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GI Flashcards

1
Q

If anyone over 55 has ALARMS symptoms what should be done

A

OGD

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2
Q

If no ALARMS symptoms what is initially recommended

A
  • Lifestyle advice
  • Antacids OTC
  • Stop dyspepsia inducing medication
  • Review in 4W
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3
Q

If no improvement in 4W what should be done

A
  • Test for H.Pylori
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4
Q

If H.pylori test is positive what is done

A
  • Treat for H.Pylori
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5
Q

When does H.pylori not need to be re-tested for

A
  • If symptoms improve. If not, re-test in 4W
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6
Q

If initial H.Pylori test is negative what is done

A
  • PPI for 4W or H2 antagonist
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7
Q

If no improvement using a PPI or H2-antagonist what is done

A
  • Long-term PPI and OGD
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8
Q

What are 12 dyspepsia inducing drugs

A
  • A blockers
  • B blockers
  • Calcium channel blockers
  • Nitrates
  • Benzo’s
  • TCAs
  • Corticosteroids
  • Bisphosphonates
  • Aspirin
  • NSAIDs
  • Anti-muscarinics
  • Theophylline
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9
Q

What dose/route/frequency of alginate is given

A

SODIUM ALGINATE WITH POTASSIUM BICARBONATE

1 Tablet BD
PO
Chew immediately after meals or before bedtime

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10
Q

What 3 medications are given to eradicate H.Pylori

A

PPI

Amoxicillin

Clarithromycin

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11
Q

What 3 medications are given to eradicate H.pylori if someone is penicillin allergic

A

PPI
Metronidazole
Clarithromycin

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12
Q

What dose/route/frequency of PPI is given

A

OMEPRAZOLE
40mg BD
PO
Review: 7d

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13
Q

What dose/route/frequency of amoxicillin is given

A 
AMOXICILLIN
1g BD
PO
Review:7d 
Indication: H.Pylori Eradication
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14
Q

What dose/route/frequency of clarithromycin is given

A

CLARITHROMYCIN
500mg BD
PO
Review:7d

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15
Q

What dose/route/frequency of metronidazole is given

A

METRONIDAZOLE
20mg OD
PO
Review: 7d

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16
Q

If someone is H.pylori negative with dyspepsia what is given

A

H2 receptor antagonist or PPI

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17
Q

What dose/route/frequency is used for long-term H2 receptor antagonist use

A

RANITIDINE
150mg BD
PO
Review: 6W

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18
Q

What is an alginate/antacid

A

Salt (magnesium, aluminum) and sodium bicarbonate

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19
Q

What can magnesium alginates cause

A

Diarrhoea

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20
Q

What can aluminum alginates cause

A

Constipation

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21
Q

When should potassium/sodium antacids be used with caution

A

Renal failure - risk fluid overload and hyperkalaemia

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22
Q

Explain antacids and taking other drugs

A

Wait 2h before taking other drugs (listed below) as antacids reduce their absorption

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23
Q

What 6 drugs does antacids reduce absorption of

A
  • ACEi
  • Antibiotics (Cephalosporin, Ciprofloxacin, Tetracycline)
  • Bisphosphonates
  • Digoxin
  • Levothyroxine
  • PPI
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24
Q

What two drugs does antacids increase the excretion of and why

A
  • Aspirin. Lithium - increases alkalinity of urine
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25
What is the MOA of omeprazole
Inhibits H+ - K+ channels in gastric pareital cells reducing acid excretion
26
What are two common side effects of omeprazole
Headache GI disturvance
27
What can omeprazole use result in
Increases C. Diff risk
28
What electrolyte abnormality can long-term omeprazole use cause
Hypomagnaesaemia
29
How does hypomagnesaemia present clinically
- Tetany | - Ventricular arrhythmias
30
What is a relative contraindication of omeprazole and why
- Osteoporosis. Long-term omeprazole use increases risk of fractures
31
What drug does omeprazole reduce the efficacy of
- Clopidogrel.
32
If a patient is on clopidogrel what should they be given
- Lansoprazole | - Pantoprazole
33
What advice should be given to patients on omeprazole
Report any ALARMS symptoms
34
If a patient is on omeprazole for more than one year, how should it be monitored
Serum magnesium
35
What is the MOA of amoxicillin
Inhibits cross-linking of peptidoglycan chains causing water to enter and lysis
36
What class of drug does amoxicillin belong to
Broad spec penicillin
37
What are GI side effects of amoxicillin
1. Nausea. Diarrhoea 2. Increases risk C.Diff 3. Acute liver injury - causes cholestatic jaundice and hepatitis
38
What immunology SE does amoxicillin predispose to
- Penicillin allergy | - Anaphylaxis
39
If first exposure of amoxicllin in a patient with an allergy, when will the rash appear
7-10d
40
If a repeat exposure of amoxicllin in a patient with an allergy, when will the rash appear
2d
41
What is an absolute CI to amoxicillin
Allergy
42
What are 3 relative CI to amoxicilin
- Risk of C Diff - Penicillin associated liver injury - Renal impairment
43
What drug does amoxicillin enhance the effect of and why
Warfarin. | Kills gut flora that produce vitamin K.
44
What advice should be given to patients on amoxicillin
If develop a rash - seek medical advice
45
What is checked before starting amoxicillin
Allergy
46
What are 5 SEs of clarithromycin
- GI disturbance (Nausea, Diarrhoea, Abdo Pain) - Allergy - Antibiotic associated colitis - Cholestatic jaundice - Prolong QT - Ototoxicity
47
What is an absolute CI of clarithromycin
Allergy
48
What is the effect of clarithromycin on CYP450
CYP450 Inhibitor
49
Due to inhibiting CYP450 what can clarithromycin cause when given with warfarin
Bleeding
50
Due to inhibiting CYP450 what can clarithromycin cause when given with statins
Myopathy
51
What drugs may clarithromycin interact with to cause arrhythmias
Other drugs that prolong WT (SSRI, Amiodarone, Anti-psychotics, Quinine, Quinolones)
52
What is checked before starting clarithromycin
Allergies
53
What are two common side effects of metronidazole
- GI upset, N+V | - Hypersensitivity reactions
54
What are 4 neurological SEs of metronidaozle
- Peripheral neuropathy - Optic neuropathy - Seizures - Encephalopathy
55
When should metronidazole dose be reduced
Liver impairment
56
What is an absolute CI to metronidazole and why
Alcohol. Metronidazole inhibits acetaldehyde dehydrogenase causing acetaldehyde to build up and hang-over life effects.
57
What drug does metronidazole increase toxicity of
LITHIUM
58
What is the effect of metronidazole on CYP450
Inhibitor
59
What can metronidazole cause when given with warfarin
Causes bleeding - due to inhibiting CYP450
60
What advice is given to patients on metronidazole
Do not drink alcohol whilst on metronidazole and 48h post treatment
61
What is checked before starting metronidazole
Allergy
62
What should be checked before 10d following starting metronidazole
LFTs | FBC
63
What is the MOA of ranitidine
H2 antagonist. Stops histamine release stimulating gastric parietal cells
64
What are 3 SEs of ranitidine
- Headache - Dizziness - GI (diarrhoea or constipation)
65
When should dose of ranitidine be reduced
Hepatic impairment

PSA (3 decks)

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