GI system

Question 1

which medication should NOT be used in pregnant women/ women trying to concieve to treat acid reflux

Answer 1

Misoprostol

note: it can be used for peptic ulcers but it is also used to terminate pregnancies. if any females use this, they need to be on contraception

Question 2

which two laxatives should only be used in palliative care (terminally ill)

Answer 2

co-danthramer and co-danthrusate

• these are both stimulant laxatives
• note this is because animal studies say they are potentially carcinogenic*

Question 3

which laxative can be used to treat hepatic encephalopathy

Answer 3

lactulose

note: hepatic encephalopathy is a nervous system disorder brought on by severe liver disease

Question 4

what is the first line treatment for both short-duration constipation and chronic constipation

Answer 4

bulk-forming laxative e.g bran,ispaghula husk (fybogel), methylcellulose and sterculia

• ensure adequate fluid intake.
• if ineffective, use osmotic laxative e.g lactulose/ macrogols*

Question 5

what is the first line treatment for opioid-induced constipation

Answer 5

an osmotic laxative (e.g lactulose or macrogols)

or

• docusate sodium (this is both a stimulant + faecal softener)
• note: naloxegol used if these ones don’t work*

Question 6

what is the first choice laxative for faecal impaction

Answer 6

macrogols

• this is in both adults + children

Question 7

how do you manage constipation in pregnant/ breastfeeding patients

Answer 7

if dietary advice not worked

first:
- fibre supplements in the form of bran or wheat

if still not worked:
- bulk forming laxatives e.g bran, ispaghula husk (fybogel), methylcellulose and sterculia

*note: avoid stimulant laxatives e.g bisacodyl, sodium picosulfate, senna (especially if near full term/ unstable pregnancy)