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Pre Reg Pharmacy > R.CHAPTER 1- Gastro Intestinal System > Flashcards

R.CHAPTER 1- Gastro Intestinal System Flashcards

1
Q

Example of chronic bowel disorder?

A
  • Coeliac Disease
  • IBD (Inflammatory bowel disease)
  • IBS(Irritable bowel syndrome)
  • Diverticulitis & diverticulitis disease
  • short bowel syndrome
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2
Q

Symptoms chronic bowel disorder?

A

Abdominal pain
Diarrhoea
Rectal Bleeding

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3
Q

coeliac Disease?

A
  • Autoimmune condition associated with chronic inflammation of small intestines
  • Immune response triggered by gluten
  • leads to malabsorption of nutrients
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4
Q

Symptoms of coeliac Disease?

A
  • Abdominal Pain
  • Bloating
  • Constipation
  • Diarrhoea
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5
Q

How to reduce complications of Coeliac disease?

A

Calcium & vit D, folic acid, iron.

Reduce complications of osteoprosis/bone diease. Lack of iron- anaemia

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6
Q

Non-drug treatment of Coeliac Disease?

A

Strict, lifelong, gluten free diet.

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7
Q

Drugs used in Coeliac Disease?

A
  • Supplementation with calcium, vitamin D and folic Acid
  • Osteoprosis & bone disease treatment
  • prednisolone (initial management whilst awaiting specialist advice)
  • bisphosphonates
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8
Q

Diverticular Disease

A

-Diverticula causes intermittent lower abdominal pains without inflammation or infection.

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9
Q

Diverticular prevalence

A

Increase with age, mainly patients >40

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10
Q

Diverticular-Non drug treatment

A

Diet and lifestyle changes
Eat healthy, balanced diet, increase fibre,
weight loss, stop smoking, exercise.

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11
Q

Diverticular treatment

A

No antibiotics,
bulk forming laxatives-eg ispaghul husk
Paracetamol
Antispadmotics

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12
Q

Drugs that may increase perforation of diverticular disease?

A

Nsaids and opioids

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13
Q

Diverticulitis symptoms

A
  • Infected or inflamed diverticula
  • more severe abdominal pain
  • fever & general malaise
  • Large rectal bleeds
  • Fistula
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14
Q

Diverticulitis treatment?

A
  • High fibre diet
  • bran supplement
  • bulk forming laxative
  • antispasmodics (relief colic)
  • antibiotics (signs of infection)-eg co-amoxiclav
  • elective surgery
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15
Q

Drugs to avoid in diverticulitis

A

Anti-motility drugs (codeine phosphate & loperamide)

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16
Q

Inflammatory Bowel Disease (IBD)

and cause

A

2 conditions;
-chron’s disease
-ulcerative colitis
caused by genetic factors and problems with immune system

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17
Q

IBS

similarity between chrons & ulcerative colitis

A
  • long term conditions

- inflammation of the gut

18
Q

IBS- what is Chron’s

A

inflammation of any part of digestive system from mouth to bottom

19
Q

IBS- What is Ulcerative colitis

A

inflammation of colon (large intestine)

20
Q

Inflammatory bowel disease symptoms

A
  • Abdominal pain
  • rectal bleeding
  • diarrhoea
  • fever
  • weight loss
  • anal fissure
  • ulcers
  • anaemia
  • mouth ulcers
21
Q

other sypmtoms of IBS

A

-Inflammation and pain of some joints (arthritis)
-skin rashes
-inflammation of middle layer of eye (uveitis)
-liver inflammation
NB;symptoms come and go

22
Q

complications of chron’s

A
  • stricture(narrowing of GI tract)-leads to difficulty in passing food leading to vomiting and sickness
  • perforation; holes in the GI tract. contents of GI tract leak out and cause infection or abscess in abdomen (can be serious or life threatening)
  • Fistula
  • cancer (higher risk of developing colon cancer than general population)
23
Q

chron’s non-drug treatment

A

Diet change
stop smoking
stress management
bowel condition worsen by stress

24
Q

Drugs used to treat IBD

A
  • Aminosalicylates; eg mesalazine, balsalazide, olsalazine and sulphasalazine (may stain some soft contact lenses) >reduce inflammation in gut
  • immunosuppresants (affecting immune response):methotrexate, azathioprine, mercaptopurine (reduce activity of immune response
  • biologic therapy (monoclonal antibodies):infliximab, adalimumab, golimumab. Require specialist supervision
  • corticosteroids - use when symptoms are severe but not for maintainance (oral prednisolone, methylprednisolone, budesonide, hydrocortisone)
  • antibiotics
  • other medication>to treat diarrhoea and constipation
25
Q

Ulcerative colitis

Acute mild to moderate ulcerative colitis

A

1) proctitis-1st line(topical aminosalycilate) if no improvement after 4 weeks then add oral aminosalicylate if no improvement add oral or topical corticosteroid
2) proctosigmoiditis and left sided ulcerative colitis-1st line topical aminosalicylate
3) Extensive ulcerative colitis: 1st line (topical) aminosalicylate and high dose oral aminosalicylate.

26
Q

Treatment for severe ulcerative colitis (life threatning)

A

i.v corticosteroids & infliximab

27
Q

How to maintain remission in mild to moderate ulcerative colitis

A
  • use aminosalicylates
  • avoid corticosteroids because of side effects
  • oral azathioprine or mercaptopurine used when two or more inflammatory exacerbations in a 12month period that required a systemic corticosteroid.
28
Q

Drug treatment for UC

A
  • High fibre or low residue diets
  • Antimotility drugs (codeine/loperamide)
  • colestyramine: can improve diarrhoea
29
Q

UC- Aminosalicylates

A
  • sulfasalazine- older aminosalicylates>more side effects (stain contact lenses-yellow)
  • newer aminosalicylates: mesalazine, basalazine and olsalazine (fewer side effect)
  • bone marrow suppression>report any bruising, bleeding, purpura, sore throat, fever or malaise.
  • perform blood count and stop drug immediately if suspicion of blood dyscrasia
  • monitor renal function before starting at 3 months of treatment and then annually during treatment
30
Q

uc- Aminosalisylates side effects

A
  • Nephrotoxicity
  • Salicylate hypersensitivity
  • yellow/orange bodily fluids with sulfasalazine (soft contact lenses may be stained
  • corticosteroids, immune response
31
Q

Irritable bowel syndorme (IBS)

A
  • long term chronic condition of the bowel
  • mainly affects people aged 20-30yrs
  • more common in women
32
Q

symptoms of IBS

A
  • abdominal pain
  • bloating
  • diarrhoea or constipation
33
Q

Ibs non-drug treatment

A
  • diet and lifestyle changes
  • increase physical activity, eat regularly without missing meals
  • limit fresh fruit consumption
  • if increase in fibre required, then use soluble fibre (e.g oats sterculia &ispaghula husk). Avoid insoluble ones (eg bran) and ‘resistant starch’ because they exacerbate symptoms
  • Increase water intake (at least 8 cups daily). Reduce caffeine, alcohol, fizzy drinks
34
Q

Drugs used in IBS

A

-Antispasmodics & antimuscarinics for abdominal pains
G.I spasms. They relax the muscles in the gut (e.g mebeverine, hyoscine, peppermint oil).

  • Treating constipation: Increase fibre, use laxatives but avoid lactulose (cause bloating)
  • Linaclotide works differently from others and shown to reduce pain, bloating and constipation.
  • Treating diarrhoea: loperamide
  • Treating bloating: peppermint oil
  • Antidepressants: tricyclic antidepressants (eg amitriptyline) and SSRI (eg fluoxetine)- is unlicensed (for patients not responding to laxatives, antispasmodics or loperamide)
  • cognitive therapy: CBT>relaxed
35
Q

Causes of constipation

A
  • Inadequate fibre: Fibre adds bulk to stools and improves bowel function eg fruit, vegetables, cereal and whole bread.
  • Inadequate fluid intake
  • medication (pain killer) eg codeine, morphine, antacids, antidepressants, iron tablets.
  • medical conditions: eg underactive thyroid, IBS, some bowel disorders
  • pregnancy: due to hormonal changes slowing bowel movement or baby growing bigger
36
Q

Red flags for constipation

A 
50+
Anaemia
Abdo pain
weight loss
blood in stool
37
Q

Different laxatives (BOSS)

A
  • Bulk (bran, ispaghula husk, sterculia, methyl cellulose)
  • Osmotic (macrogols (laxido), lactulose)
  • Stimulant (Bisacodyl, Senna)
  • Sofetners (liquid paraffin)
    other: linoclotide, prucalopride
38
Q

Constipation Meds

A

Bulk foaming laxatives (fecal softner)

  • Increase bulk in the stool like fibre
  • Onset of action up to 72hrs
  • Occasionally can cause symptoms of bloating, cramping and flatulence
  • Used in: colostomy, ileostomy, haemorrhoids and anal fissures, IBS, divertular disease & ulcerative colitis

Stimulant laxatives
(eg bisacodyl, sodium picosulfate, senna, glyceral & co-danthrusate)
-co-danthramer (only reserved for terminally ill patients to treat constipation due to its carcinogenecity and colours urine red)
-increase intestinal motility
-onset 8-12hrs (bedtime dose recommended)
-stimulant laxative suppositories act quicker within 20-60mins
-SE-abdominal cramps, abuse risk which may cause hypokalaemia

Faecal softener: decrease surface tension and increase penetration of liquid into faecal mass. softens and wets faeces.

Liquid parafin (avoid, anal seapage with prolonged use)- can cause malabsorption of fat soluble vitamins (ADEK)

Docusate sodium (most commonly used softener, weak stimulant activity)

Peanut (arachis) eneama soften and lubricate faeces.

Ostmotic laxative
2 types (lactulose & macrogols 3350):
Increase amount of water in large bowel either by drawing fluid from body into bowel or maintaining fluid in the bowel
-Lactulose can take up to 2days for max effect, not suitable for immediate relief
-side effects of lactulose (abdominal pain and bloating)
-macrogols act faster e.g movicol
-Stronger osmotic laxatives (e.g phosphate enemas & magnesium salts) used to clear bowel quickly

39
Q

constipation

MHRA advice on stimulant laxatives?

A
  • new pack size restrictions
  • age
  • safety warnings
  • only use stimulant laxatives if other (bulk, osmotic) are not effective.
  • children<12
40
Q

Constipation Management

A
  • short duration constipation (bulk, osmotic, stimulant)
  • pregnancy (BOS)
  • chronic constipation (BOS)
  • opioid induced constipation (OS/Naloxegol/methylnatrexone-avoid bulk)
  • Faecal Impactions (OS)
  • children (OS)avoid<12yrs (FOC, OS children)
41
Q

Patient and carer advice for bulk forming laxative

A

preperations that swell in contact with liquid should be carefully swallowed with water. not to be taken immediately before going to bed. may take a few days to develop.

Pre Reg Pharmacy (36 decks)

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