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GPhC Exam: The Gastrointestinal System

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What are the key topics in the gastrointestinal system?

This is the first chapter in the British National Formulary (BNF) which introduces the following areas: dyspepsia and gastro-oesophageal reflux disease (GORD), antispasmodics (i.e. drugs used irritable bowel syndrome), antisecretory drugs and mucosal protectants (i.e. proton pump inhibitors, H2-receptor antagonists), acute diarrhoea, chronic bowel disorders (i.e. Crohn’s disease, ulcerative colitis, diverticulitis), constipation (i.e. opioid-induced constipation in palliative care, faecal impaction in children), and drugs affecting intestinal secretions.

There will also be slight overlaps with the infections section which covers gastrointestinal system infections such as, Clostridioides difficile, Campylobacter enteritis, acute diverticulitis, and Helicobacter pylori infection.

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Top tips on the gastrointestinal system GPhC exam questions

  • The BNF has lots of detail on individual treatment summaries/conditions in this section. Try to create links between these summaries and individual drug classes or specific drug monographs.
  • For conditions such as Helicobacter pylori infection, it is crucial to know about the different treatment regimens which may consist of a combination of a proton pump inhibitor and two antibacterial drugs. Here there is an obvious overlap between the gastrointestinal (GI) system and infections section, and you should understand the relationship between them.
  • Remember that ‘dyspepsia’ is an umbrella term for a variety of upper GI symptoms which can at times be caused by an underlying health issue or the concomitant use of another drug – a large number of drug classes cause GI effects though some of the common ones include antimuscarinics, non-steroidal anti-inflammatory drugs (NSAIDs), beta-blockers, corticosteroids, and tricyclic antidepressants.
  • Dyspepsia symptoms can often be managed without the use of drug treatments thus, counselling on lifestyle changes would play a significant role.
  • To aid your studies, you can create symptom control/management flow charts of individual conditions and include both drug and non-drug management options.
  • You will come across NSAIDs often in this chapter as the use of NSAIDs are associated with GI conditions, such as peptic ulcers. Once again, study the significance of this and any related clinical guidelines that are available.
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High risk/narrow therapeutic index drugs in this section

AMINOSALICYLATE: MESALAZINE

Drug action

What is it used for?

Cautions

(Very) common side effects

·        Blocks cyclooxygenase and inhibits prostaglandin production in the colon thus, combats inflammation.

·        Treatment of acute attack of mild to moderate ulcerative colitis and maintenance of remission

·        Renal function – to be monitored before starting treatment, at 3 months and annually thereafter

·        Arthralgia (joint pain)

·        Cough

·        Diarrhoea, nausea, vomiting, GI discomfort

·        Dizziness, headache

·        Leucopenia (reduced white blood cells)

·        Skin reactions

IMMUNOSUPPRESSANT: AZATHIOPRINE

Drug action

What is it used for?

Cautions

(Very) common side effects

·        Inhibits metabolism of purine which causes inhibition of DNA, RNA, and protein synthesis

·        Severe acute Crohn’s disease

·        Maintenance of remission of Crohn’s disease

·        Maintenance of remission of acute ulcerative colitis

·        Individuals experiencing any hypersensitivity reaction will need to be taken off the drug immediately

·        Full blood count to be monitored weekly for first 4 weeks, and then every 3 months

·        Bone marrow depression

·        Leucopenia

·        Pancreatitis

·        Thrombocytopenia (low blood platelet count)

·        Higher risk of infections

Example questions

  1. Mr T has a prescription for Sulfasalazine 500mg tablets which states “1-2g QDS, please supply for 28 days”. In order to supply enough tablets for 28 days, how many tablets will be needed to fulfil this prescription?
  1. A customer approaches the pharmacy counter and requests a box of Loperamide 2mg capsules for diarrhoea. She tells you that she had consumed some food at a party which did not suit her stomach. The customer asks you about the recommended dose. From the following options, which would be the most appropriate advice to provide to the customer with regards to the dose?
  • Take two capsules immediately
  • Do not take more than eight capsules in 24 hours
  • Take two capsules initially and then one capsule after each bowel motion for up to 5 days. Do not take more than eight capsules in 24 hours.
  • Take one capsule initially and then one capsule after each bowel motion for up to 3 days. Do not take more than eight capsules in 24 hours.
  • Take one capsule after each bowel motion for 3-5 days. Do not take more than eight capsules in 24 hours.

Written by Fatima Sazzad, GPhC Reg No. 2212805

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