GI SYSTEM- CHRONIC BOWEL DISORDERS, GORD, DYSPEPSIA, CONSITPATION, DIARRHOEA Flashcards
(209 cards)
1
Q
What is coeliac disease?
A
Gluten allergy causes inflammation in small intestine- malabsorption.
2
Q
What are the 5 symptoms of coeliac disease?
A
Diarrhoea
Abdominal pain
Bloating
Malnutrition
lactose intolerance
3
Q
What is 2 treatment options for coeliac disease?
A
Gluten free diet
Vitamin supplements
4
Q
What is diverticular disease?
A
Develop in mucosal lining of colon.
infection
5
Q
What are 2 treatments for diverticular disease?
A
High fibre diet + bulk forming laxatives
6
Q
What is inflammatory bowel disease?
A
Ulcerative colitis + crohn’s disease
7
Q
What are 5 symptoms of inflammatory bowel disease?
A
Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue
Mouth ulcers
8
Q
What are 3 drug classes which help with acute flare ups + maintenance in inflammatory bowel disease?
A
Aminosalicylates
Corticosteroids
Drugs affecting immune system
9
Q
What 2 drugs are contra-indicated in U.colitis?
A
Loperamide
Codeine
cause colonic dilation - BAD
10
Q
List 4 aminosalicylates?
A
Balsalazide
Mesalazine
Olsalazine
Sulfasalazine
11
Q
What is 1st line drug treatment for mild-moderate UC?
A
topical Aminosalicylates
2nd line - oral version
12
Q
What is 1st line alternative drug for mild-moderate UC?
A
Aminosalycilates, then oral , then
corticosteroids
13
Q
What is 1st line drug for acute Crohn’s disease (1 episode)?
A
Corticosteroids
14
Q
List 5 corticosteroids?
A
Beclometasone
Budesonide
Hydrocortisone
Methylprednisolone
Prednisolone
15
Q
What 6 drugs affect the immune system?
A
Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate
MABs
Janus kinase inhibitors
16
Q
What is 1st line drug for acute moderate to severe UC?
A
Immune system drugs
e.g. JAK inhibitors
17
Q
What is 1st line for acute crohn’s disease (2 + episodes + remission)?
A
Immune system drugs
18
Q
What is MOA of aminosalicylates?
A
Reduces cytokine + free radical formation.
inhibits prostaglandin synthesis
19
Q
What is 1st line use of aminosalicylates?
A
Ulcerative colitis , CD
20
Q
What are 4 main SEs of aminosalicylates?
A
Blood disorders
Nephrotoxicity
Salicylate hypersensitivity
Hepatotoxicity
21
Q
What 3 things should be monitored on aminosalicylates? (sulfasalazine)
A
FBC + LFT - blood disorders (monthly for 3 months)
RFT- nephrotoxicity (before, 3 months, year)
22
Q
What is patient counselling for aminosalicylates?
A
Report signs of infection or blood disorders.
e.g. sore throat, fever, mouth ulcers, bleeding or bruising.
23
Q
What aminosalicylates stains soft contact lenses?
A
Sulfasalazine
24
Q
What colour does sulfasalazine stain contacts and urine?
A
Yellow orange
25
What does sulfasalazine label say?
This med may colour urine, This is harmless.
26
What drug interacts with aminosalicylates?
Lactulose
27
What is the risk of if patient has G6PD deficiency?
neonatal haemolysis
28
How is RFT monitoring done for aminosalicylates?
Before treatment
At 3 months
Annually
29
How is monitoring done for sulfazalazine?
LFTs and FBC monthly for 1st 3 months
30
What is the risk of aminosalicylates in pregnancy?
Risk of haemolysis in 3rd trimester- give enough folate.
31
What is irritable bowel syndrome (IBS)?
Affects digestive sysyem
32
What are 3 antispasmodics for GI spasm?
Alverine
Mebeverine
peppermint oil
33
What are 2 SEs of peppermint oil?
Heartburn
Throat irritation
34
What 2 medications are used for constipation related to IBS?
Any class laxative except lactulose
Linoclotide
35
What are 4 antimuscarinics?
Atropine
Hyoscine butyl-bromide
dicycloverine
propantheline bromide
36
What antispasmodic can be used in pregnancy?
Peppermint oil
37
What is 1st line treatment for diarrhoea?
Oral rehydration therapy
Loperamide next
38
What is last resort for IBS?
Low dose TCA
39
What are 3 main symptoms of IBS?
Lower abdominal colic
Bloating
Diarrhoea - constipation
40
What are non pharmacological treatments for IBS?
Diet and lifestyle changes, exercise
Limit fruit to 3 portions max
Review fibre intake, if more needed, use soluble one e.g isphagula husk
8 cups water a day
Avoid sorbitol in diarrhoea
If probiotics used, continue 4 weeks + review
41
Why is lactulose NOT recommended in IBS?
Can cause bloating
42
When is linaclotide used for IBS constipation?
Patients who have not responded to laxatives from the different classes + who have had constipation for at least 12 months
43
What is Short bowel syndrome?
Intestinal failure after large surgical resection
44
What are 2 treatments for Short bowel syndrome?
Vitamins + mineral supplement - deficiency
Diarrhoea = give loperamide
45
What are 3 symptoms of Short bowel syndrome?
Malnutrition
Diarrhoea
Poor drug absorption
46
What 2 preparations are NOT suited for Short bowel syndrome?
Enteric coated or Modified release
47
What 4 drugs may need to be prescribed at a higher dose or IV due to short bowel syndrome?
warfarin
oral contraceptives
Digoxin
levothyroxine
48
What 3 preparations are used in short bowel syndrome?
Uncoated
Soluble tablets
liquid
49
What is constipation?
Infrequent difficult to pass or incomplete stools
50
What are 5 red flags for constipation?
Blood in stool
Sudden weight loss
Abdominal pain
Anaemia
New onset -50 + years
51
What are 3 symptoms of constipation?
Dry, hard, lumpy stools
Less than 3 times a week
Straining, abdominal pain, bloating
52
What is 1st line treatments for constipation? (BOS)
Bulk forming laxatives
Osmotic laxatives
Stimulant laxatives
53
What are 3 examples of bulk forming laxatives?
Ispagula husk
Methylcellulose - fecal softner
Sterculia
(Bran)
54
What is onset of action for bulk laxatives?
within 72 hrs
55
When are bulk forming laxatives used?
After dietary measures do not work
First line constipation
56
What are 4 main SEs of bulk forming laxatives? (BICH)
Bloating + flatulence
Intestinal obstruction
Cramping
Hypersensitivity
57
How to avoid intestinal obstruction with bulk forming laxatives?
Drink enough water
swallow tablet with lots of water, not before bed
58
List 3 osmotic laxatives?
Lactulose
macrogol 3350
magnesium hydroxide
59
List 5 stimulant laxatives?
Senna
Glycerol suppositories
Bisacodyl
Sodium picosulfate
Co-danthrusate
Co-danthramer
Docusate sodium
60
What 2 stimulant laxatives are limited to terminally ill patients due to carginogenicity?
co-danthramer + co-danthrusate
61
Why are Stimulant laxatives avoided in intestinal obstruction?
can cause abdominal cramp + increase intestinal motility
62
What 2 other properties does glycerol suppositories have?
Lubricant
Rectal stimulant
63
What does Docusate sodium act as?
BOTH stimulant laxative + faecal softener
64
How do fecal softeners act?
decreasing surface tension + increasing penetration of intestinal fluid into the faecal mass
65
List 4 stool softeners?
Liquid paraffin
Docusate (weak stimulant)
Glycerol (rectal stimulant)
Methylcellulose (bulk forming)
66
Why is Liquid paraffin cautioned?
Side effects e.g.
anal seepage + risks of granulomatous disease of the GI tract or of lipoid pneumonia on aspiration.
67
How do enemas with arachis oil work?
lubricate + soften impacted faeces + promote a bowel movement
68
Which osmotic laxative is not fully absrobed?
Lactulose
69
What osmotic laxative is used for hepatic encephalopathy?
Lactulose
70
What is Prucalopride?
selective serotonin 5HT4-receptor agonist
prokinetic properties
71
When is Prucalopride used?
Licensed for chronic constipation in adults, when other laxatives have failed.
72
What is linaclotide?
guanylate cyclase-C receptor agonist
73
When is linaclotide used?
Licensed for the treatment of moderate- severe IBS associated with constipation.
74
When is onset of osmotic laxatives?
2-3 days
except lactulose (48 hrs)
75
What is onset of action for lactulose?
48 hrs
76
When are osmotic laxatives used?
2nd line
+ or switch if stools still hard
77
What are some SEs of osmotic laxatives?
Diarrhoea, bloating, flatulence, cramps, nausea (lactulose)
Dehydration
78
When are stimulant laxatives used?
3rd line - if stool hard to pass
79
What are 5 SEs of stimulant laxatives? (RED DAHL)
Red-brown urine
Diarrhoea
Abdominal cramps
Hypokalaemia
Lazy bowel syndrome
80
What colour urine does senna cause?
Red brown urine
81
What colour urine does co-danthrusate cause?
Orange
82
What is onset of action of stimulant laxatives?
6-12 hrs
83
What is onset of glycerol suppositories?
15-30 mins
84
What is a contra-indication of stimulant laxatives?
NOT used in intestinal obstruction
85
What is an MHRA warning for stimulant laxative pack size?
Smaller pack size OTC
2 short courses for 12 + years
86
What electrolyte imbalance can stimulant laxatives cause?
Hypokalaemia
87
What age can stimulant laxatives be not used in?
Stimulant laxatives should NOT be used in children under 12 years of age without advice from a prescriber
Children aged 12 - 17 years, products can be supplied under the supervision of a pharmacist.
88
What are 4 SEs of stool softeners? (GLAM)
Granuloma in GI tract
Lipoid pneumonia
Anal seepage/ irritation
Malabsorption of fat soluble vitamins
89
What are 4 fat soluble vitamins?
A, D, E + K
90
When are prucalopride + linaclotide used ?
If pt unresponsive to 2+ laxatives in different classes after 6 months
91
What 2 drugs are used for opioid- induced constipation if other laxatives do not work?
Methylnaltrexone
Naloxegol
92
What type of laxatives should be AVOIDED in opioid- induced constipation?
Bulk forming - intestinal obstruction + colic
93
What 2 types of laxatives are 1st line recommended in opioid induced constipation?
osmotic + a stimulant laxative (or docusate sodium)
94
What is 1st line for constipation in children?
Macrogol + stimulant laxative
95
What is 1st line for constipation in pregnancy + breast-feeding?
Bulk forming laxatives (or glycerol suppositories if response MIA)
e.g. bran/wheat
96
What 2 laxatives to avoid near term pregnancy?
Senna
Bisacodyl
97
What is treatment of faecal impaction for hard stools?
high dose of an oral macrogol
98
What is treatment of faecal impaction for soft stools?
oral stimulant laxative should be started or added to the previous treatment.
99
What is fecal impaction treatment if oral laxatives don't work + stool is soft?
bisacodyl
100
What is fecal impaction treatment if oral laxatives don't work + stool is hard?
glycerol
101
What is fecal impaction treatment nothing works?
a sodium-acid phosphate with sodium phosphate or arachis oil enema
102
What is diarrhoea?
Passing loose stools - increase frequency + volume
103
What are 7 red flags for diarrhoea?
Unexplained weight-loss
Rectal bleeding
Persistant diarrhoea
Systemic illness
Hospitalised
Abx
Foreign travel - except Western Europe, austrailia , North america, New zealand.
104
What are 2 symptoms of diarrhoea?
Frequent watery stools
Dehydration
105
What is 1st line treatment for diarrhoea?
Oral rehydration salts
106
What does oral rehydration salts contain?
Glucose
Rice powder
Na+
K+
107
What is Racecadotril used for?
Treatment of diarrhoea in adjunct to oral rehydration salt in people 3 months+
108
List 7 anti-diarrhoeals?
Loperamide
Codeine
Co-phenotrope
Kaolin
Kaoline with morphine
methylcellulose
rifaximin
109
What is rifaximin used in?
Traveller's diarrhoea
110
What abx is used as prophylaxis for traveller's diarrhoea but not routinely recommended?
Ciprofloxacin
111
MOA of loperamide?
Binds to opioid receptors in gut wall + slow motility = increases transit time
112
What is co-phenotrope?
Opioid + antimuscarinic
Diphenoxylate + atropine
113
What is loperamide used for?
Traveller's diarrhoea + normal
114
What is dose of loperamide in 12+?
4mg stat dose
2mg after loose stool for 5 days
115
What is max loperamide dose a day?
16mg
116
what age is loperamide syrup not licensed in?
Syrup not licensed for use in children under 4 years.
117
what age is loperamide capsules not licensed in?
Capsules not licensed for use in children under 8 years.
118
When is loperamide NOT licensed?
NOT licensed for use in children for chronic diarrhoea.
119
What are 2 contraindications of loperamide?
Colitis - abx related, UC
Worsens conditions -e.g. abdominal distension
120
What are 4 SEs of loperamide?
Dizziness
flatulence
headache
nausea
121
What is an MHRA warning related to high doses of loperamide?
serious cardiac SEs with high doses- misuse.
Remind patient of dose
122
What age is loperamide not recommended in?
Not recommended for children under 12 years (in children)
123
Can loperamide be used in pregnancy?
No- no info
124
What to give in loperamide overdose?
Naloxone
monitor 48 hrs - CNS depression
125
What is dyspepsia?
Umbrella term - group of upper abdo symptoms
126
What are 6 symptoms of dyspepsia?
Upper abdo pain
Heart burn
Gastric reflux
belching/gas
bloating/ feeling full
N+V
127
What are 4 red flags of dyspepsia?
GI bleeding
unexplained weight loss
dysphagia
55+ years (cannot explain symptoms)
128
What 4 things can cause dyspepsia?
functional - no cause
Peptic ulcer
GORD
cancer
129
What 5 drugs can cause dyspepsia? (NBC)
NSAIDs
Nitrate
Bisphosphonate
CCB, corticosteroid
130
What is 1st line treatment for uninvestigated dyspepsia?
PPI 4 weeks
Do H pylori test
High risk patients = elderly, NA
131
What happens when clopidogrel + omeprazole given?
Clopidogrel conc reduced
132
What is treatment for functional dyspepsia?
PPI or H2 receptor antagonist - 4 weeks (e.g. ranitidine)
H pylori test
132
What are 2 symptoms of GORD?
Heartburn
unpleasant taste
132
What is GORD?
Gastric content comes back up into oesophagus.
133
What drugs may cause GORD? (TANC-B)
NSAID, Nitrate
Bisphosphonates, BB
CCB, corticosteroid
Alpha blocker, Antimuscarinics
TCA
134
What is treatment for univestigated GORD?
PPI 4 weeks (same as dyspepsia)
135
What is treatment for endoscopy confirmed GORD?
PPI (4-8 weeks)
OR
H2 receptor antagonist
136
What is treatment for severe oesophagitis?
PPI- 8 weeks
137
What is 1st line treatment of GORD in pregnancy?
Diet + lifestyle
138
What is 1st line drug treatment of GORD in pregnancy?
Antacids
Omeprazole (severe syx)
OR
Ranitidine
139
What are peptic ulcers?
Open sores in lining of stomach or duodenum
140
What are 2 high risk patients of peptic ulcers?
history of complicated ulcer
2+ risk factors
141
What are 2 main causes of peptic ulcers?
NSAID use
H. pylori infection
142
What are other risk factors of peptic ulcer?
65+ years
High dose + long termuse
SSRIs - GI bleeding
Serious co-morbidity e.g CVD, HT, DM
Smoking
143
What are 7 symptoms of peptic ulcers?
Burning pain
Dyspepsia
Heartburn
Nausea
Bloating
Appetite loss
Weight loss
144
Wha ti is treatment for NSAID-induced ulcer?
PPI or H2 antagonist - 8 weeks
H pylori test
Stop NSAID
145
What to give if NSAID needs to be continued but patient has ulceration?
Consider COX-2 inhibitor instead + PPI
146
What is treatment for GORD if patient has NO NSAID history and No h, pylori?
PPI or H2-receptor antagonist should be used
for 4–8 weeks
147
What to do if patient with GORD H. pylori positive?
Treat infection first
148
What 2 tests to diagnose H. pylori?
C13 urea breath test
Stool Helicobacter antigen.
149
When to not do H pylori test?
Within 2 weeks PPI or 4 weeks of abx
150
what is h pylori treatment?
PPI (BD) + 2 antibiotics (amoxicillin, clarithromycin or Metronidaxole)
151
How many times is PPI taken a day for H. pylori treatment?
BD
152
What is 1st line H pylori treatment if penicillin allergy?
PPI
Metro
Clarithromycin
153
MOA of antacids?
Neutralises gastric acid
Symptomatic relief within 15-30 mins.
154
What is 2nd line H pylori tx if penicillin allergy?
PPI
Metro
Levofloxacin *
155
MOA of alginate?
Forms viscous gel raft on top of stomach contents to prevent reflux.
156
List 4 antacids?
Aluminium salt
Magnesium salt
Calcium salt
Sodium salt
157
What are 2 long acting antacids?
Aluminium salt
Magnesium salt
158
What is a constipating antacid?
Aluminium salt
159
What is a laxative antacid?
Magnesium salt
160
List 2 alginates?
Alginic acid
Sodium alginate
161
What antacid formulation is more effective than tablets?
Liquid
162
When is low Na+ preparations useful in ?
Patients with HTN, HF, Kidney failure + fluid retention.
163
What are 2 uses for antacids/alginates?
Dyspepsia
GORD
164
How to take antacids/alginates?
After each main meal, at bedtime or PRN.
165
What 3 drugs/classes drug absorption is reduced by antacids/alginates absorption?
Bisphosphonates
tetracyclines
quinolone (cipro)
166
What can antacids/alginates damage?
Enteric coating of other tablet
167
How to prevent antacids/alginates from reducing absorption of other drugs?
Give other drugs 2 hrs apart
168
MOA of PPI?
Blocks gastric acid secretion - blocks H+/K+ ATPase in parietal cells
Most effective
169
What PPI is taken 30-60 mins before food?
Lansoprazole
169
What PPI is safe in pregnancy?
Omeprazole
169
What are 3 uses for PPI?
Peptic ulcer
Dyspepsia
GORD
170
What is dose for PPIs?
Lowest effective dose for shortest period
171
How to take PPI?
Swallow whole. Leave 2 hr gap between indigestion remedies.
172
List 5 SEs with PPIs? (G-CASH)
GI disturbances
Clearance reduced (methotrexate toxicity)
Antiplatelet effect - clopidogrel
SCLE
Hypomagnesaemia +fractures
173
What does PPI mask?
Gastric cancer
174
What does PPI do to bones?
Cause increase in fractures + GI infections
175
What does Omeprazole do to clopidogrel?
Reduces antiplatelet effect
176
Omeprazole + Methotrexate?
Reduces MTX clearance = builds up = toxic
177
MOA of H2 receptor antagonists?
Blocks gastric acid secretion - blocks H2 receptors in parietal cells.
178
3 uses of H2 antagonists?
Peptic ulcer
GORD
DyspepsiaW
179
What are 4 H2 antagonists?
Cimetidine
Famotidine
Nizatidine
Ranitidine
180
What H2 antagonist is enzyme inhibitor?
Cimetidine
181
What H2 antagonist is discontinued (MHRA)?
Ranitidine - stopped due to safety, No new patients should be started on it.
182
What are 4 main SEs of H2 antagonists?
Headaches
Rashes
Dizziness + diarrhoeaq
183
What does H2 antagonist mask?
Gastric cancer
184
What is contra-indicated in aminosalicylates?
Salicilate hypersensitivity
185
What age is ulcerative colitis most common in?
15-25 years
186
What is proctitis?
Inflammation of rectum
187
What is proctosigmoiditis?
Inflammation rectum + sigmoid colon
188
What is left- sided colitis?
Colon distal to the splenic flexure
(my right)
189
What is extensive colitis?
Colon close to the splenic flexure and includes pan-colitis
More is affected
190
What are 3 main symptoms of UC?
Bloody diarrhoea
Urgent need to poo
Abdo pain
191
What are 4 complications of UC?
Colorectal cancer
secondary osteoporosis
VTE
toxic megacolon
192
When to consider adding topical or oral corticosteroid in proctitis?
If taking aminosalicylates for 4 weeks not working.
193
How long to try oral steroids for proctitis?
4-8 weeks
194
What is 1st line for proctosigmoiditis + left-sided UC?
Topical aminosalicylates as well.
195
What is used as 1st line for mild-moderate extensive UC?
Topical aminosalicylate + high dose oral aminosalicylate
196
What is given in life threatening severe UC?
IV steroid methylpred or HC.
assess surgery
197
What is given in life threatening severe UC if steroids contra-indicated?
Ciclosporin or surgery.
198
What is licensed for relief of diarrhoea linked to crohn's disease?
Colestyramine
199
What 6 drugs can cause peptic ulcers and should be stopped if suspected?
NSAIDs
aspirin
bisphosphonates,
immunosuppressive agents (e.g. corticosteroids),
potassium chloride, selective (SSRIs) recreational drugs
200
Patient with peptic ulcers testing positive for H-pylori should be reviewed when after starting treatment?
Reviewed 6–8 weeks after starting eradication treatment + re-tested, depending on the size of the lesion
201
What is an MHRA alert about PPis?
Proton pump inhibitors (PPIs): very low risk of subacute cutaneous lupus erythematosus.
can occur weeks, months or even years after exposure to the drug
consider discontinue use + avoid sunlight if developing lesions
202
Who is IBS more common in?
Women
203
What age group does IBS affect?
20-30 years
204
205
When should patients with peptic ulcer need to be reviewed again for H. Pylori?
Patients with peptic ulcers (gastric or duodenal) who tested positive for H. pylori should be reviewed 6–8 weeks after starting eradication treatment and re-tested, depending on the size of the lesion.
