OTC GI Flashcards by Molly Moss

What is the BMI needed for orlistat to be supplied?

28 or above

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When do you refer patients who want orlistat?

Levothyroxine 
Amiodarone
Ciclosporin
Warfarin and DOACS
Acarbose
Anti epileptics

Take caution if oral contraceptives, ADEK vitamin deficiency

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What conditions need to be referred if a patient wants orlistat?

Diabetes
Hypertension
High cholesterol

Chronic malabsorption syndrome
Cholestasis 
Pregnancy or breastfeeding
Kidney disease
Failure to lose weight after 3 months

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How do you take orlistat?

1 capsule TDS

Prevents absorption of dietary fat

18+

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What is the advice needed for orlistat?

Not substitute for healthy diet
5 portions fruit and veg
18-30g fibre
2.5L fluids
Exercise 30mins/day 5 days a week
Alcohol, 2-3 units a day if interspersed with several alcohol free days

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What are the symptoms of constipation?

Small hard stools passed less frequently than normal

Straining
Incomplete emptying
Abdominal cramps/bloating
Nausea

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When do you refer constipation?

Blood in stools
Unexplained weight loss, appetite loss
Patients over 40 with sudden change in bowel habit
Medication ADR 
Constipation and lethargy, weight gain , coarse, thinning hair, dry skin
Stimulant laxatives abuse
Obstruction 
> 2 weeks

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What are the OTC products for constipation?

BOSS laxatives

Bulk forming
Osmotic
Stimulant
Stool softeners

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What are the bulk forming laxatives OTC?

Isphagula husk 6+
Sterculia 6+
Methylcellulose

2-3 days
Oesophageal or intestinal obstruction

Swallow with water and not immediately before bed

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What are the osmotic laxatives used OTC?

Macrogol 12+/2-11 movicol
Lactulose 3 months +
Magnesium sulphate 12+

2-3 days

Discomfort, flatulence, cramps

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What are the stimulant laxatives used OTC?

Senna 6+/12+
Bisacodyl 10+
Sodium picosulfate 10+
Docusate 18+

6-13 hours

Glycerin suppositories, 15-30 mins

Hypokalaemia, diarrhoea, lazy bowel
Take at night

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What is used otc for pregnant women constipation?

Bulk forming or lactulose

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What is the caution for elderly patients with constipation?

Caution recommending bulk forming as risk of obstruction

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What is used for children OTC constipation?

Lactulose

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What is used for opioid induced constipation otc?

Lactulose and stimulant laxative

Avoid bulk forming

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What is the advice for constipation?

Lifestyle advice

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What causes dyspepsia?

Indigestion
GORD
Gastritis
Gastric or duodenal ulcers

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What are the symptoms of dyspepsia?

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Vague abdominal pain above the belly button
Bloating, belching, flatulence, early satiety
Fullness
Nausea
Vomiting
Heartburn

What are the referral criteria for dyspepsia?

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ALARM

Anaemia 
Loss of weight
Anorexia
Recently changed or new, over 55 
Malaena

How do you rule out peptic ulcers in dyspepsia?

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Persistent gnawing,boring pain from one point in the abdomen

How do you rule out cardiovascular problems?

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Pain radiating to jaw, back and arms

Pain precipitated by exercise and not relieved by antacids

When else should dyspepsia be referred?

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Symptomatic treatment > 4 weeks

Medication ADR

Refuse PPI if due for endoscopy in 14 days

Previous ulcer

Children

Regurgitation

Jaundice

What are the OTC products for dyspepsia?

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Antacids

Alginates - gaviscon suitable in pregnancy

Take after each main meal and at bedtime or when required

What are the antacid interactions?

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Impairs absorption of other drugs, leave 2 hour gap

Tetracyclines, quinolones, bisphosphonates

High sodium content - fluid retention

Damage enteric coatings by increasing stomach pH

What are the PPIs used OTC?

Omeprazole Esomeprazole Pantoprazole 18+, max supply 14 days. Max use 4 weeks Once daily, swallow whole Omeprazole interacts with warfarin, phenytoin, clopidogrel

What is the advice for dyspepsia?

``` Stop smoking Avoid excess alcohol Caffeine, chocolate Avoid bending over Raise head of bed Weight reduction ```

What are the symptoms of haemorrhoids?

``` Swollen veins Protrude into anal canal or prolapses outside anus Dull pain on defaecation Slight rectal bleeding Perianal itching and burning Swelling and soreness in perineum ```

When should you refer haemorrhoids?

``` Blood in stools Abdominal pain, nausea, vomiting, fever, malaise, loss of appetite Altered bowel habit Tenesmus Severe sharp pain on defaecation Symptoms > 3 weeks Unresponsive > 1 week OTC failure Constipating medication ```

What are the OTC products used for haemorrhoids?

Soothing agents Mild astringents Local anaesthetics, 12+ Products with hydrocortisone 18+, avoid in pregnancy/breastfeeding

What is the advice for haemorrhoids?

Increase dietary fibre Treat constipation if present Clean with attention to minor faecal soiling Pregnancy increases risk of haemorrhoids

What are the symptoms of diarrhoea?

Frequent, loose water stools Abdominal cramps Nausea Flatulence Dehydration

What are the referral criteria for diarrhoea?

Babies < 3 months < 1 year, diabetic, elderly > 1 day < 3 years > 2 days ``` Refer everyone > 3 days ALARM Faecal impaction Recent travel abroad Severe vomiting, high grade fever Chronic diarrhoea > 3 weeks ```

What medication needs referral when diarrhoea occurs?

``` Magnesium antacids NSAIDs Iron Laxatives Antibiotics Digoxin PPI Diuretics SSRI ```

What are the OTC products for diarrhoea?

ORT all ages 1-2 sachets after each loose motion Loperamide 12+, 2 caps after each loose motion maximum 8 in a day Not recommended in pregnancy or breastfeeding Kaolin and morphine 12+ Bismuth 16+

What is the advice for diarrhoea?

``` Stay hydrated Eat plain, bland foods Babies - dilute formula feeds to quarter strength, more frequently than normal Avoid drinks with high sugar Avoid milk ```

What is advice for people travelling abroad with regards to diarrhoea?

Drink bottled water Avoid uncooked fish, meat, poultry Wash hands regularly and use clean towels

What are the symptoms of IBS?

Lower abdominal spasms Bloating Alternating constipation and diarrhoea

When should IBS be referred?

Children > 45 first time symptoms Blood in stools Bowel obstruction ALARM Pregnant women Depression

What are the OTC products are the antispasmodics used in IBS?

Mebeverine 18+ Alverine 12+ Peppermint oil 15+ Swallow capsules whole, irritates mouth and oesophagus Heartburn

What OTC antimuscarinics are used for IBS?

Hyoscine 12+ Dicycloverine 12+ Additive anticholinergic effect with antihistamines, TCAs, antipsychotics, avoid in glaucoma and prostatic enlargement

What is used for constipation in IBS?

Bulk forming

What is used for diarrhoea in IBS?

Loperamide 18+

What is the advice for IBS?

``` Limit to 3 portions fruit and veg Increase soluble fibre Avoid insoluble fibre Eat regularly and avoid missing meals 8 glasses water Limit stress Probiotics ```

OTC GI Flashcards

(43 cards)