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Applied Pharmacy Practice > Minor Ailments - Gastrointestinal queries in Community Pharmacy > Flashcards

Minor Ailments - Gastrointestinal queries in Community Pharmacy Flashcards

1
Q

What are Common GI Queries?

A
  • Dyspepsia/Indigestion
  • Gastro-Oesephogeal Reflux Disease (GORD)
  • Constipation
  • Diarrhoea
  • Nausea and Vomiting
  • Piles
  • Irritable Bowel Syndrome (IBS)
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2
Q

How to deal w/ common GI queries?

A
  • Define each condition
  • Symptoms
  • Causes
  • Referral (red-flags)
  • Treatment/management (life-style changes)
  • Remember WWHAM
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2
Q

what is ‘Dyspepsia/Indigestion’?

A
  • Refers to a group of symptoms, that are linked to eating and drinking – associated with excess acid
    SYMPTOMS:
  • Bloating
  • Burping
  • Stomach cramps
  • Flatulence
    CAUSES:
  • Certain foods
  • Time of eating
  • Caffeine
  • Medication
  • GI tract problems (ulcer,cancer, infection)
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2
Q

What is GORD?

A
  • Indigestion or Heartburn or Acid Reflux or GORD
  • Often terms are used interchangeably by patients
  • Heartburn (acid reflux) occurs when the sphincter muscle between the stomach and oesophagus open allowing stomach acid to leak back up into the oesophagus
  • Indigestion (dyspepsia) occurs when acid from the stomach comes into contact with the lining of the digestive system
  • GORD is a more chronic severe form of acid reflux
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3
Q

What is Gastro-oesophageal
Reflux Disease (GORD)?

A
  • Reflux of gastric content into the oesophagus
    **SYMPTOMS **:
  • Gastric pain
  • Discomfort and wind
  • Nausea
  • Acidity (back of throat)
  • Abdominal pain
    CAUSES:
  • Diet and lifestyle:Overeating, drinking,obesity
  • Pregnancy
  • Incompetence of oesophageal sphincter (hernia, drug induced)
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3
Q

treatment of GORD = lifestyle advice

A
  • Diet changes: avoid large meals, fatty/hot spicy
    food, reducing alcohol consumption and stop
    smoking
  • Avoid aggravating factors
  • Raising the head of the bed and not lying down
    within three hours of taking a meal
  • Loosing weight if overweight
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3
Q

treatment of GORD = antacids

A
  • Raise pH (neutralize/ counteract excess acid) & provide rapid relief
  • Alter absorption of certain drugs and damage enteric coating of tablets
    ** Sodium Bicarbonate**
  • Belching of CO2, less suitable in flatulence
  • Sodium content
    ** Aluminium and Magnesium Hydroxide**
  • Aluminium causes constipation
  • Magnesium causes diarrhoea
  • Used in combination – counteract both problems
  • i.e Remegel, Rennie, Gaviscon
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3
Q

treatment of GORD = Alginates

A
  • Rafting agents
  • Could be mixed with antacids = raft forming alginate & antacid
  • Forms a raft/viscous foam
  • Floats on top of the stomach contents
  • Protects oesophagus during reflux
  • i.e Gaviscon Advance
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4
Q

what is a H2-receptor antagonist?

A
  • Competitive antagonist of H2-receptor
  • Inhibit histamine-induced acid secretion
  • Effective at night
  • OTC: Ranitidine (Zantac) no longer available OTC due to international recall – minimal amounts of NMDA (probable carcinogen) found.
  • Slower acting than antacids
  • i.e Famotidine – POM
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4
Q

What is Diarrhoea?

A
  • Passing soft or watery stool at an increased
    frequency (> 3 times/day)
  • Common and debilitating condition
  • Can be life-threatening due to dehydration
  • Symptoms include: crampy stomach pains, fever, loss of appetite, nausea and vomiting
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4
Q

When to refer GORD?

A
  • Dysphagia= difficulty / discomfort swallowing
  • Hematemesis= vomiting caused by internal bleeding
  • Weight loss
  • Vomiting
  • Upper abdominal masses
  • Repetitive request for OTC supply
  • Onset of new symptoms
  • Upper epigastric pain= pain in upper abdomen
  • Hunger pain
  • Night pain relieved by eating
  • Drug induced
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5
Q

How to manage Diarrhoea?

A
  • General advice - drink plenty of fluid, high
    carbohydrate food
  • if Drug induced = review medication and counselling
  • Oral rehydration therapy
  • Antibiotics
  • Antimotility drugs
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5
Q

What are Proton pump inhibitors (PPIs)?

A
  • Inhibit a chemical system called the hydrogen-potassium adenosine triphosphatase enzyme system (otherwise known as the ‘proton pump’)
  • PPIs are converted to active drugs at acid pH
  • Regular use to be effective as they have preventative role rather than symptomatic (think NSAIDs)
  • Inhibit certain drugs metabolism thus increase their concentration
  • i.e Omeprazole, Pantoprazole & Esomeprazole
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6
Q

What causes Diarrhoea?

A
  • Bacterial or viral infection - food is culprit
  • Broad spectrum antibiotics – alter natural gut flora leading to superinfection
  • Medication: PPIs, Magnesium salts, NSAIDs, Metformin, Iron salts. Excessive use of laxatives
  • Change of climate and country – body not used to different water and food
  • Anxiety and too much alcohol
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7
Q

what are the signs of dehydration?

A

DRY:
* Mouth, lips cracked, eyes
* Loose skin, lack of elasticity
* Sunken features
URINE/GI:
* Low output
* Concentrated
* Low abdominal pain, burning sensation in stomach, loss of appetite
HEAD:
* Dizziness, light-headedness, tiredness,
headaches
* Clammy hands and feet
* Confusion and irritability

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7
Q

Treatment for dehydration = Oral Rehydration Therapy (treatment for diarrhoea)

A
  • Dehydration causes electrolyte disturbances – problems with certain drugs (e.g. diuretics)
  • Specific mixture of electrolytes and glucose
  • Made up to correct osmolality- freshly boiled and cooled water
  • Number required depends on number of watery stools
  • Dioralyte/Rehydration salts
8
Q

Treatment of diarrhoea = Antimotility agents

A
  • Symptomatic but limited use
  • Reduce motility of the gut, allowing reabsorption or water and minerals
  • Allow control of diarrhoea- less disturbances to daily activities
  • Loperamide widely used – less central side effects
9
Q

Treatment of diarrhoea = Antibiotics

A
  • Most cases are viral in nature
  • If bacterial infection confirmed by stool culture, then correct antibiotic prescribed
  • Traveller’s diarrhoea: need to ascertain any recent travel history
10
Q

When to refer diarrhoea?

A
  • Length of diarrhoea >3 days
  • Blood in stool
  • Moderate to severe dehydration- not properly self managed- elderly
  • Drug induced (clindamycin, colchicine)
  • Recent travel – check
  • Regular purchase of codeine based products
11
Q

What causes constipation?

A

LIFESTYLE:
* Diet lacking fibres,/fluid lack of exercise
* Hospital admission, depression, anxiety
* Ignoring call to stool ( go tot teh bathroom)
Metabolic/drugs/neurological:
* Hypothyroidism, hypercalcemia, hypokalaemia,
diabetes
* Opiates, irons, antacids, antidepressants,
* Dementia, stroke, multiple sclerosis, parkinsonism
Bowel disorders:
* Anal pathology
* Tumour
* Diverticular disease ( a condition that ffects the large intestine)

11
Q

What is Constipation?

A
  • Altered bowel habits, reduced frequency and passing hardened faeces
  • The Rome IV diagnostic criteria for constipation
    include spontaneous bowel movements occurring fewer than three times a week.
  • Usually harmless but can indicate underlying serious disorders
  • What is important is REGULARITY not FREQUENCY
12
Q

How to manage Constipation?

A

Lifestyle changes
* Balanced diet , high in fibre and non-starch
polysaccharides
* High fluid intake Increased exercise
Laxatives
* Medicines that increases the number of bowel
movements
* Osmotic/Stimulant/Bulk-forming/Softeners

13
Q

When to consider laxatives?

A
  • Straining to pass stool that might affect other conditions like haemorrhoids or angina
  • Temporary illness which causes constipation e.g. lack of movement or loss of appetite
  • Elderly person develop constipation due to low mobility
  • Drugs taken concomitantly
  • Also (not related to constipation): before colonoscopy
13
Q

treatment of constipation = stimulant laxatives

A
  • Stimulate nerve endings in gut which causes muscle to contract - speeds up peristalsis
  • Taken at bedtime, takes 8-12 hours to work
  • Rapid relief of symptoms
  • Short term- risk of bowel nerve damage
  • Can cause cramps/gripping pain
  • i.e Senna, bisacodyl, glycerol (also osmotic in its action
13
Q

treatment of constipation = bulk forming agents

A
  • Swell up in gut to increase faecal mass
  • Stimulates peristalsis
  • Take few days to work , should be taken with plenty of water and not immediately before bed - risk of bowel obstruction
  • Equivalent to high fibre diet
  • Can cause wind/bloating
  • i.e Isphagula, methycellulose, sterculia
14
Q

treatment of constipation = osmotic laxatives

A
  • Increase the flow of water into the intestines to produce softer and easier-to-pass stools
  • Variable onset of action: phosphate enema (within 1 hour), lactulose (2-3 days), macrogols (12-24 hrs) and Magnesium salts (2-4 hours)
  • Lactulose is broken down in the gut and increases volume of faeces and water content
  • Can cause abdominal ramp and wind
  • i.e Lactulose, macrogols, (phosphates and sodium citrates in enemas for urgent relief of constipation), magnesium salts, glycerol
15
Q

treatment of constipation = Faecal softeners

A
  • Lubricating and softening faeces making them easier to pass
  • Small quantities due to serious side effects
  • Include: paraffin seepage from faeces which irritate the anus
  • Absorption of paraffin from the gut can cause damage to the gut wall
  • Interferes with absorption of fat-soluble vitamins (A, D, E, and K)
  • i.e Docusate
16
Q

what is Nausea and Vomiting?

A
  • Common occurrence
  • Could following exposure to bacterial toxin
  • May reflect serious underlying pathology
  • Focus on GI related nausea and vomiting for OTC supply
17
Q

when to refer constipation?

A
  • Drug induced when regular laxatives are needed
  • Sudden onset of symptoms with no apparent reason especially in elderly
  • Blood in faeces (bare in mind haemorrhoids and straining)
  • Overuse – slimming purposes
  • Severe abdominal pain
18
Q

What causes Nausea and Vomitting?

A
  • Alcohol
  • Bacterial and viral infection
  • Motion sickness
  • Drugs (anticancer, NSAIDs, iron salts,
    erythromycin, SSRIs….)
  • Peptic ulceration, migraine, pregnancy, head
    trauma
  • Meniere’s disease ( inner ear issue) , renal failure
19
Q

Treatment for Nausea & vomittting

A
  • Manage the symptoms
  • Oral rehydration therapy
  • Preventative measures (diet)
  • i.e Dioralyte, Pepto-bismol
20
Q

When to refer Nausea & vomitting?

A
  • Blood in vomit
  • Duration > 2 days
  • Weight loss
  • Severe abdominal pain
20
Q

What are the symptoms of Haemorrhoids?

A
  • Common bleeding after going to the toilet
  • Itching and irritation
  • Sense of not fully emptying rectum when going
    to the toilet
  • Sense of fullness around the anus
20
Q

How to manage Haemorrhoids?

A
  • Eat plenty of fibre: fruit, vegetables, wholemeal
    bread….
  • Drink plenty of water: adults advised to drink 2 L
    a day. Alcoholic drinks can be dehydrating
  • Fibre supplements: bulk forming agents/bran
  • Toileting: respond to the call to toilet/not
    postpone, resist straining
  • Treating and managing constipation if present
  • Choice of preparation depends on location
  • Creams/Ointments more suitable for external use
  • Suppositories for internal use
  • Topical Corticosteroids to reduce inflammation and itching
  • i.e Germoloids, Anusul plus HC ointment, Anusol suppositories
20
Q

What are Haemorrhoids (Piles)?

A
  • Swollen veins in the lining of the anus and rectum
  • External at the anus or internal in the rectum
  • Occur because of increased pressure on
    haemorrhoidal vein
  • Made worse by straining and constipation
  • Pregnant women are particularly prone
20
Q

What are the symptoms of IBS?

A

Gripy, colicky pain across lower abdomen
* Wind and bloating
* Fatigue and disturbed bowel habits
* Diarrhoea and constipation
* OTC supply will be based on whether patient has confirmed IBS

20
Q

What is Irritable bowel syndrome (IBS)?

A
  • Common bowel disorder
  • Ages 20-30, more common in women
  • Abnormal contractions of the muscles in the
    large intestine and increased sensitivity of the
    bowel to the presence of gas and movement
  • Causes are poorly understood - may be related
    to anxiety and depression or certain food types
20
Q

How to manage IBS?

A
  • Diary of diet, activity – define aggravating factors and avoid
  • Diarrhoea and constipation management as discussed in previous section
    Non-medical treatment
  • Cognitive behavioural therapy
  • Hypnotherapy
  • Acupuncture
    Antispasmodics=
  • work by relaxing the intestine muscle so relive muscle spams
  • i.e Hyoscine, mebeverine, peppemint oil, alverine

Applied Pharmacy Practice (18 decks)

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