1. Gastro-intestinal system (drugs) Flashcards
1
Q
Commonly used drugs for GI conditions (16)
A
- Aminosalicylates
- Corticosteroids
- Monoclonal antibodies
- Antispasmodics
- Laxatives
- Anti-diarrhoeals
- Antacids
- PPIs
- H2 receptor antagonist
- Diagnostic agents
- Vasopressin analogues
- Antidepressants
- Antimuscarinics
- Lipase inhibitors
- Bile acids
- Pancreatic enzymes
2
Q
Examples of aminosalicylates (2)
A
- Mesalazine
2. Sulfasalazine
3
Q
Aminosalicylates key info (3)
A
- Patients should be advised to report any explained bleeding, bruising purpura, sore throat, fever or malaise that occurs during treatment
- If suspcision of a blood dyscrasia: stop drug immediately+perfomr blood count
- Monitoring: renal function before, at 3mths and then anually if oral treatment
4
Q
Examples of corticosteroids used for GI conditions (6)
A
- Beclometasone dipropionate
- Budesonide
- Benzyl benzoate,bismuth oxide, bismuth subgallate, hydrocortisone acetate, peru balsam+zinc oxide (Anusol-HC)
- Cinchocaine with hydrocortisone (Proctosedyl)
- Cinchocaine with prednisolone (Scheriproct)
- Hydrocortisone+lidocaine (Xyloproct)
5
Q
Examples of monoclonal antibodies used for GI conditions (1)
A
- Vedolizumab
6
Q
Examples of antispasmodics (3)
A
- Peppermint oil
- Alverine citrate
- Mebeverine
7
Q
Types of laxatives (6)
A
- Osmotic laxatives
- Stimulant laxatives
- Bulk-forming laxatives
- Selective 5-HT4 receptor agonists
- Softening laxatives
- Opioid receptor antagonists
8
Q
Examples of osmotic laxatives / osmotic bowel preps (4)
A
- Macrogol 3350 with anhydrous sodium sulfate, ascorbic acid, potassium chloride, sodium ascorbate and sodium chloride (Movicol bowel prep)
- Lactulose
- Macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride (Movicol, CosmoCol, Laxido)
- Sodium acid phosophate with sodium phosphate (phosphates enema/ cleen enema)
9
Q
Examples of stimulant laxatives (5)
A
- Magnesium citrate with sodium picosulfate (Picolax)
- Bisacodyl
- Co-danthramer
- Glycerol
- Senna
10
Q
Examples of bulk forming laxatives (1)
A
- Isphagula husk (Fybogel)
11
Q
Examples of selective 5-HT4 receptor agonists (1)
A
1.Prucalopride
12
Q
Examples of softening laxatives (3)
A
- Arachis oil
- Docusate sodium
- Liquid paraffin
13
Q
Examples of opioid receptor antagonists (1)
A
- Naloxegol
14
Q
Bulk forming laxatives - key info (3)
A
- If small hard stools if fibre cannot be increased in diet
- Onset of action of up to 72h
- MUST drink lots of water to avoid obstruction
15
Q
Stimulant laxatives - key info (3)
A
- Increase intestinal motility
- Often cause abdominal cramp
- Manufacturer advises avoid in intestinal obstruction
16
Q
Faecal softeners - key info (2)
A
- Decrease surface tension
2. Increase penetration of intestinal fluid into the fecal mass
17
Q
Osmotic laxatives - key info (2)
A
- 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)
- May sometimes have a dehydrating effect
18
Q
Examples of antipropulsives (1)
A
- Loperamide hydrochloride
19
Q
Examples of antacids (3)
A
- Sodium alginate with potassium bicarbonate (Gaviscon advance)
- Bismuth subsalicylate (Pepto-bismol)
- Sodium alginate with calcium carbnate and sodium bicarbonate (Gaviscon, Peptac, Rennie)
20
Q
Antacids - key info (3)
A
- Magnesium containing antacids tend to be laxative, whereas aluminium containing antacids may be constipating
- Bismuth containing antacids not recommended because absorbed bismuth can be neurotoxic, causing encephalopathy. They tend to be constipating.
- 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
- 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
- Heal gastric and duodenal ulcers by reducing gastric acid output as a result of histamine H2 receptor blockade
- Also used to relieve the symptoms of GORD
- Do not use for Zollinger-Ellison syndrome because PPIs are more effective
- May mask symptoms of gastric cancer - rule out malignancy if presenting with alarm symptoms
23
Q
Examples of H2 receptor antagonists (3)
A
- Cimetidine
- Famotidine
- Ranitidine
24
Q
PPIs - key info (17)
A
- Effective short term treatment for gastric and duodenal ulcers
- Also used in combination with antibiotics for eradication of Hpylori
- Following endoscopic treatment of severe peptic ulcer bleeding, an IV high dose PPI reduces the risk of rebleeding and the need for surgery
- Can be used for the treatment of dyspepsia and GORD
- PPIs also used for prevention and treatment of NSAID associated ulcers
- 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
- Can be used to reduce the degradation of pancreatic enzyme supplements in patients with CF
- Can also be used to control excessive secretion of gastric acid in Zollinger-Ellison syndrome -high doses often required
- Inhibit gastric acid secretion by blocking the hydrogen-potassium ATP enzyme system (proton pump) of the gastric parietal cell
- MHRA warning: SCLE
- Can increase the risk of fractures (especially if high doses for >year in the elderly)
- May increase the risk of GI infections including Cdiff
- Patients at risk of osteoporosis should maintain adequate intake of Ca and vit D and if necessary receive other preventative therapy
- Potentially inappoprirate in elderly for >8 weeks
- May cause hypomagesameia (more common after 1 y of treatment, but sometimes after 3 months)
- Consider monitoring magnesium if prolonged treatment
- 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
- Very low risk of subacute cutaneous lupus erythematous
- May occur weeks/ months/ years after exposure
- 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 - In most cases symptoms resolve n PPI withdrawl, steroids may be necessary if still getting symptoms
26
Q
Examples of PPIs(3)
A
- Esomeprazole
- Lansoprazole
- 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
- The intestinal smooth muscle relaxant properties of antimuscarinic and other antispasmodic drugs may be useful in IBS
- Antimuscarinics reduce intestinal motility. Can be used for the management of IBS
- Use tertiary amines (atropine, dicycloverine, hysocine) for GI smooth muscle spasm
- 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
- Dicycloverine less marked antimuscarinic action than atropine+some direct action on smooth muscle
- Hyoscine butylbromide is poorly absorbed
7, Atropine outmodelled - clinical virtues outweighed by s/es
29
Q
Antispasmodics for GI - key info (4)
A
- Believed to be directed relaxants of intestinal smooth muscle
- May relieve pain in IBS
- No serious adverse effects
- Like all antispasmodics, should be avoided in paralytic ileus
30
Q
Examples of antimuscarinics for GI
A
- Hyoscine butylbromide
31
Q
Examples of bile acids (2)
A
- Cholic acid
2. Ursodeoxycholic acid
32
Q
Examples of vasopressin analogues used for GI conditions (1)
A
- Terlipressin (glypressin)
33
Q
Examples of lipase inhibitors (1)
A
- Orlistat
34
Q
Examples of pancreatic enzymes
A
- Pancreatin (Creon, Nutrizym, Pancrease, Pancrex)
