GI system
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- Created by: AJ-A
- Created on: 21-04-22 21:38
Which antibiotics are commonly used to treat C.Diff?
first episode: 1st line - Vancomycin
2nd line - Fidaxomicin
Relapse (within 12 weeks): Fidaxomicin
If more than 12 weeks - Fidaxomicin or Vancomycin
If life-threatening: Specialist may give Vancomycin and IV metronidazole
2nd line - Fidaxomicin
Relapse (within 12 weeks): Fidaxomicin
If more than 12 weeks - Fidaxomicin or Vancomycin
If life-threatening: Specialist may give Vancomycin and IV metronidazole
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which antibacterials are associated with c.diff infection
Clindamycin, cephalosporins (especially third and fourth generation), fluoroquinolones, and broad-spectrum penicillins have been frequently associated with C. difficile infection
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name a Non-drug treatment for Crohn’s disease
smoking cessation
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Treatment of Coeliac disease?
non-drug; Strict life-long gluten-free diet
Drug; Key nutrients malabsorption so replenish with calcium / vitamin d (pts advised not to self-medicate)
Drug; Key nutrients malabsorption so replenish with calcium / vitamin d (pts advised not to self-medicate)
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Drug treatment for Ulcerative colitis; proctitis
1st Line:topical Aminosalicylate’s
if no remission within 4 weeks:Add oral aminosalicylate
If still not adequate add oral/topical corticosteroid for 4-8 weeks
if no remission within 4 weeks:Add oral aminosalicylate
If still not adequate add oral/topical corticosteroid for 4-8 weeks
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side effects of Aminosalicylate’s
Orange/yellow staining of body fluids
Patients should be advised to report any signs of blood disorder e.g fever, malaise, sore throat etc.
contact lenses staining
Patients should be advised to report any signs of blood disorder e.g fever, malaise, sore throat etc.
contact lenses staining
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drug treatment for proctosigmoiditis and left sided colitis
first line: Topical aminosalicylate
if no remission within 4 weeks add high dose oral aminosalicylate or change to high dose oral aminosalicylate and 4-8 weeks of topical corticosteroid.
If still no remission stop topical treatment and change to oral ami
if no remission within 4 weeks add high dose oral aminosalicylate or change to high dose oral aminosalicylate and 4-8 weeks of topical corticosteroid.
If still no remission stop topical treatment and change to oral ami
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Mesalazine prescribed by brand or generic?
Brand
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Before prescribing MAB one must be screened for
Tuberculosis
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A common side effect of MAB is:
A flu-like infusion reaction
(prevented by pre-treatment with antihistamine, paracetamol with/without corticosteroid)
(prevented by pre-treatment with antihistamine, paracetamol with/without corticosteroid)
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how long is contraception required when on MAB
during and for at least 18 weeks after treatment
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Can i breastfeed whilst on MABs
Yes
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Drug trmt for IBS include:
Antispasmodic drugs (Alverine citrate, Mebeverine hydrochloride + Peppermint Oil)
Laxative
Loperamide
low dose TCA such as Amitriptyline can be used for abdominal pain/discomfort
Laxative
Loperamide
low dose TCA such as Amitriptyline can be used for abdominal pain/discomfort
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Drug treatment for extensive ulcerative colitis
first line: topical aminosalicylate AND high-dose oral aminosalicylate
If no remission within 4 weeks, stop topical aminosalicylate treatment and offer a high-dose oral aminosalicylate and 4 to 8 weeks of an oral corticosteroid
If no remission within 4 weeks, stop topical aminosalicylate treatment and offer a high-dose oral aminosalicylate and 4 to 8 weeks of an oral corticosteroid
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Treatment of acute severe ulcerative colitis
is regarded as a medical emergency
Intravenous corticosteroids (such as hydrocortisone or methylprednisolone) should be given to induce remission in patients while assessing the need for surgery.
IV Ciclosporin if corticosteroid C/I
second line (no imp
Intravenous corticosteroids (such as hydrocortisone or methylprednisolone) should be given to induce remission in patients while assessing the need for surgery.
IV Ciclosporin if corticosteroid C/I
second line (no imp
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Which results in more side effects when used to maintain remission in UC: single daily doses of oral aminosalicylates or multiple daily dosing
single daily doses. although they are more effective
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when can oral azathioprine or mercaptopurine [unlicensed indications] be considered to maintain remission in UC
if there has been two or more inflammatory exacerbations in a 12-month period that required treatment with systemic corticosteroids, or if remission is not maintained by aminosalicylates, or following a single acute severe episode.
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Treatment of acute Crohn's disease
(Monotherapy)
(Monotherapy)
A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone)
for first presentation in 12 month period
for first presentation in 12 month period
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In crohn's disease what add-on treatment is prescribed if there are two or more inflammatory exacerbations in a 12-month period:
Azathioprine or mercaptopurine [unlicensed indications] can be added to corticosteroid to induce remission.
If pt can't tolerate azathioprine/mercaptopurine or if TPMT enzyme activity is deficient methotrexate can be added to the corticosteroid
If pt can't tolerate azathioprine/mercaptopurine or if TPMT enzyme activity is deficient methotrexate can be added to the corticosteroid
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Can Azathioprine or Mercaptopurine be used to maintain remission in Crohn's disease?
Yes as monotherapy AND if used during acute treatment with corticosteroid to induce remission
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Drug treatment for Crohn's related diarrhoea
Loperamide, Codeine, Colestyramine
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Symptom relief for fistulating crohn's disease
Metronidazole or Ciprofloxacin (alone or in combination)
Metronidazole is usually given for 1 month but no more than 3 months due to peripheral neuropathy.
Azathioprine/Mercaptoputine is used to control inflammation and continued for maintenance.
Inflixi
Metronidazole is usually given for 1 month but no more than 3 months due to peripheral neuropathy.
Azathioprine/Mercaptoputine is used to control inflammation and continued for maintenance.
Inflixi
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Drug treatment for GI spasms?
Antispasmodics e.g. alverine citrate, mebeverine, peppermint oil
Antimuscarinics e.g. Buscopan (hyoscine butylbromide), atropine, dicycloverine, propantheline bromide
Antimuscarinics e.g. Buscopan (hyoscine butylbromide), atropine, dicycloverine, propantheline bromide
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Red flag symptoms for constipation:
new onset in >50, pt is anaemic, has abdominal pain, has unexplained weight loss, has blood in stool
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Laxative abuse leads to:
Hypokalemia
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Bulk-forming laxatives are of value in adults with small hard stools, give 4 examples.
Bran, Ispaghula, sterculia and methylcellulose
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what is the onset of action of bulk-forming laxatives
72 hours
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Examples of stimulant laxatives include
Sodium picosulfate, Bisacodyl, Senna,
Co-danthramer/Co-danthrusate (used in terminally ill patients)
Co-danthramer/Co-danthrusate (used in terminally ill patients)
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Examples of faecal softeners (laxatives) include:
Docusate Sodium, Glycerol suppositories
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Arachis oil is used to lubricate and soften impacted faeces. Liquid paraffin is also sometimes used as a lubricant for the passage of stools but one should be aware of its adverse effects which include:
Anal seepage, Risk of granulomatous disease of the GI tract or of lipoid pneumonia on aspiration (aspiration is when you swallow a solid/liquid down the wrong pipe)
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Examples of Osmotic laxatives include:
Lactulose (not absorbed from the GI tract), Macrogols
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How to treat: short term constipation
start with bulk-forming laxative, if stools remain hard, add or switch to osmotic laxative. If stools are soft but difficult to pass add stimulant laxative.
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How to treat: Opioid induced constipation
Avoid bulk-forming laxative. Start with osmotic laxative or docusate sodium (to soften the stool) and a stimulant laxative.
Use Naloxegol when response to other laxatives is inadequate
(may use methylnaltrexone bromide if inadequate response)
Use Naloxegol when response to other laxatives is inadequate
(may use methylnaltrexone bromide if inadequate response)
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How to treat: faecal impaction in pts with hard stools
High dose of oral macrogol.
If inadequate consider rectal glycerol alone or with bisacodyl.
Alternatively try docusate sodium enema or sodium citrate enema
If inadequate consider rectal glycerol alone or with bisacodyl.
Alternatively try docusate sodium enema or sodium citrate enema
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How to treat: faecal impaction in pts with soft stools
Oral stimulant laxative. If inadequate consider rectal bisacodyl
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How to treat: chronic constipation
treatment should be started with a bulk-forming laxative.
if stools still hard add or change to osmotic laxative. if inadequate response add stimulant.
May use prucalopride in women if pt has tried 2 laxatives from different classes for at least 6 months
if stools still hard add or change to osmotic laxative. if inadequate response add stimulant.
May use prucalopride in women if pt has tried 2 laxatives from different classes for at least 6 months
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How to treat: constipation in pregnancy/breastfeeding women
first line - bulk-forming laxative. Bran.
Osmotic may be used.
If necessary bisacodyl/senna can be used but avoid senna if there is a history of unstable pregnancy. only a short course of stimulant should be used in pregnancy.
May use docusate/glycerol
Osmotic may be used.
If necessary bisacodyl/senna can be used but avoid senna if there is a history of unstable pregnancy. only a short course of stimulant should be used in pregnancy.
May use docusate/glycerol
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How to treat: constipation in children
if no faecal impaction, treat with macrogol. if inadequate add stimulamant. change to stimulant if macrogol not tolerated.
if stools remain hard add lactulose or docusate sodium
if stools remain hard add lactulose or docusate sodium
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How to treat: faecal impaction in children
if >1yr an oral macrogol is used. may escalate dose depending on response.
If faeces still impacted after 2 weeks may add stimulant such as sodium picosulfate.
If stools are hard may add osmotic such as lactulose
If faeces still impacted after 2 weeks may add stimulant such as sodium picosulfate.
If stools are hard may add osmotic such as lactulose
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Red flag symptoms for diarrhoea:
unexplained weight loss, rectal bleeding, persistent diarrhoea, a systemic illness, has received recent hospital treatment or antibiotic treatment, or following foreign travel
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Loperamide is the main drug treatment for diarrhoea but should be avoided when?
In bloody or suspected inflammatory diarrhoea and when there is significant abdominal pain
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which antibiotic is used for the prophylaxis of traveller's diarrhoea
ciprofloxacin (routine use is not recommended)
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when managing dyspepsia urgent endoscopic investigation is required for patients with what symptoms?
dysphagia, significant acute gastrointestinal bleeding, or in those aged 55 years and over with unexplained weight loss and symptoms of upper abdominal pain or reflux
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Drugs that may cause dyspepsia include:
alpha-blockers, antimuscarinics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, non-steroidal anti-inflammatory drugs (NSAIDs), theophyllines, and tricyclic antidepressants
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treatment for uninvestigated dyspepsia
PPI for 4 weeks and test for H.pylori
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Treatment for functional dyspepsia
PPI or H2 receptor antagonist for 4 weeks
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Other cards in this set
Card 2
Front
which antibacterials are associated with c.diff infection
Back
Clindamycin, cephalosporins (especially third and fourth generation), fluoroquinolones, and broad-spectrum penicillins have been frequently associated with C. difficile infection
Card 3
Front
name a Non-drug treatment for Crohn’s disease
Back
Card 4
Front
Treatment of Coeliac disease?
Back
Card 5
Front
Drug treatment for Ulcerative colitis; proctitis
Back
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