Chapter 5 Gastroenterology. Dose. Route. Units. Given. Dose. Route. Units. Given

Transcription

1 Chapter 5 Gastroenterology Georgia Woodfield TERLIPRESSIN CIPROFLOXACIN 2 initial dose 500 Every 4 hours until bleeding controlled can be reduced to 1 after initial dose if side effects develop or if patient is <50 kg Normal duration of treatment is for 72 hours (or until haemostasis is achieved) Twice daily Can be given at a dose of 400. However, as it is the GI tract that is the target in this instance and additionally it is very irritant to veins, the oral route is preferential. Can cause hypertension and hypotension, which may already be present in a patient with haemorrhagic shock. This limits its use. Caution in patients with heart disease (due to it decreasing cardiac output). Can cause prolonged QT interval. OMEPRAZOLE 20 40, can be given (if active bleeding ulcer seen at oesophagogastroduodenoscopy) Generally given at the higher dose in this situation of confirmed peptic ulcer on endoscopy. In of severe recurrent ulceration, e.g. Zollinger Ellison syndrome, the dose can be up to 120 per day (divided doses). Essential Practical Prescribing, First Edition. Georgia Woodfield, Benedict Lyle Phillips, Victoria Taylor, Amy Hawkins and Andrew Stanton by John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

2 LANSOPRAZOLE Generally given at the higher dose in this situation of confirmed peptic ulcer on endoscopy. May be used instead of omeprazole where there are intolerances or known drug interactions, e.g. omeprazole and clopidogrel (should be switched to lansoprazole if on clopidogrel). PANTOPRAZOLE 80 stat then 8 /h for 72 hours then infusion Stat then as an infusion over (up to) 72 hours This is given after acute GI bleed where the patient is still obtunded or shocked, and therefore would not tolerate oral medication. Can also be given orally as a tablet PROPRANOLOL for variceal bleed 40 BD Increase to 80 BD if blood pressure will allow Long-acting propranolol at either 80 or 160 can be used to improve compliance. HYDROCORTISONE 100 QDS Higher doses of steroids offer no greater benefit, but lower doses are less effective (Mowat et al., 2011). Intravenous steroids are generally given for up to 5 days. There is no benefit beyond 7 10 days (Turner et al., 2007). ENOXAPARIN 40 SC needs reduction in renal failure to 20, or where CrCl is very low, 50 units BD heparin SC may be substituted.

3 METRONIDAZOLE 400 TDS Can be given (500 TDS) if oral is not tolerated. Causes nausea and taste disturbances. Has a disulfiram-like reaction with alcohol. Metronidazole is an enzyme inhibitor and may therefore interact with other medications, notably warfarin. reduction in severe hepatic impairment: give 400 () or 500 () once daily. VANCOMYCIN 125 /NG QDS can be increased to 500 QDS in patients who are worsening or have signs of severe colitis. Intracolonic vancomycin (500 in ml saline 4 12 hourly) can be given as a retention enema. This involves administering the drug via a Foley catheter per rectum with the 30 ml balloon inflated and catheter clamped. After 60 minutes the balloon is deflated and catheter removed (Apisarnthanarak et al., 2002). The make-up of this prescription is an powder for reconstitution; however, it is licensed to give this compound orally for C. difficile treatment. FIDAXOMICIN 200 Twice daily Give for days.

4 LACTULOSE for hepatic encephalopathy ml BD Titrate up to keep bowels moving twice daily. VITAMIN K 10 Usually given for 3 consecutive days to ensure adequate replacement (Amarapurkar and Amarapurkar, 2011) None SENNA 1 2 tablets Tablets Best taken at night but can be twice daily Takes 8 12 hours to work, hence night-time regimen is best. LACTULOSE ml ml Up to TDS Takes hours to exert its effect. LYETHYLENE GLYCOL (Movicol ) ISPAGHULA HUSK (Fybogel ) 1 3 sachets 1 2 sachets, containing 3.5 g of ispaghula husk granules Up to four sachets per day Can cause flatulence and abdominal distension. Laxatives should not be given in cases of bowel obstruction. Up to TDS Movicol comes in lemon or chocolate flavour. 1 sachet is dissolved in half a glass of water (approximately 125 ml). 8 sachets can be given in 1 day for faecal impaction, this should be for short-term use only at this high dosage.

5 CITRAMAG and SENNA for bowel prep 1 sachet Citramag (magnesium citrate) at 4 pm and 8 pm the day before the procedure 10 tablets of senna at 4 pm the day before At 4 pm and 8 pm the day before the procedure or, if patient s procedure is later on the morning, 1 sachet at 8 pm the day before and again at 8 am the morning of the procedure These timings will vary according to Trust protocol The patient must adhere to a clear fluid diet the day before the procedure, then nil by mouth from midnight. This advice varies according to the Trust and according to the timing of the endoscopy. Some centres may recommend a low-residue diet for 3 5 days prior to the colonoscopy. According to the centre, this regimen also may vary when a patient has significant comorbidities such as renal or heart failure. These patients may have the senna omitted, or may have moviprep ( a polyethylene glycol solution) instead of Citramag.