GI OTC Flashcards

Question

What is dyspepsia? (3)

Answer 1

Indigestion Heart burn Trapped wind

Answer 2

Hurried meals Overindulgence (food/drink) Spicy food Smoking Overweight Pregnancy Medicines (NSAIDs, Digoxin, Iron) HF H.pylori.

Answer 3

Epigastric discomfort shortly after eating/drinking Feeling of fullness Heartburn Trapped wind N+V

Answer 4

1. Antacids: Mg salts (Milk of Magnesia): - Can cause diarrhoea Al salts - can cause constipation Bismuth salts (Pepto-Bismol): - Avoid if aspirin-sensitive, pregnant, not for < 16 yrs. Combination prep.: - Co-magaldrox. 2. Activated simeticone: - Antifoaming agent - Reduces surface tension of gas bubbles - Windsettlers 3. Alginates: - Useful to treat acid reflux - Raft effect - Combination with antacids - Gaviscon, Peptac. 4. PPI: - Omeprazole 20mg/10mg tablets - For recurrent heartburn - 20mg OD - No improvement after 2 weeks =Refer - Can use up to 4 weeks at 10mg dose - Use lowest effective dose - Available as GSL (esomeprazole)

Answer 5

Digoxin Enteric coated tablets Lithium serum levels reduced by sodium bicarbonate. Tetracycline Warfarin Iron Alendronic Acid Avoid concomitant administration 2-4 hrs either side of dose.

Answer 6

Small regular meals Avoid meals late at night Avoid highly spiced meals. Avoid bending/stooping Don’t wear tight clothes Raise head of the bed Take antacids about 1 hr after food.

Answer 7

GP Referral: - 1st time dyspepsia 45 yrs + Endoscopy Referral: - > 55 yrs and with alarm signs or persistent unexplained symptoms: - Persistent vomiting - Appetite loss - Difficulty swallowing - Feeling of lump in throat - GI bleeding.

Answer 8

Disturbance to normal motility of large bowel. Diagnosed by elimination Emotion Stress Food intolerances. F>M 2x likely to experience IBS. Adolescents + young people.

Answer 9

Young people: - Bloating - Alternative bouts of constipation/diarrhoea - Abdominal Pain Rectal fullness, incomplete evacuation.

Answer 10

Nausea Back Pain Urinary frequency/urgency.

Answer 11

Should only offer IBS treatment OTC if the condition has previously been diagnosed by a Dr: 1. Anti-spasmodic: Intestinal smooth muscle relaxants C/i = paralytic ileus - Mebeverine (Colorado IBS) - Hyoscine butylbromide (Buscopan IBS) - Peppermint Oil (Colpermin) contains arachis oil. 2. Anti-diarrhoeals: Loperamide (Imodium): - Decreases bowel motility - Reduces stool frequency and urgency - Poor BBB penetration. 3. Bulking agent: Ispaghula husk (Senokit High Fibre) - Improves constipation and diarrhoea.

Answer 12

Food diary - record triggers Ask if taking other medicines. Try not to rush meals. Eat balanced diet and plenty of fluids. Take regular exercise Relaxation

Answer 13

If symptoms persist for > 2 weeks despite treatment or if symptoms have changed: - Bloody stools - Not had IBS diagnosed by Dr - Fever - Unexplained weight loss

Answer 14

Change in lifestyle, eating habits. Reduced fluid intake Lack of exercise Medication Depression IBS Anal fissures Haemorrhoids Pregnancy Refusal to obey urge to pass stool.

Answer 15

Decrease in bowel movement frequency. Hard Stools Straining What is the normal bowel habit?

Answer 16

1. Diet and lifestyle changes and increase fluids. 2. Bulk forming laxatives: - Ispaghula husk: - Slow action (24-72 hrs) - Taken with plenty of water - Not taken at bedtime - Not for frail elderly/bed bound - Can alter medication absorption. 2. Stimulant laxatives: Stimulate the nerve endings in the bowel wall: - Anthraquinones: Senna (Senokot, Ex-lax) - Act within 8-12 hrs. 3. Diphenylmethane derivatives: - Bisacodyl (Dulcolax tablets + supps) - Sodium picosulphate (Dulcolax-pico, Dulcolax Perles) 4. Osmotic laxatives: Retains fluid in the bowel so stimulating peristalsis and forming a loose stool. More powerful than bulk laxatives. - Mg salts (Mg sulphate = Epsom salts, Mg Hydroxxide = Milk of Magnesia) - Effective within 3 hrs - Lactulose/Macrogol (polyethylene glycol 3350) - Longer action = up to 72 hrs of regular dosing - Sweet tasting - C/i lactose/galactose intolerance. - Caution in diabetes. ‘Babies and children < 14 yrs can take lactulose if their doctor recommends it. Don’t give lactulose to a child < 14 yrs unless their doctor has said it’s ok.’ 5. Glycerol (Glycerin Suppositories 1g,2g and 4g) - Effective within 1-2 hrs. 6. Faecal Softeners: - Docusate sodium (Diocytyl caps) - Little if any straining required. - Effective within 1-3 days.

Answer 17

GSL = >18 yrs P = 12 yrs Pack size limits: - Standard strength = 20 - Max. Strength = 10 - Syrup = 100ml Inappropriate/overuse use = short-term occassional relief only.

Answer 18

Improve diet, exercise, increase fluids. Don’t take stimulant laxatives regularly. Don’t take bulk laxatives at bedtime. Pregnancy: - Osmotic/bulk forming = safe - Stimulant = c/i Breastfeeding: - Stimulant laxatives = c/i Babies: - Breastfeeding: May need extra water from a bottle. - Bottle fed: Are they making feed with sufficient water. Elderly: - Increase fluids = dehydration - Bulk laxatives = care in bed bound or inactive patients.

Answer 19

Constipation + - Illness and unable to work - Children/babies who exhibit ill symptoms - Bloody stools - Continuous severe pain - Weight loss - Diarrhoea unless diagnosed IBS - Self medication not effective after 4-5 days. - Fever/night sweats - N+V

Answer 20

Piles = Varicose dilatations of the veins in the lower part of the large intestine +/or anus becomes engorged with blood.

Answer 21

Anal infections (scratching/STI) Sports (e.g. cycling) Sitting/standing for long periods Pregnancy Constipation Pelvic area lesion Laxative abuse

Answer 22

Itching in perineal area Not always but can be painful. Can be sharp pain on defaecation Bright red blood on stool and toilet paper.

Answer 23

As per constipation: - Increase in intra-abdominal pressure. - Old age - Dehydration - Inadequate fibre in diet - Medication

Answer 24

1. Topical preparations (creams/ointments/suppositories) Astringents Local anaesthetics Antipruritics Heparinoids Emollients Antiseptics (Anusol, Preparation H, Germoloids) Treat symptom not cause. 2. Hydrocortisone (Adjunct) - No > 7 days - Not for pregnancy/BF - Adults > 18 yrs - Not used if broken skin or infection.

Answer 25

Hygiene Diet Not to scratch area Avoid straining Increase activity Laxatives (faecal softeners)

Answer 26

Duration > 3 weeks Internal anal pain Rectal Bleeding Suspected drug induced constipation Recurrent piles (regular recurrence)

Answer 27

Viral/Bacterial/Bacterial toxins Inner ear disorders Migraine Motion Sickness Meningitis Medication = Digoxin, Theophylline, NSAIDs. Pregnancy

Answer 28

Ensure px doesn’t become dehydrated - offer electrolyte replacement. Sip water little and often. Avoid dairy products + greasy food for 24 hrs. Pregnancy - morning sickness: - Frequent small meals - Ginger - Sea-bands Re-introduce light diet when hungry.

Answer 29

Projectile vomiting = babies / adults Vomiting stained with blood Vomiting with associated weight loss 2 days often the cut off but consider the overall health of the patient Babies < 12 months and symptoms > 24 hrs Children < 3 yrs and elderly and symptoms for 48 hrs. People with diabetes if persistent.

Answer 30

Bowel movement = increase frequency and change in consistency.

Answer 31

Bacterial/Viral Diet changes/overindulgence Medication Food allergies Secondary to a medical conditions e.g. diabetes, hyperthyroidism, IBS. Stress

Answer 32

1. No treatment usually resolves itself. 2. Must maintain fluid intake: - Oral rehydration sachets (Dioralyte): - Mix with recommended amount of water - Will keep for 1hr or 24 hrs if in fridge. - Sip little and often 3. Anti-diarrhoeal: - Loperamide (Imodium caps): - Decreases bowel motility - For adults + children > 12 yrs 4. Morphine containing products (Kaolin + Morphine = Diocalm): - Combined with an adsorbent - Can be a problem of dependence - Not recommended 5. Bismuth Salicylate (Pepto-Bismol): - C/I aspirin allergy.

Answer 33

Ensure high fluid intake. If recommending OTC product emphasise how to take correctly. If no better after OTC tx or symptoms worsen = see GP. Babies: - Ensure bottles are properly sterilised and making feeds properly. - Refer: < 12 months and symptoms > 24 hrs, < 3 yrs and elderly and symptoms for> 48 hrs, older adults and children > 72 yrs.

Answer 34

1. Elderly: - If symptoms persist for 48 hrs. 2. Refer if: - Chronic diarrhoea - Recurrent diarrhoea - With fatigue/pain lasting > 2 days 3. Refer ALL patients if: - Weight loss - Bloody stool - Persistent mucous in stool - Symptoms change/worsen - Alternating diarrhoea/constipation.