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Pre-Reg Clinical > 1. Gastro-intestinal system (drugs) > Flashcards

1. Gastro-intestinal system (drugs) Flashcards

1
Q

Commonly used drugs for GI conditions (16)

A
  1. Aminosalicylates
  2. Corticosteroids
  3. Monoclonal antibodies
  4. Antispasmodics
  5. Laxatives
  6. Anti-diarrhoeals
  7. Antacids
  8. PPIs
  9. H2 receptor antagonist
  10. Diagnostic agents
  11. Vasopressin analogues
  12. Antidepressants
  13. Antimuscarinics
  14. Lipase inhibitors
  15. Bile acids
  16. Pancreatic enzymes
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2
Q

Examples of aminosalicylates (2)

A
  1. Mesalazine

2. Sulfasalazine

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3
Q

Aminosalicylates key info (3)

A
  1. Patients should be advised to report any explained bleeding, bruising purpura, sore throat, fever or malaise that occurs during treatment
  2. If suspcision of a blood dyscrasia: stop drug immediately+perfomr blood count
  3. Monitoring: renal function before, at 3mths and then anually if oral treatment
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4
Q

Examples of corticosteroids used for GI conditions (6)

A
  1. Beclometasone dipropionate
  2. Budesonide
  3. Benzyl benzoate,bismuth oxide, bismuth subgallate, hydrocortisone acetate, peru balsam+zinc oxide (Anusol-HC)
  4. Cinchocaine with hydrocortisone (Proctosedyl)
  5. Cinchocaine with prednisolone (Scheriproct)
  6. Hydrocortisone+lidocaine (Xyloproct)
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5
Q

Examples of monoclonal antibodies used for GI conditions (1)

A
  1. Vedolizumab
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6
Q

Examples of antispasmodics (3)

A
  1. Peppermint oil
  2. Alverine citrate
  3. Mebeverine
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7
Q

Types of laxatives (6)

A
  1. Osmotic laxatives
  2. Stimulant laxatives
  3. Bulk-forming laxatives
  4. Selective 5-HT4 receptor agonists
  5. Softening laxatives
  6. Opioid receptor antagonists
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8
Q

Examples of osmotic laxatives / osmotic bowel preps (4)

A
  1. Macrogol 3350 with anhydrous sodium sulfate, ascorbic acid, potassium chloride, sodium ascorbate and sodium chloride (Movicol bowel prep)
  2. Lactulose
  3. Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride (Movicol, CosmoCol, Laxido)
  4. Sodium acid phosophate with sodium phosphate (phosphates enema/ cleen enema)
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9
Q

Examples of stimulant laxatives (5)

A
  1. Magnesium citrate with sodium picosulfate (Picolax)
  2. Bisacodyl
  3. Co-danthramer
  4. Glycerol
  5. Senna
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10
Q

Examples of bulk forming laxatives (1)

A
  1. Isphagula husk (Fybogel)
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11
Q

Examples of selective 5-HT4 receptor agonists (1)

A

1.Prucalopride

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12
Q

Examples of softening laxatives (3)

A
  1. Arachis oil
  2. Docusate sodium
  3. Liquid paraffin
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13
Q

Examples of opioid receptor antagonists (1)

A
  1. Naloxegol
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14
Q

Bulk forming laxatives - key info (3)

A
  1. If small hard stools if fibre cannot be increased in diet
  2. Onset of action of up to 72h
  3. MUST drink lots of water to avoid obstruction
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15
Q

Stimulant laxatives - key info (3)

A
  1. Increase intestinal motility
  2. Often cause abdominal cramp
  3. Manufacturer advises avoid in intestinal obstruction
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16
Q

Faecal softeners - key info (2)

A
  1. Decrease surface tension

2. Increase penetration of intestinal fluid into the fecal mass

17
Q

Osmotic laxatives - key info (2)

A
  1. Increase amount of water in the large bowel (either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with)
  2. May sometimes have a dehydrating effect
18
Q

Examples of antipropulsives (1)

A
  1. Loperamide hydrochloride
19
Q

Examples of antacids (3)

A
  1. Sodium alginate with potassium bicarbonate (Gaviscon advance)
  2. Bismuth subsalicylate (Pepto-bismol)
  3. Sodium alginate with calcium carbnate and sodium bicarbonate (Gaviscon, Peptac, Rennie)
20
Q

Antacids - key info (3)

A
  1. Magnesium containing antacids tend to be laxative, whereas aluminium containing antacids may be constipating
  2. Bismuth containing antacids not recommended because absorbed bismuth can be neurotoxic, causing encephalopathy. They tend to be constipating.
  3. Calcium-containing antacids can induce rebound acid secretion: with modest doses the clinical significance is doubtful, but prolonged high doses also cause hypercalcemia and alkalosis and can also precipitate the milk alkali syndrome.
21
Q

Examples of anti-foaming drugs (1)

A
  1. Simeticone (infacol)

Added to an antacid as an antifoaming agent to relive flatulence. These preparations may aid hiccup in palliative care.

22
Q

H2 receptor antagonists - key info (4)

A
  1. Heal gastric and duodenal ulcers by reducing gastric acid output as a result of histamine H2 receptor blockade
  2. Also used to relieve the symptoms of GORD
  3. Do not use for Zollinger-Ellison syndrome because PPIs are more effective
  4. May mask symptoms of gastric cancer - rule out malignancy if presenting with alarm symptoms
23
Q

Examples of H2 receptor antagonists (3)

A
  1. Cimetidine
  2. Famotidine
  3. Ranitidine
24
Q

PPIs - key info (17)

A
  1. Effective short term treatment for gastric and duodenal ulcers
  2. Also used in combination with antibiotics for eradication of Hpylori
  3. Following endoscopic treatment of severe peptic ulcer bleeding, an IV high dose PPI reduces the risk of rebleeding and the need for surgery
  4. Can be used for the treatment of dyspepsia and GORD
  5. PPIs also used for prevention and treatment of NSAID associated ulcers
  6. In patients who need to continue NSAID treatment after an ulcer has healed, the dose of PPI should not normally be reduced because asymptomatic ulcer deterioration may occur
  7. Can be used to reduce the degradation of pancreatic enzyme supplements in patients with CF
  8. Can also be used to control excessive secretion of gastric acid in Zollinger-Ellison syndrome -high doses often required
  9. Inhibit gastric acid secretion by blocking the hydrogen-potassium ATP enzyme system (proton pump) of the gastric parietal cell
  10. MHRA warning: SCLE
  11. Can increase the risk of fractures (especially if high doses for >year in the elderly)
  12. May increase the risk of GI infections including Cdiff
  13. Patients at risk of osteoporosis should maintain adequate intake of Ca and vit D and if necessary receive other preventative therapy
  14. Potentially inappoprirate in elderly for >8 weeks
  15. May cause hypomagesameia (more common after 1 y of treatment, but sometimes after 3 months)
  16. Consider monitoring magnesium if prolonged treatment
  17. Prescribe for apporpriate indications a tthe lowest effective dose for the shortest period. Need for long term treatment should be reviewed periodically.
25
Q

MHRA warning for PPIs (4)

A
  1. Very low risk of subacute cutaneous lupus erythematous
  2. May occur weeks/ months/ years after exposure
  3. If patient treated with PPI develops lesions especially in sun exposed areas of the skin - and accompanied by athralgia:
    - avoid exposing skin to sunlight
    - consider SCLE diagnosis
    - consider discontinuing PPI
  4. In most cases symptoms resolve n PPI withdrawl, steroids may be necessary if still getting symptoms
26
Q

Examples of PPIs(3)

A
  1. Esomeprazole
  2. Lansoprazole
  3. Omeprazole
27
Q

Examples of diagnostic agents (1)

A

Urea (13C)

Used to diagnose gastro-duodenal Hpylori infections

28
Q

Antimuscarinics for GI - key info (7)

A
  1. The intestinal smooth muscle relaxant properties of antimuscarinic and other antispasmodic drugs may be useful in IBS
  2. Antimuscarinics reduce intestinal motility. Can be used for the management of IBS
  3. Use tertiary amines (atropine, dicycloverine, hysocine) for GI smooth muscle spasm
  4. The quarternary amine ammonium compounds are less lipid soluble than atropine and so less liely to cross the BBB+ less well absorbed from the GI tract
  5. Dicycloverine less marked antimuscarinic action than atropine+some direct action on smooth muscle
  6. Hyoscine butylbromide is poorly absorbed
    7, Atropine outmodelled - clinical virtues outweighed by s/es
29
Q

Antispasmodics for GI - key info (4)

A
  1. Believed to be directed relaxants of intestinal smooth muscle
  2. May relieve pain in IBS
  3. No serious adverse effects
  4. Like all antispasmodics, should be avoided in paralytic ileus
30
Q

Examples of antimuscarinics for GI

A
  1. Hyoscine butylbromide
31
Q

Examples of bile acids (2)

A
  1. Cholic acid

2. Ursodeoxycholic acid

32
Q

Examples of vasopressin analogues used for GI conditions (1)

A
  1. Terlipressin (glypressin)
33
Q

Examples of lipase inhibitors (1)

A
  1. Orlistat
34
Q

Examples of pancreatic enzymes

A
  1. Pancreatin (Creon, Nutrizym, Pancrease, Pancrex)

Pre-Reg Clinical (25 decks)

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