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A - Pharmacy COPY > Chapter 1 - Gastro-intestinal System > Flashcards

Chapter 1 - Gastro-intestinal System Flashcards

1
Q

Aminosalicylates are efficacious in the maintenance of remission of of which IBD?

A

Ulcerative colitis

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2
Q

What is the active component of aminosalicylates and where does it exert its therapeutic effect?

A

5- aminosalicylic acid (5-ASA)

Exerts it’s therapeutic effect in the lower bowel, which is why it is more efficacious in the maintenance of remission in UC than Chron’s disease

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3
Q

Which drugs are included in the aminosalicylate class?

A

Sulfasalazine, Mesalazine, Balsalazide. Olsalazine

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4
Q

What serious side-effect are aminosalicylates affiliated with?

A

Blood dyscrasias - patients should be advised to report any signs of unexplained bleeding, bruising, sore throat, malaise, fever, purpura during treatment

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5
Q

Irritable bowel syndrome (IBS) is categorised by….?

A

Recurrent episodes of abdominal pain + abnormal bowel motility (which can either be constipation, diarrhoea or both). Bloating and passage of mucus may also be presenting features.

Symptoms often relieved on defecation

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6
Q

What pharmacological treatments are available for the treatment of IBS?

A

Antispasmodics
Laxatives (if constipation if main presenting feature)
Anti-motility drugs e.g loperamide (if diarrhoea is main presenting feature)
Antimuscarinics (e.g hyoscine butylbromide)

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7
Q

Drugs which belong to antispasmodics class include:

A

Alverine
Mebeverine
Peppermint Oil

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8
Q

How do antispasmodics work?

A

Direct (local) effect on gut smooth muscle - causes relaxation. Does not generally have an effect on gut motility

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9
Q

Gastric and duodenal ulcers are generally associated with the use of which class of drugs or which microorganism?

A

NSAIDs

Helocobacter pylori

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10
Q

For H.pylori associated ulcers, what does initial therapy comprise of?

A

PPI
Clarithromycin
Amoxicillin or Metronidazole

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11
Q

If a patient has been recently treated with a macrolide what is the preferred treatment regimen for H.pylori eradication?

A

PPI + Amoxicillin + Metronidazole

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12
Q

If a patient has been recently treated with metronidazole, what is the preferred treatment regimen for H.pylori eradication?

A

PPI + Clarithyromycin + Amoxicillin

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13
Q

Treatment with PPI, Clarithyromycin, Amoxicillin and Metronidazole are all TWICE daily regimens, expect in the combination of which regimen?

A 
Omeprazole 20mg BD
\+
Amoxicillin 500mg TDS
\+ 
Metronidazole 400mg TDS
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14
Q

The dose of clarithromycin if treating with amoxicillin for H.pylori induced gastric/duodenal ulcers is?

A

500mg BD

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15
Q

The dose of clarithromycin if treating with metronidazole for H.pylori induced gastric/duodenal ulcers is?

A

250mg BD

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16
Q

Dose of amoxicillin for the treatment of H.pylori induced gastric/duodenal ulcers is?

A

1g BD for all regimens apart from:

Omeprazole 20mg BD + Amoxicillin 500mg TDS + Metronidazole 400mg TDS

17
Q

What is sucralfate?

A

mucosal protectant - forms an adherant complex with the mucosa of the ulcer site and provides a protective barrier over the ulcer

18
Q

How should sucralfate be taken?

A

1 hour before food

19
Q

Psychiatric reactions have been reported with regular use of H2-receptor antagonists (rantidine, cimetidine etc). Which groups of patients are more vulnerable to these side effects?

A

Elderly or the very ill

20
Q

H2- receptor antagonists can be sold OTC for the short-term relief of which indication and for adults/children over ………. years old?

A

Short term relief of dyspesia (max 2 week supply)

licensed for >16 years old

21
Q

What is misoprostol and what is it used for?

A

Synthetic prostaglandin analogue - protects the gastroduodenal mucosa by inhibiting basal, stimulated and nocturnal acid secretion.

Used for the healing and prophylaxis of NSAID induced ulcers.

Misoprotol is also a potent uterine stimulant - can be used to induce abortion

22
Q

What should a female of child bearing age be aware of if taking misoprostol for the treatment of duodenal/gastric ulcers?

A

Effective contraception should be used. Misoprostol is teratogenic, particularly in the first trimester

23
Q

When would you see PPIs being used intravenously?

A

Following endoscopic treatment of severe peptic ulcer bleeding, an intravenous, high-dose proton pump inhibitor reduces the risk of rebleeding and the need for surgery.

24
Q

What is the MOA of PPIs?

A

Block the H+/K+ -ATPase pump of the gastric parietal cell, thereby reducing gastric acid secretion

25
Q

Who are PPIs cautioned in?

A

Elderly - increased risk of fractures, particularly if PPIs are used in high doses for >1 year
Patients who are at risk of osteoperosis - also increases risk of fractures
May increase the risk of GI infections including C.diff

26
Q

PPIs may increase the risk of C.diff. True or False

A

True

27
Q

Which 2 electrolyte disturbances may occur with prolonged use of PPIs?

A

Hypomagnasaemia

Hyponatraemia

28
Q

Hyoscine butylbromide can be sold as a P drug for IBS. What is the limitation in pack size in mg.

A

240mg max per pack.

Dose should not exceed 20mg/dose with a max daily dose of 80mg,

29
Q

Orlistat at the prescribed dose is?

A

120mg TDS

30
Q

What is the MOA of orlistat?

A

lipase inhibitor - binds with active serine sites of the gastric and pancreatic lipases - inactivated enzymes are unable to hydrolyse dietary triglycerides into free fatty acids and monoglycerides - therefore not able to absorb and fats are passed through digestive system.

31
Q

In patients who suffer with reduced pancreatic exocrine secretion, what preparations are available to help assist in the digestions of starch, fat and proteins?

A

Pancreatin (pancreatic enzymes):

  • Creon
  • Pancrease
  • Pancrex
32
Q

How should pancreatin preparations be administered?

A

pancreatin inactivated by excessive heat, should not be given with very hot foods.

gastro resistant preparations should be given with milk, slightly acidic soft food/liquids such as apple juice and swallowed whole - pancreatin inactivated by gastric acid, therefore taking it with food is best to reduce chances of inactivation by gastric acid

Adequate hydration should be maintained if taking higher strength pancreatin especially

33
Q

What types of preparations should be avoided in stoma patients?

A

Enteric coated and modified release because of insufficient release of active ingredient

34
Q

There are two main types of stoma - what are they?

A

ileostomy (small intestine)

colostomy (large intestine)

35
Q

Gastric secretion increases or decreases stoma output?

A

increases

PPIs or somatostatin analogues (ocreotide and lanreotide) are used to reduce this risk

36
Q

patients who have high stoma output can use which two drugs to try and reduce it?

A

loperamide (tablets better than capsules - capsules take longer to disintegrate)

codeine phosphate

A - Pharmacy COPY (35 decks)

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