Lower GI

Question 1

What are four common symptoms of trapped wind?

Answer 1

1)Passing a lot of wind,

2)crampy stomach pains,

3)a bloated belly,

4)pain in the upper abdomen.

Question 2

Name a medication that can have trapped wind as a side effect.

Answer 2

Metformin is a medication that can cause trapped wind as a side effect.

Question 3

What is the mechanism of action for simeticone in treating trapped wind?

Answer 3

It brings together small gas bubbles in the gut to form bigger bubbles, allowing trapped air to pass more easily.

Question 4

Besides medication, what are two lifestyle changes that can help treat trapped wind?

Answer 4

Increasing exercise and cutting down on trigger foods, potentially by using a food diary.

Question 5

What sort of trigger foods can cause bloating or trapped wind?

Answer 5

cabbage, beans, lentils

processed, sugary, spicy or fatty foods

Question 6

What advice can be given to a patient about what they should do about preventing or helping their bloating?

Answer 6

Do
exercise regularly to improve your digestion and help prevent bloating – exercise can also help when you’re feeling bloated

chew with your mouth closed to avoid swallowing air

drink plenty of water

eat foods high in fibre if constipated

eat smaller, more frequent meals instead of large meals

massage your stomach from right to left to release trapped wind

Question 7

How is constipation typically defined in clinical practice?

Answer 7

The passage of stools less frequently than the person’s normal pattern, often fewer than three times a week.

Question 8

Why are elderly individuals at a higher risk of constipation?

Answer 8

Due to polypharmacy, multiple co-morbidities, and reduced food and liquid intake.

Question 8

What advice can be given to a patient about what they shouldn’t do to increase the chance of them having trapped wind or bloating?

Answer 8

Don’t
do not drink lots of fizzy drinks, alcohol or caffeine in coffee and tea

do not eat lots of foods that are known to cause gas, like cabbage, beans or lentils

do not eat large meals late at night before bed, or slouch when eating

do not eat lots of processed, sugary, spicy or fatty foods

do not eat food you are intolerant to, if you have a food intolerance

Question 9

What are some additional symptoms that may accompany constipation, even with daily bowel movements?

Answer 9

Excessive straining, lower abdominal pain or discomfort, distension, or bloating.

Question 10

How does pregnancy increase the risk of constipation?

Answer 10

Increased foetal pressure and higher progesterone levels reduce peristalsis. ( involuntary constriction and relaxation of the muscles of the intestine or another canal)

Question 11

Which class of drugs used for allergies can cause constipation?

Answer 11

antihistamines

Question 12

Opioids are a well-known cause of which lower gastrointestinal condition?

Answer 12

constipation

Question 13

What is considered a ‘red flag’ for constipation in a patient over 40?

Answer 13

A change in bowel habits with no identifiable cause.

Question 14

Constipation lasting longer than _____ with no identifiable cause is a red flag requiring referral.

Answer 14

14 days

Question 15

What symptom, when accompanying constipation, is considered a red flag?

Answer 15

The presence of blood in the stool.

Question 16

What is the recommended daily fibre intake for adults to help manage constipation?

Answer 16

Adults should aim to consume 30 g of fibre per day.

Question 17

What lifestyle advice should be given regarding the urge to defecate to help manage constipation?

Answer 17

Advise responding immediately to the sensation of needing to defecate.

Question 18

What does the mnemonic ‘BOSS’ stand for in the context of laxative types?

Answer 18

Bulk forming,
Osmotic,
Stimulant,
Stool softeners.

Question 19

What is the mechanism of action of bulk-forming laxatives?

Answer 19

They increase the bulk of the stool, which helps to stimulate bowel movement.

Question 20

What is the typical onset of action for a bulk-forming laxative?

Answer 20

Approximately 72 hours.

Question 21

What important counselling point should be given with bulk-forming laxatives regarding fluid intake?

Answer 21

It is important to maintain adequate fluid intake.

Question 23

How do osmotic laxatives like lactulose work?

Answer 23

They are metabolised by gut bacteria, causing water to move into the intestines by osmosis, stimulating peristalsis.

Question 24

Glycerol suppositories are a type of _____ laxative with an onset of action of 15-30 minutes.

Answer 24

osmotic

Question 25

What is the mechanism of action of stimulant laxatives like senna?

Answer 25

They stimulate intestinal mobility by decreasing the absorption of water and electrolytes from the intestines.

Question 26

What is the onset of action for oral osmotic laxatives like macrogols?

Answer 26

Approximately 48 hours.

Question 27

What is a key counselling point for patients taking senna?

Answer 27

Senna may discolour urine, and it is not intended for prolonged use.

Question 28

Overuse or abuse of stimulant laxatives can lead to what specific electrolyte imbalance?

Answer 28

Hypokalaemia (low potassium).

Question 29

What is the minimum age for over-the-counter (OTC) use of senna?

Answer 29

Patients must be over 12 years old.

Question 30

How do stool softener laxatives, such as docusate sodium, work?

Answer 30

They decrease surface tension and increase the penetration of liquid into the stools.

Question 31

Long-term use of stool softeners like liquid paraffin can lead to the malabsorption of which vitamins?

Answer 31

Fat-soluble vitamins (A, D, E, K).

Question 32

For short-duration constipation, what is the first-line laxative choice according to the 'BOS' framework?

Answer 32

Bulk-forming laxatives.

Question 33

If a bulk-forming laxative is unsuitable for short-duration constipation, what is the second-line choice?

Answer 33

An osmotic laxative.

Question 34

What is the third-line laxative choice for short-duration constipation, pregnancy or breastfeeding?

Answer 34

A stimulant laxative.

Question 35

For opioid-induced constipation, what is the first-line laxative choice according to the 'FOCOS' framework?

Answer 35

An osmotic laxative.

Question 36

If an osmotic laxative is insufficient for treating opioid-induced constipation, what is the second-line choice?

Answer 36

A stimulant laxative.

Question 45

How is acute diarrhoea defined in terms of duration?

Answer 45

Diarrhoea lasting less than 14 days.

Question 46

Diarrhoea lasting for more than 4 weeks is defined as _____ diarrhoea.

Answer 46

chronic

Question 47

What are two signs of dehydration related to fluid status?

Answer 47

Decreased urine output and hypotension (low blood pressure).

Question 48

What is the primary purpose of an Oral Rehydration Solution (ORS)?

Answer 48

To replace electrolytes lost during rapid bowel evacuation and reduce the chance of dehydration.

Question 49

What are the five main components of an Oral Rehydration Solution (ORS)?

Answer 49

Glucose, sodium, potassium, chloride, and citrate.

Question 50

What is the initial dose of loperamide for treating diarrhoea in adults?

Answer 50

Two capsules (4mg) immediately.

Question 51

After the initial dose, what is the subsequent dosing for loperamide?

Answer 51

One capsule (2mg) after each loose stool.

Question 52

What is the maximum number of bismuth subsalicylate (Pepto-Bismol) tablets that can be taken in 24 hours?

Answer 52

A maximum of 16 tablets in 24 hours.

Question 52

What is the minimum age for over-the-counter (OTC) loperamide use?

Answer 52

Patients must be over 12 years old.

Question 53

Why is diarrhoea lasting longer than 3 days in children and the elderly a red flag?

Answer 53

It poses a significant dehydration risk.

Question 53

A patient with diarrhoea who has recently been in a tropical area should be referred. True or False?

Answer 53

True, especially if the diarrhoea is very watery.

Question 54

What underlying pathology might severe abdominal pain with diarrhoea be suggestive of?

Answer 54

A more serious condition like diverticulitis.

Question 55

What is the most common causative organism of vulvovaginal candidiasis (vaginal thrush)?

Answer 55

A superficial fungal infection, usually with Candida albicans.

Question 55

Name two risk factors for developing vaginal thrush.

Answer 55

Recent antibiotic use and uncontrolled diabetes.

Question 56

What is the age range for which over-the-counter (OTC) thrush treatments are available?

Answer 56

Ages 16 to 60.

Question 56

A patient reports more than two thrush infections within six months. What advice should be given?

Answer 56

The patient should see their doctor.

Question 56

Describe the characteristic vaginal discharge associated with thrush.

Answer 56

A thick, white discharge, often with a 'cottage cheese' appearance.

Question 57

What advice should be given regarding contraception when using OTC thrush products?

Answer 57

OTC thrush products can damage condoms, so other methods of contraception are required.

Question 58

A patient experiencing their first ever symptoms of thrush is considered a _____ and should be referred.

Answer 58

red flag

Question 59

What is a red flag for thrush concerning the frequency of infection?

Answer 59

Recurrent thrush, defined as more than 4 episodes in 12 months.

Question 60

Under the Pharmacy First service, who is eligible for UTI treatment in a community pharmacy?

Answer 60

Women aged 16-64 years old.

Question 61

A woman who has had two UTIs in the past 6 months is not eligible for treatment under the Pharmacy First service. True or False?

Answer 61

True, this is considered recurrent and requires referral.

Question 62

What symptom would make a patient with a suspected UTI ineligible for Pharmacy First treatment?

Answer 62

Fever within the past 48 hours.

Question 63

When should a patient with a suspected UTI be urgently referred?

Answer 63

If they are systemically unwell, have kidney pain/tenderness, shaking chills (rigors), or a temperature of 37.9°C or above.

Question 63

What are the three key diagnostic features of an uncomplicated UTI in the pharmacy setting?

Answer 63

New nocturia (waking at night to urinate), cloudy urine, dysuria (burning when passing urine).

Question 64

According to the Pharmacy First pathway, if a patient presents with two of the three key UTI symptoms, what is the next step?

Answer 64

Treat for a UTI without needing a urine dipstick test.

Question 65

What advice should be given regarding the administration of nitrofurantoin tablets?

Answer 65

They should be taken with food or milk.

Question 65

What is the first-line antibiotic used to treat uncomplicated UTIs under the Pharmacy First service?

Answer 65

Nitrofurantoin

Question 66

What is the standard treatment duration for an uncomplicated UTI with nitrofurantoin under the Pharmacy First service?

Answer 66

A 3-day course.

Question 67

What is a common, harmless side effect of nitrofurantoin on urine?

Answer 67

It can cause discoloured dark yellow or brown urine

Question 68

Name three common gastrointestinal side effects of nitrofurantoin.

Answer 68

Nausea, vomiting, diarrhoea, or loss of appetite.

Question 69

What advice can a pharmacist give to a person who has a UTI that they should do?

Answer 69

Do wipe from front to back when you go to the toilet keep the genital area clean and dry drink plenty of fluids, particularly water, so that you regularly pee during the day and do not feel thirsty wash the skin around the vagina with water before and after sex pee as soon as possible after sex promptly change nappies or incontinence pads if they are soiled wear cotton underwear

Question 70

What advice can a pharmacist give to a person who has a UTI that they should NOT do?

Answer 70

do not use scented soap around the genital area do not hold your pee in if you feel the urge to go do not rush when going for a pee – try to fully empty your bladder do not wear tight underwear do not drink lots of alcoholic drinks, as they may irritate your bladder do not have lots of sugary food or drinks, as they may encourage bacteria to grow

Question 71

What lifestyle advice can you give to a person experiencing thrush that they should do to to ease it?

Answer 71

use water and an emollient (like E45 cream) instead of soap to wash the affected area dry properly after washing wear cotton underwear avoid sex until thrush has cleared up if sex is uncomfortable if given a pessary use it at night as it keeps the product in place

Question 72

What lifestyle advice can you give to a person experiencing thrush that they should NOT do to to ease it?

Answer 72

Don’t do not use soaps or shower gels do not use douches or deodorants on your vagina or penis do not wear tight underwear or tights