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GI System Flashcards

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1
Q

What is coeliac disease?

A

Autoimmune condition associated with chronic inflammation of the small intestine, restricting nutrient absorption.

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2
Q

What is the cause of coeliac diseases?

A

Gluten intolerance

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3
Q

Symptoms of coeliac disease?

A

Diarrhoea
Abdominal pain
Bloating
Malabsorption of key nutrients e.g. Ca and vit. D

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4
Q

Can coeliacs disease cause osteoporosis?

A

Yes due to reduced absorption of vit D and Ca

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5
Q

How is coeliacs disease treated?

A

Gluten-free diet
Vitamin and mineral supplements following discussion with a HCP
Prednisolone for initial management while awaiting specialist advice

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6
Q

What is diverticulitis?

A

Small bulges or pockets in the lining of the intestine

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7
Q

What are the symptoms of diverticulitis?

A

Lower abdominal pain
Constipation and diarrhoea

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8
Q

Treatment of diverticulitis?

A

High fibre diet
Bulk forming laxatives E.g. methyl cellulose to treat diarrhoea and constipation
Uncomplicated can be treated with simple analgesics such as paracetamol

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9
Q

Does diverticulitis require antibiotics?

A

Yes when presenting with symptoms of infection or immunocompromised

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10
Q

What is inflammatory bowel disease?

A

Umbrella term for ulcerative colitis and Crohn’s disease

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11
Q

What is ulcerative colitis?

A

Inflammation and ulcers in the colon or rectum

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12
Q

Symptoms of IBD?

A

Bloody diarrhoea, abdominal pain, weight loss, fatigue and mouth ulcers

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13
Q

True or false:
During a flare up of UC, symptoms can be seen elsewhere such as mouth ulcers, arthritis, sore skin, weight gain and fatigue

A

True

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14
Q

What are the long-term complications of UC?

A

Colorectal cancer
Secondary osteoporosis
VTE

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15
Q

What is Crohn’s disease?

A

Inflammation of the GI tract (anywhere from mouth to anus)

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16
Q

First line treatment for mild-moderate UC?

A

Aminosalicylates
Or corticosteroids as alternative

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17
Q

Examples of aninosalicylates?

A

Mesalazine
Sulfasalazine

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18
Q

First line treatment for 1 acute CD flare up per year?

A

Corticosteroids
Alternatively can use aminosalicylates

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19
Q

First line treatment for 2+ acute CD flare ups per year or to maintain remission?

A

Immunosuppressant
E.g. azathioprine or methotrexate

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20
Q

First line treatment for moderate - severe UC?

A

Immunosuppressant
E.g. azathioprine or methotrexate

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21
Q

Can loperamide and codeine be used in IBD related diarrhoea?

A

NO. Only for CD as it can cause paralytic ileum in UC PTs

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22
Q

Can corticosteroids be used for long-term remission of CD?

A

No due to side effects such as osteoporosis and diabetes

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23
Q

Side effects of aminosalicylates?

A

Blood disorders - STOP and report signs of infection or blood disorders - do a FBC
Nephrotoxicity
Salicylate hypersensitivity

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24
Q

What is the main side effect of sulfasalazine?

A

Colours body fluids yellow - orange

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25
Interaction between lactulose and MR mesalazine?
Lactulose decreases pH of the intestines meaning MR preparations may not be released
26
Symptoms of irritable bowel syndrome?
Lower abdominal colic Bloating Diarrhoea or constipation
27
Treatment of abdominal colic in IBS?
Antispasmodics E.g. Alverine, mebeverine and peppermint oil or Antimuscarinics E.g. atropine, Hyoscine butylbromide
28
Which laxative can not be used in IBS?
Lactulose - can cause bloating which can worsen IBS symptoms
29
First line treatment for diarrhoea in IBS?
Loperamide
30
Red flag constipation symptoms?
New onset in someone >50 Anaemia Abdominal pain Weight loss Blood in stool
31
Treatment for constipation?
1st line = lifestyle advice 2nd line = laxatives - “BOS” Bulk-forming, osmotic then stimulant laxative
32
Examples of bulk-forming laxatives?
Isphagula husk Methylcellulose
33
Onset of bulk-forming laxatives?
Can start working in 24 hours but can take up to 72 hours for full effect
34
Side effects of bulk forming laxatives?
Intestinal obstruction Bloating and flatulence Cramping Hypersensitivity - isphagula husk
35
Important counselling for bulk-forming laxatives?
Maintain adequate fluid intake, take with water and not before bed.
36
Example of an osmotic laxative?
Lactulose Macrogol Magnesium hydroxide
37
Onset of action for osmotic laxatives?
2-3 days 48hours for lactulose
38
Side effects of osmotic laxatives?
Diarrhoea, bloating, flatulence, cramps, nausea and dehydration. Does settle over time, maintain fluid levels to minimise risk of dehydration.
39
Examples of stimulant laxatives?
Senna Docusate Bisacodyl Glycerol suppositories
40
Onset of stimulant laxatives?
6-12 hours 15-30mins for glycerol suppositories
41
Side effects of stimulant laxatives?
Abdominal cramps Diarrhoea Hypokalaemia Lazy bowel syndrome Red-brown urine with senna
42
What colour does senna change your urine?
Red-brown Not harmful
43
OTC stimulant laxatives pack size and age?
Each PT limited to 2 short courses for PTs > 12 years old
44
What can be given to a PT unresponsive to 2+ laxatives from different classes?
Prucalopride Linaclotide
45
Which laxatives can be given in opioid-induced constipation?
Lactulose + senna
46
If first line laxatives for opioid induced constipation don’t work what can be given?
Methylnaltrexone Naloxegol
47
Is lifestyle advice first line for children with constipation?
No Offer “OS”
48
When is senna contraindicated for patients?
At term in pregnancy or if history of unstable pregnancy as can stimulate uterine contractions
49
1st line treatment for diarrhoea?
Oral rehydration salts (Diarolyte)
50
What is Rifaximin?
Antidiarrhoeal used for travellers diarrhoea
51
Can codeine be used for diarrhoea?
Yes
52
Age restriction for loperamide?
12+
53
Loperamide dose?
4mg STAT followed by 2mg after each loose motion for 5 days. Max 16mg in a day
54
Contraindications for loperamide?
Antibiotic associated colitis Peristalsis and abdominal distension
55
MHRA alert for loperamide?
Serious cardiac effects with high doses such as a prolonged QT interval, cardiac arrest or death
56
Loperamide antidote?
Naloxone
57
Red flag symptoms in dyspepsia?
GI bleeding Weight loss Dysphagia (difficulty swallowing) 55+ years old
58
Treatment of uninvestigated dyspepsia?
PPI for 4 weeks Test for h. Pylori
59
Treatment of diagnosed functional dyspepsia?
PPI or H2 receptor antagonist for 4 weeks Test for h. Pylori infection
60
Counselling for lansoprazole?
30-60mins before food
61
Which PPI is safest in pregnancy?
Omeprazole
62
PPI counselling?
Swallow whole, do NOT take indigestion remedies 2 hours before or after. Can take up to 2-3 days to work so can use antacid to bridge
63
What complications can PPIs lead to?
Can increase osteoporosis and c. Diff infections - stop
64
MHRA alert with PPIs?
Lupus erythematosis - lesions on sun-exposed areas Counsel PTs to avoid sunlight exposure and consider stopping PPI
65
Which electrolyte disturbance caused by PPIs predisposes to digoxin toxicity?
Hypomagnesaemia
66
Omeprazole interactions?
Clopidogrel - decreases antiplatelet effect Methotrexate - decreases clearance of methotrexate causing toxicity
67
Example of a h2 receptor antagonist?
Cimetidine Famotidine Ranitidine
68
Which h2 receptor antagonist is safest in pregnancy?
Ranitidine
69
Drugs which can cause GORD?
NSAIDs Nitrates Bisphosphonates CCBs Corticosteroids Beta blockers TCAs
70
Treatment of uninvestigated GORD?
Same as dyspepsia PPI for 4 weeks
71
Treatment of diagnosed GORD?
PPI for 4-8 weeks OR h2 receptor antagonist
72
Treatment of severe oesophagitis?
PPI for 8 weeks
73
Treatment of GORD in pregnancy?
1st line = Diet and lifestyle 2nd line = antacids 3rd line or symptoms are severe = Omeprazole or ranitidine
74
What are the 2 main causes of peptic ulcers?
H. Pylori and NSAIDs
75
Main symptom of a peptic ulcer?
Burning upper abdominal pain
76
Treatment of NSAID induced ulcer?
PPI or H2 receptor antagonist for 8 weeks H. Pylori test Stop NSAID or offer a selective cox-2 inhibitor + gastric protection. Misoprostal also an option but colic and diarrhoea are dose-limiting side effects therefore limiting use.
77
Non NSAID or non H. Pylori induced ulcer treatment?
PPI or H2 receptor antagonist for 4-8 weeks
78
Which test is used to diagnose H. Pylori?
Urea breath test and stool helicobacter antigen test. Do not perform test within 2 weeks of PPI or 4 weeks of antibiotic treatment
79
1st line H. Pylori eradication therapy?
7 days of PPI (BD) + 2 antibiotics from: Amoxicillin, Clarithromycin and metronidazole 1st line = PAC Avoid A if penicillin allergic Avoid C if recent treated with a macrolide
80
2nd line H. Pylori eradication therapy if patient has penicillin allergy?
PML = PPI (BD) + Metronidazole + Levofloxacin
81
Why do antacids contain both aluminium and magnesium salts?
Aluminium is constipating and magnesium is laxative therefore cancel each other out
82
When should high sodium containing antacids be cautioned?
Hypertension, heart, liver or kidney failure or PTs taking lithium
83
Which medications interact with antacids therefore requiring a 2H gap before and after?
Bisphosphonates Tetracyclines Quinolones PPI
84
How to take antacids?
After each meal, at bedtime or PRN
85
Treatment for food allergy?
Avoid food items Chlorphenamine - can be used to treat allergic symptoms such as hives Sodium chromoglicate
86
GI spasms treatment?
Antimuscarinics or antispasmodics
87
Examples of antimuscarinics?
Propantheline Hyoscine butylbromide (buscopan)
88
Antimuscarinic side effects?
“Can’t see, can’t pee, can’t spit, can’t shit” Opposite to cholinergic side effects
89
MHRA alert for Hyoscine butylbromide injections?
Serious side effects which are more likely to effect patients with underlying coronary heart disease. Side effects include tachycardia, hypotension and anaphylaxis.
90
Examples of antispasmodics?
Alverine, mebeverine and peppermint oil
91
Contraindication for antispasmodics?
Paralytic ileus
92
Counselling for peppermint oil?
Swallow capsules whole due to irritation of mouth and oesophagus
93
Anal fissure symptoms?
Linear split Sharp pain on defecation Bleeding (bright red)
94
Treatment of acute anal fissure?
Constipation - Tx = bulk forming laxative or osmotic as alternative Pain relief - Tx = simple analgesic or local anaesthetic (max a few days)
95
How many weeks is considered chronic for an anal fissure?
6+ weeks
96
Treatment of chronic anal fissure?
GTN rectal ointment inserted into the anal canal. Increases blood supply to area to improve healing
97
Symptoms of haemorrhoids?
Swelling Pain and bleeding after defecation Bright red blood Itchy
98
Treatment of haemorrhoids?
Constipation - Tx = bulk forming laxative Pain relief - Tx = simple analgesic (avoid NSAIDs in bleeding) Topical - Tx = local anaesthetic (max a few days) or corticosteroids (max 7 days)
99
What is exocrine pancreatic insufficiency?
Reduced pancreatic enzyme secretion
100
Treatment of pancreatic insufficiency?
Replacement therapy and vitamin supplements if deficient
101
Dietary advice for pancreatic insufficiency?
Distribute food intake into 3 meals and 2-3 snacks Avoid foods hard to digest E.g. high fibres foods Avoid reduced fat diets Avoid alcohol
102
How to take pancreatin?
Take with meals and snacks Do not mix with excessively hot food or drink and discard mixture after 1H Maintain adequate hydration at all times
103
What options are there if pancreatic levels still low with pancreatin?
May require an acid suppressor as enzymes may be denatured in the stomach making them less effective. Enteric coated pancreatin is also an option.
104
Pancreatin side effects?
GI effects Irritation of the perioral skin and buccal mucosa - excessive doses can effect the perianal area Can cause hypersensitivity reactions when handling powders Fibrosing colonopathy (colon wall forms thick scar tissue) can occur in cystic fibrosis PTs with high doses
105
Contraindications for pancreatin?
Children < 15 years old with cystic fibrosis as it is associated with colon strictures
106
Which medical forms are unsuitable in stoma patients?
EC and MR
107
Which formulations are preferred in stoma patients?
Fast acting medications E.g. soluble, uncoated, liquids and capsules
108
Are stoma patients at increased or decreased risk of GI side effects with drugs?
Increased
109
Which medications increase GI effects in stoma patients?
NSAIDs, opioids, iron, magnesium and aluminium antacids
110
Which electrolyte imbalance is caused by stomas?
Hypokalaemia - due to increased water depletion in stoma which predisposes to digoxin toxicity Consider potassium sparing diuretic or potassium supplement to counter this
111
Which laxative can be given to colostomy stoma patient?
Bulk forming if necessary

PharmEducate Notes (8 decks)

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