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PA- AP > GI > Flashcards

GI Flashcards

1
Q

Indications for PPI

A
  • Prevention and treatment for PUD
  • Treatment for GORD and dyspepsia
  • Eradication of helicobacter pylori
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2
Q

Side effects for PPI

A

-Abdominal pain
- constipation
- diarrhoea
- Headache
- Hypomagnesaemia

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3
Q

Contraindication for PPI

A
  • can mask symptoms of gastric/oesophageal cancer
  • Osteoporosis
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4
Q

Monitoring for PPI

A
  • Investigation should be carried out if symptoms persists after medication or if any alarm symptoms arise
  • For GORD - review annually
  • if prolonged use(>1yr) then check serum magnesium
  • If withdrawing from prolonged therapy- reduced dose and frequency
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5
Q

Patient education for PPI

A
  • Ensure duration is made clear
  • Report alarming symptoms like : weight loss, swallowing difficulty, vomiting blood, altered
    blood in the stool
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6
Q

Key interaction for omeprazole

A

clopidogrel

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7
Q

MOA for PPI

A
  • Proton pump inhibitors (PPIs) reduce gastric acid secretion. They act by irreversibly inhibiting H+/K+-ATPase in gastric parietal cells.
  • This is the ‘proton pump’ responsible for secreting H+ and generating gastric acid.
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8
Q

Examples of PPI

A

Omeprazole, Lansoprazole, esomeprazole

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9
Q

Example of H2 receptor antagonist

A

ranitidine, cimetidine, famotidine

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10
Q

Indications for H2 receptor antagonist

A
  • PUD-2nd line after PPI
  • GORD and dyspepsia -2nd line
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11
Q

Side effects for H2 receptor antagonist

A
  • usually mild
  • bowel disturbances
  • Headache and dizziness
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12
Q

contraindication for H2 receptor antagonist

A

Dose reduced in renal impairment

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13
Q

Monitoring for H2 receptor antagonist

A

Same as PPI
- Investigation should be carried out if symptoms persists after medication or if any alarm symptoms arise
- For GORD - review annually
- if prolonged use(>1yr) then check serum magnesium
- If withdrawing from prolonged therapy- reduced dose and frequency

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14
Q

Patient education for H2 receptor antagonist

A

Ensure that the intended duration of therapy is clear and
emphasise the need to report any ‘alarm’ symptoms (e.g. weight loss,
swallowing difficulty, vomiting blood, altered blood in the stool),
should they arise

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15
Q

Key interaction for H2 receptor antagonist

A

interacts with drugs metabolised by cytochrome P450 enzymes, notably including aminophylline/theophylline, amiodarone,
citalopram, phenytoin, quinine, and warfarin.

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16
Q

MOA for H2 receptor antagonist

A
  • Histamine H2-receptor antagonists (‘H2-blockers’) reduce gastric acid secretion.
  • Acid is normally produced by the proton pump of the gastric parietal cell, which secretes H+ into the stomach lumen in exchange for drawing K+ into the cell.
  • The proton pump is regulated by, among other
    things, histamine.
  • Histamine is released by local paracrine cells and binds
    to H2-receptors on the gastric parietal cell.
  • Via a second-messenger system, this activates the proton pump. Blocking H2-receptors therefore
    reduces acid secretion.
  • However, as the proton pump can also be
    stimulated by other pathways, H2-blockers cannot completely suppress gastric acid production.
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17
Q

Indications for alginates and antacids

A

GORD

Dyspepsia

18
Q

Side effects for alginates and antacids

A
  • Diarrhoea (Magnesium salts)
  • Constipation (Aluminium salts)
19
Q

Contraindication for alginates and antacids

A

Na and K containing prep-use with caution in renal failure

20
Q

Monitoring for alginates and antacids

A

red flag symptoms then review with specialist

21
Q

Patient education for alginates and antacids

A
  • relive within 20 min
  • taken after mealtimes and before bed
  • Temporary measure
  • Discuss lifestyle modification
22
Q

Key interaction for alginates and antacids

A

can reduced serum conc of drugs like ACE inhibitor , some antibiotics like ciprofloxacin, digoxin, levothyroxine and PPI

23
Q

MOA of alginates and antacids

A
  • Antacids work by buffering stomach acid. Alginates act to increase the viscosity of the stomach contents, which reduces the reflux of acid into the oesophagus.
  • After reacting with stomach acid they form a floating ‘raft’, which separates the gastric contents from the gastro-oesophageal junction to prevent mucosal damage.
  • There is some evidence that they also inhibit
    pepsin production
24
Q

Examples alginates and antacids

A

Gaviscon

25
Q

Examples of laxatives

A

macrogol 3350, lactulose (osmotic laxatives) senna, docusate sodium (stimulant laxatives)

26
Q

Indication for laxative

A
  • Constipation
  • Bowel prep
  • Hepatic encephalopathy (lactulose only)
27
Q

Side effect for laxative

A
  • Flatulence
  • Abdo cramps
  • diarrhoea
  • nausea
  • Melanosis coli (Long term use)
28
Q

Contraindication for laxative

A

intestinal obstruction

29
Q

Monitoring for laxative

A
  • stool chart
  • electrolyte
30
Q

Patient education for laxative

A
  • for it work need to drink plenty of water
  • if passing more than 2 or 3 soft stool per day then dose should reduced or stopped
31
Q

Key interaction for laxative

A
  • Macrogols
  • starch based thickeners
32
Q

Indication for metoclopramide

A

Prophylaxis and treatment of nausea and vomiting

33
Q

Side effects for metoclopramide

A
  • Diarrhoea
  • extrapyramidal effects
  • QT-interval prolongation
  • Arrythmias
34
Q

Contraindication

A
  • neonates, children and young adults
  • Parkinson’s disease
35
Q

Monitoring for metoclopramide

A

resolution of symptoms

36
Q

Patient education for metoclopramide

A
  • Only short term is recommended
  • Stop and seek medical attention if side effects occur
37
Q

Key interaction for metoclopramide

A
  • antipsychotic
  • dopaminergic agents
38
Q

Indication for loperamide

A
  • Symptomatic treatment of acute diarrhoea
  • Chronic diarrhoea
  • Faecal incontinence
  • Pain of bowel colic in palliative care
39
Q

Side effects for loperamide

A
  • GI disorders
  • Headache
  • Nausea
40
Q

Contraindication for loperamide

A
  • ulcerative colitis
  • children under 12
41
Q

Key interaction for loperamide

A
  • Clozapine
  • Dronedarone
  • Tepotinib
  • Velpatasvir
42
Q
A

PA- AP (11 decks)

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