Chapter 1- Gitsys - GI Tract BNF PDF

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GI Tract BNF...

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Chapter 1: GI System 1.1

Dyspepsia and gastro-oe gastro-oesophageal sophageal reflux disease

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1.2

Antispasmodics and other drugs a affecting ffecting gut motility

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1.3

Anti-muscarinics - describes indications, cautions, contraindications and side effects before the monographs Other antispasmodics – how they work and uses Motility stimulants - how they work and uses

Ulcer-healing d drugs rugs

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1.4

Describes dyspepsia Describes GORD and how to treat it according to symptom severity and children Antacids and Simeticone o Note - Blue box with Low Na+ - appears in brackets under preparations o Interactions – they can impair absorption of drugs and may damage enteric coatings. Compound alginate preparations – how they work Indigestion preparations on sale to the public (brand and generic names/ingredients)

Describes peptic ulcers H.pylori infections – when and how o treat and how to test for it o Table - Recommended regimes for H. Pylori eradication o NSAID-associated ulcers – how to treat and what to do if NSAID use continues. H2 Receptor antagonists - describes indications, cautions, interactions and side effects before the monographs Selective antimuscarinics – Pirenzepine (disontinied) Chelates and Complexes o CSM – Bezoar formation with Sucralfate Prostaglandin analogues o Misoprostal Contraindicated in women on childbearing age Proton Pump Inhibitors - describes indications, cautions and side effects before the monographs o NICE advice on PPI indications for use Other ulcer healing drugs.

Acute diarrhoea

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Adsorbants and bulk forming laxatives Anti-motility drugs

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1.5

Chronic diarrho diarrhoeas eas

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1.6

Describes chronic bowel disorders – what they are and how to treat o Irritable Bowel Syndrome o Malabsorption Syndromes o Inflammatory Bowel Disease  How to treat ulcerative colitis (UC) and crohns disease (CD)  NICE Infliximab for Crohns disease  Maintenance of remission of acute UC and CD  Adjunctive treatment of inflammatory bowel disease  Antibiotic associated colitis  Diverticular disease o Aminoglycosides - describes indications, cautions, contraindications and side effects before the monographs  Blood disorders – advise to report any symptoms of blood dyscrasia o Corticosteriods o Cytokine inhibitors o Food allergy

Laxatives

o Cautions on use of laxatives o Use in children o Mechanism and Indications  Bulk forming laxatives  Stimulant Laxatives  Other stimulant laxatives – i.e. on sale to the public  Faecal softners  Osmotic laxatives  Bowel cleansing solutions 1.7

Loca Locall preparations for rectal and anal disorders

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Soothing haemorrhoidal preparations Compound haemorrhoidal preparations with corticosteroids o Use in children Rectal sclerosants

1.8

Stoma care - What drugs are suitable and not sui suitable table with stomas.

1.9

Drugs affe affecting cting intestinal secretion

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Drugs affecting biliary composition and flow Bile acis sequestrants Aprotinin Pancreatin 2

o CSM – High dose preps associated with large bowel strictures in children with cystic fibrosis between 2-13 years. Name

Mechanism of Indication action gastro-oesophageal -oesophageal reflux disease 1.1 Dyspepsia and gastro Mild gastroHydroxides that 1.1.1 oesophageal neutralise the Antacids and reflux disease acid. Dimeticone Simeticone is antifoaming so Magnesium reduces Aluminium flatulence Dimeticone As above 1.1.2 Form a raft on Compound contents of stomach alginates Gaviscon, Rennie 1.2 Antispasmodics and other drugs a affecting ffecting gut motility Reduce intestinal IBS and Antimuscarinics motility diverticular Atropine, disease dicycloverine, hyoscine, propantheline Br Other Direct relaxants IBS and antispasmodics of intestinal diverticular Alverine, smooth muscle disease Mebeverine, Peppermint oil Motility stimulants Metoclopramide Domperidone

Dopamine antagonists  stimulate gastric emptying & intestinal transit

Non-ulcer dyspepsia Non-specific and cyotoxicinduced N+V

Side-effect Side-effectss

Special warnings

Inter Interactions actions

Contain Na – avoid in hypertension

Antacids should be preferably not taken at same time as other drugs as they impair absorption.

Mg  Laxative Al  Constipating Caution with sodium content Esp if diet restricted Constipation, dry mouth etc. C/I in glaucoma etc

Use with caution due to s/e

No serious adverse effects. Peppermint oil may cause heartburn Dystonic (EPS) reaction in young women and children (avoid)

Avoid in paralytic ileus. Some contain fibre  swell in contact liquids

Other antimuscarinics

See section 4.6

Ulcer-healing ealing drugs 1.3 Ulcer-h H.pylori infe infection ction  1-week triple therapy with a PPI, amoxicillin and metronidazole or clarithromycin NSAID-a NSAID-associated ssociated ulcers  withdraw NSAID, PPI first-line. Misoprostol alternative. H2-antag. for duodenal ulcers only. Cimetidine – cP450 Care esp in 1.3.1 GI Reduce gastric Healing of inhibitors  avoid with elderly due to H2-receptor disturbances, output via H2gastric and masking of gastric warfarin, theophylline and antagonists headache, receptor blockade duodenal phenytoin cancer. dizziness Cimetidine ulcers Famotidine Caution in hepatic Nizatidine impairment Ranitidine 1.3.4 Synthetic Gastric and Diarrhoea (may Avoid in young Prostagla Prostaglandin ndin analogue – duodenal be severe) women – removes analogues antisecretory and ulcers esp. in contraceptive Misoprostol protective effects effects elderly with NSAID use Omeprazole enhances GI side-effects. Caution in liver 1.3.5 Proton pump Inhibit the H+-K+- NICE: NSAIDdisease,pregnancy effects of warfarin and Reduced induced adenosine inhibitors phenytoin. & BF. May mask acidity may ulcers if triphosphate Omeprazole gastric cancer – increase continuing pump (proton Lansoprazole care if symptoms chance of GI Tx; and only pump) of gastric

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parietal cell severe reflux infections change & > 45 yr 1.4 Acute diarrhoea First line treatm treatment: ent: oral rehydration therapy especially in frail and elderly people Antimotility drugs can be used for short-term symptomatic relief in adults but not in children Antispasmodics are occasionally used in treating abdominal cramps associated with diarrhoea but not for primary Tx Antibacterials are rarely needed for simple gastro-enteritis (usually viral). Cipro can sometimes be given prophylactically 1.4.1 Adsorb Adsorbents ents & bulkbulk-forming forming drugs Not recommended for acute diarrhoea - kaolin 1.4.2 Antimo Antimotility tility Reduce intestinal Use in Abdo cramps, Loperamide use drugs motility through children drowsiness. Adults max. 5 Codeine mu-opiate differs, Loperamide: days. Child 3 days Co-phenotrope receptors (reduce (OTC doesn’t cross Loperamide smooth muscle Loperamide the BBB  contractions  = 12 yrs). avoids CNS reabsorption). effects. diarrhoeass 1.5 Chronic diarrhoea Irritable Bowel S Syndrome: yndrome: pain constipation or diarrhoea. High fibre diet, bran etc. Psychological aggravating factors. Malabsorption syndromes: e.g. coeliac disease (gluten-free diet) or pancreatic insufficiency (pancreatin supplements) Inflammat Inflammatory ory Bowel Disease Disease:ulcerative colitis & Crohn’s disease. Use aminosalicylates & corticosteroids esp budesonide Antibiotic-a Antibiotic-associated ssociated colitis: Clostridium difficile . Particular hazard with clindamycin. Tx: vancomycin or metronidazole Divert Diverticular icular disease: Treat with high-fibre diet, bran and bulk-forming drugs. Antimotility drugs are contra-indicated. None. Report BloodUlcerative Sulfasalazine: Aminosalicylates unexplained disorders, colitis 7 5-ASA and Sulfasalazine bruising, bleeding, Use is CI in mod-severe diarrhoea, maintenance sulfapyridine (a Mesalazine sore throats, fever renal impairment nausea, of remission carrier). Others Balsalazine headache only have 5-ASA Olsalazine Colestyramine Anion exchange Chronic Take other drugs 1 hr resin – bile salts diarrhoea before or 4-6 hrs after to reabsorption avoid malabsorption 1.6 Laxativ Laxatives es Bulk Bulk-forming -forming Increase fecal mass which Full effect days a laxatives stimulates peristalsis – bran, few days to ispaghula husk develop Stimulant laxativ laxatives es Increase intestinal motility – Abdo cramp Long term use docusate, biscodyl, dantron (only can lead to nonin terminally ill patients), glycerol functioning colon suppositories, senna and hypokalemia Faecal softeners Lubricate and soften the faeces Anal irritation Avoid immediately CSM: avoid prolonged use arachis oil, liquid paraffin before bed of paraffin Osmotic laxativ laxatives es Retain fluid in the bowel by Flatulence, Lactulose  useful for osmosis – lactulose, macrogols cramps hepatic encephalopathy Avoid using laxatives except: where straining will exacerbate a condition e.g. angina or increase risk of rectal bleeds e.g. haemorrhoids. Also in drug-induced constipation, to expel parasites after antithelmintic therapy, to clear the alimentary canal before surgery and radiological procedures. Prolonged use is seldom necessary except in the elderly. preparations ations for rectal and anal disorders 1. 1.7 7 Local prepar 1. 1.7 7.1 Soothing haemorrhoidal preps: contain mild astringents e.g. zinc oxide. Also contain local anaesthetics to relieve pain. Avoid excessive use due to absorption esp. in children. Use should be limited to a few days due to local irritation. 1. 1.7 7.2 Compound haemorrhoidal preps with corticosteroids (usually hy hydrocortisone): drocortisone): suitable for occasional short-term use after exclusion of infections. Prolonged use = atrophy of anal skin. Haemorrhoids in children are rare. 1.8 Stoma care Prescribing in stoma pa patients tients - need to bear in mind: formulation - EC and MR preps are unsuitable due to insufficient release. Laxatives – do not use in ileostomies due to rapid & severe dehydration. Colostomy patients may suffer constipation; use bulk-forming drugs. Anti-diarrhoeals - loperamide, codeine are effective. Antacids – diarrhoea/constipation s/e may be increased. Diuretics – use with caution due to K-depletion and dehydration. Digoxin – patients are esp

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susceptible to hypokalaemia. K supplements – use liquids Iron preps – may cause loose stools & sore skin. affecting ecting intestinal secretion 1.9 Drugs aff 1.9.1 Drugs acting Gall stone A bile acid  dissolution & on the gall bladder dissolves gall primary Ursodeoxycholic stones. Limited biliary acid to pts where other techniques cirrhosis are ineffective Cystic 1.9.4 P Pancreatin ancreatin Compensate for fibrosis, absent exocrine chronic secretions – pancreatitis, assist starch/fat/protein digestion

over MR formulations. Analgesics – opioid constipation a problem.

Hormonal contraceptives

Nausea, vomiting, diarrhoea

Avoid excessive cholesterol and calories

Irritates perioral skin and buccal mucosa if retained in mouth. GI discomfort

All of porcine origin. Inactivated by gastric acid  take with food. Inactivated by heat  cold foods. Total dose of enzyme supplements should not exceed 10,000 units of lipase/kg daily. Need to ensure adequate hydration at all times with high doses.

By Jabeen Mohammad

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