Q

What is a sign of laxative abuse?

A

Hypokalaemia

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22
Q

What is the recommended first line treatment for constipation?

A

Bulk-forming laxatives

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23
Q

Name some bulk-forming laxatives?

A

Ispaghula husk, methylcellulose (also softener), sterculia

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24
Q

How long do bulk-forming laxatives take to work?

A

72 hours

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25
What patient counsellign should be given with bulk-forming laxatives?
- Ensure adequate fluid intake | - Don't take before bed to avoid obstruction
26
What laxative is recommended for pregnant women?
bulk-forming laxatives
27
Name some stimulant laxatives?
Bisacodyl, sodium picosulfate, senna, co-danthramer, co-danthrusate, docusate, glycerol suppositories
28
How long do stimulant laxatives take to work?
6-12 hours, take before bed for an effect the following morning Suppositories take 15-30 mins
29
What can be caused by excess use of stimulant laxatives?
- lazy bowel - diarrhoea - hypokalaemia - cramps
30
Which stimulant laxative also works as a faecal softener?
Docusate
31
How long should stimulant laxatives usually be used for?
Approx 7 days
32
Which stimulant laxatives should only be used in terminally ill patients?
Co-danthramer and co-danthrusate - potential carcinogens
33
Name some osmotic laxatives?
Macrogol 3350, lactulose, magnesium hydroxide
34
Why is lactulose also useful in hepatic encephalopathy?
Lowers faecal PH and stops proliferation of ammonia-producing bacteria
35
Which laxatives can be used for chronic constipation that is unresponsive to other laxatives for at least 6 - 12 months?
- Linaclotide (in IBS) - Lubirprostone - Prucalopride
36
How should opioid-induced constipation be treated?
1. Osmotic laxative WITH stimulant laxative 2. Naloxegol 3. Methylnaltrexone AVOID bulk-forming as can cause obstruction
37
Why should senna not be recommended in the third trimester / near term?
Can stimulate uterine contractions
38
First line for constipation in children?
Macrogol with diet/behaviour intervention
39
What are some 'red-flags' when to refer in diarrhoea?
- Unexplained weight loss - Rectal bleeding - Persistent diarrhoea - Systemic illness - Recent hospital treatment/abx - Recent foreign travel - Signs of dehydration
40
When would you refer these patients with diarrhoea? - Baby under 1 - Elderly patient over 90 - Adult - Child under 3 - Child aged 12
- Baby under 1 - over 1 day - Elderly - over 2 days - Adult - over 3 days - Child under 3 - over 2 days - Child aged 12 - over 3 days
41
What age can you sell loperamide OTC?
12 plus | For diagnosed IBS over 18s only
42
What is the maximum dose of loperamide?
16mg
43
What is the MHRA warning associated with loperamide?
- Risk of cardiac adverse reactions at high doses - Can cause QT prolongation, torsades de point, cardiac arrest - Remind patients not to take over recommended dose
44
How can loperamide overdose be reversed?
Naloxone - acts on opioid receptors in GI tract
45
What antibiotic is occasionally given as prophylaxis for travellers diarrhoea?
Ciprofloxacin
46
Contra-indications for loperamide?
- Active UC | - Antibiotic associated colitis
47
'Red flags' that mean an urgent endoscopic referral is needed in acid reflux/dyspepsia?
``` A - Anaemia L - Loss of weight A - Anorexia R - Recently changes symptoms/new symptoms if >55 M - Malaena, dysphagia, heamotemesis ```
48
What are the 2 main causes of peptic ulcer?
NSAIDs + H. pylori
49
What is the treatment for H. Pylori?
Twice daily PPI + Clarithromycin + Amoxicillin OR metronidazole for one week
50
How long should PPI therapy be given for H. Pylori?
Usually just for one week | Can be given for 4 weeks if ulcer is large or complicated (eg, haemorrhage)
51
How is H. Pylori tested for?
C-Urea breath test
52
Which patients are at high risk for developing an NSAID-associated ulcer?
- Over 65s - History of peptic ulcers/GI complications - Other meds with GI side effects - Those with serious co-morbidities
53
What is sucralfate used for and what is the associated risk?
Prophylaxis of gastric ulceration | Risk of bezoar formation esp, in seriously ill patients
54
Name some H2 receptor antagonists?
Ranitidine, cimetidine, nizatidine, famotidine
55
Caution to remember with H2 antagonists?
Can mask the symptoms of gastric cancer | If patients have alarm features then must rule out malignancy
56
What side effect is associated with H2 antagonists?
Psychiatric reactions - confusion, depression, dizziness and hallucinations esp in the elderly GI side effects - nausea, diarrhoea, constipation Erectile dysfunciton Tachycardia
57
Who can buy ranitidine OTC?
- Over 16s - Max 2 weeks treatment - 75mg per dose/ max daily dose 300mg
58
Which H2 receptor antagonist is considered safest in pregnancy?
Ranitidine
59
What is misoprostol used for?
Treatment/prophylaxis of ulcer
60
Why should misoprostol be avoided in pregnancy?
Teratogenic | Can induce uterine contractions and is associated with abortion
61
How do PPIs work?
Inhibit gastric acid secretion by blocking the 'proton pump' of the gastric parietal cell
62
'PPIs are associated with a low risk of subacute cutaneous lupus eythematosus' True or false?
True - If a patient develops lesions consider this diagnosis and advise them to keep skin protected from sunlight
63
3 cautions with PPIs?
- Mask symptoms of gastric Ca - Risk of osteoporosis/fractures, advise patients to have adequate calcium and vitamin D intake - Can increase the risk of GI infections including C. Diff
64
What monitoring is required with PPIs?
- Serum magnesium - risk of hypomagnesaemia and more common if over 1 year of treatment. - Sodium - can cause hyponatraemia
65
Why should a patient taking omeprazole + digoxin be monitored?
PPIs can cause hypomagnesaemia | Low magnesium increases the risk of digoxin toxicity
66
Important interactions with omeprazole?
- Methotrexate - omeprazole is an enzyme inhibitor and can decrease methotrexate clearance - Clopidogrel - omeprazole can decrease the anti-platelet effect
67
Which PPIs can be sold OTC?
Esomeprazole (nexium) 20mg - GSL Omeprazole 10mg - maximum treatment 20mg OD for 4 weeks Pantoprazole 20mg OD for 4 weeks **Can only be sold to 18+**
68
Which drugs can interact with antacids so must be taken after a 2 hour gap?
- Tetracyclines - Quinolones - Bisphosphonates Antacids can impair absorption
69
'Antacids can lower gastric PH' | True or false?
False - they increase gastric pH and therefore can damage medicines with enteric coating
70
In what conditions should antacids with high sodium content be used with caution?
- Hypertension - Heart, liver and kidney failure - Patients on lithium - monitor levels
71
What are anti-muscarinic side effects?
Fight/fight Can't see, can't wee, can't shit, can't spit Also tachycardia, pupils dilate, confusion (elderly)
72
Which antimuscarinics can be used to treat gastro-intestinal spasm?
Hyoscine butylbromide Dicycloverine Propantheline
73
When are anti-muscarinics contraindicated?
- Enlarged prostate/urinary retention - GI obstruction - Myasthenia gravis - Glaucoma
74
What is the MHRA warning associated with hyoscine butylbromide?
Risk of serious adverse effects in patients with underlying cardiac disease Can cause tachycardia, hypotension + anaphylaxis
75
When can you sell buscopan (hyoscine butylbromide) OTC?
- Over 6s - Medically confirmed IBS - Max single dose 20mg
76
Which BMI is classed as obese?
Over 30
77
When can orlistat be sold OTC?
- Over 18s - P medicine - Treatment can only be continued past 12 weeks if 5% reduction in body weight
78
Which vitamins can orlistat impair the absorption of?
Fat soluble | D, E, A, K
79
'Olistat may decrease the plasma concs of some drugs' | True or false?
True - eg, anticoagulants, amiodarone, ciclosporin
80
What advice should be given to patients receiving Creon (pancreatin)?
- Take with meals and snacks as inactivated by gastric acid - Inactivated by heat, don't take with hot food/drinks - Ensure adequate hydration - Avoid reduced fat diets and food that is hard to digest

Pre-reg revision (14 decks)

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