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Flashcards in Gastrointestinal Disorders Deck (15)
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1

What is an example of a clear explanation of indication/benefit for Nexium Hp7?

This pack is used for ulcers caused by a bacterial infection in the gut (H.Pylori). It helps to get rid of the bacteria; and help the ulcer to heal.

2

What is an example of clear directions for Nexium Hp7?

The pack contains 3 different medicines which must all be taken:
1. Amoxicillin capsules (antibiotic): TWO capsules twice daily (morning and night).
2. Clarithromycin tablets (antibiotic): ONE tablet morning and night.
3. Esomeprazole tablet (Proton pump inhibitor: reduces acid): ONE tablet twice daily (morning and night)
• Do not crush or chew. Take during or after meals.
• The course will be 7 days. This must be completed.

3

What are 5 major counselling points regarding side effects and precautions for Nexium Hp7?

1. As it is a short course, serious side-effects are rare.
2. Watch for any signs of allergic reactions to the antibiotics (like a rash). If it is intolerable or severe, stop taking the medications and let your doctor know.
3. If you notice any change of taste; sore mouth or tongue (may indicate thrush), tell your doctor.
4. If you get severe diarrhoea (even several weeks later), tell your doctor straight away.
5. There is a potential drug-drug interaction between atorvastatin and clarithromycin (enzyme inducer), which will increase levels of atorvastatin, potentially causing muscle aches. Ask if the doctor has discussed this with them. If not, monitor and advise the patient to watch out for side effects or contact the doctor to hold atorvastatin (only relevant in patients taking atorvastatin).

4

What is an example of monitoring/tests that should be done for Nexium Hp7?

Check the patient has a follow-up endoscopy planned for 4 weeks following completion of eradication therapy.

5

If a patient has been taking ibuprofen for an injury and has developed a stomach ulcer, what 2 options can they try?

1. Paracetamol
2. Topical NSAIDS (e.g. diclofenac gel)

6

What is an example of a clear explanation of indication/benefit for Amoxicillin/clavulanic acid?

This medicine contains two active ingredients. One is amoxicillin (a penicillin antibiotic) and the other is clavulanic acid (which makes amoxicillin work better). This combination should help kill the bacteria causing the infection.

7

What is an example of clear directions for Amoxicillin/clavulanic acid?

Take ONE tablet twice daily (morning and night), as close to 12 hours apart as possible (e.g. 7am and 7pm). Swallow each tablet whole with a full glass of water. Tablets can be broken in half, but do NOT crush or chew. This tablet will work best (be absorbed better) if taken before or with the first mouthful of food, but it will still work on an empty stomach. Taking with food can also help to prevent stomach upset. You must complete the course (may need a repeat).

8

What are 4 major counselling points regarding side effects and precautions for amoxicillin/clavulanic acid?

1. A short course is unlikely to cause any serious side-effects.
2. Look out for any signs of allergic reaction (e.g. rash). If it is intolerable or severe, stop taking and let your doctor know.
3. If you notice any change of taste; sore mouth or tongue (may indicate thrush), tell your doctor.
4. If you get severe diarrhoea (even if several weeks later), let your doctor know straight away.

9

If a patient asks what the difference between amoxicillin and amoxicillin/clavulanic acid is, what should you tell them?

Although you have been on amoxicillin, this product is a combination of amoxicillin and clavulanic acid (beta lactamase inhibitor), an ingredient that increases the activity of amoxicillin. The two ingredients have an additive effect, so this should help kill the bacteria causing the infection. Be sure to take twice daily for the full 10 days for best results (will need a repeat).

10

If a patient asks if they can drink alcohol while taking amoxicillin/clavulanic acid, what should you say?

Drinking alcohol (in moderation!) doesn’t usually cause any problems.

11

What is an example of a clear explanation of indication/benefit for metronidazole (when being used for clostridium difficile overgrowth caused by other antibiotics)?

Taking antibacterials can sometimes cause the overgrowth of a certain bacteria (clostridium difficile) that causes severe diarrhoea. This antibiotic helps to kill these bacteria, which relieves the diarrhoea.

12

What is an example of clear directions for metronidazole?

Take ONE tablet three times a day with a whole glass of water, about every 8 hours (as evenly spaced throughout the day as possible). Take each dose with food if you can (to help prevent stomach upset). If you cannot stomach food, that is ok. You must complete the course (may need a repeat).

13

What are 5 major counselling points regarding side effects and precautions for metronidazole?

1. Ask the patient if they drink alcohol, and if so, they should know it is important NOT to drink alcohol whilst on these tablets and for 24 hours after finishing the course as it can make them very sick (nausea, vomiting, flushing, headache, palpitations).
2. More common side effects include nausea/ vomiting (reduced by taking with food) and diarrhoea (remember if it is being used for clostridium difficile overgrowth, they will already have diarrhoea, so don't scare them by saying this).
3. May produce a metallic taste in the mouth.
4. Can cause some dizziness (avoid driving if affected).
5. Stop taking metronidazole and check with your doctor immediately if you have any numbness, tingling, pain or weakness in hands or feet.

14

What is an example of monitoring/tests that should be done for metronidazole (used for clostridium difficile overgrowth)?

Diarrhoeal symptom resolution

15

Why can a patient take antidiarrhoeals when clostridium difficile overgrowth is being treated, but not straight away if they experience it?

Using an antidiarrhoeal can make things worse, as it keeps the bacteria in the gut. Once it is being treated, however, it is okay to manage the diarrhoea with a product like loperamide. Electrolyte replacement is also appropriate.