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PPE > 13.1 GI Motility Drugs > Flashcards

13.1 GI Motility Drugs Flashcards

1
Q

What can cause vomiting?

A 
Problems with the vestibular system
Drug Induced - Post Op, Chemotherapy
Alcohol
Pregnancy
Unpleasant Stimuli - Smells
Infections - Salmonella
Raised ICP
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2
Q

What areas of the brain are involved in vomiting?

A

The Area Postrema
The Medullary Centres
The Vestibular Areas

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3
Q

What Neurotransmitters are involved in vomiting?

A

ACh
Histamine
Serotonin
Dopamine

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4
Q

What are the 4 classes of Drug we use to treat vomiting?

A

D2 antagonists
ACh (muscarinic) antagonists
5HT antagonists
Histamine antagonists

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5
Q

How do D2 antagonists work?
Examples:
When are they used?

A

Act on the area postrema

Metoclopramide
Post Operations, if GI cause, Chemotherapy, Migraines

Domperidone
It can increase gastric emptying
Use in acute cases e.g for Parkinsons Disease medication

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6
Q

ADRs of D2 antagonists?

A

Dystonia
Galactorrhoea
Gynacomastia (increased prolactin)

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7
Q

What are the stages of vomiting?

A

Stimulation of the Vomiting Centre - Area Postrema
Warning Signs - lightheaded, fast breathing, feel hot/sweaty, pale

Glottis closes, Soft Palate raises, pyloric sphincter contracts

Diaphragm and abdominal muscles contract, Cardia Relaxes

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8
Q

What is metoclopramide?

Pharmacokinetics?

A

D2 antagonist
Oral, IM, IV
Half life of 4 hours

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9
Q

What is Domperidone?

Pharmacokinetics?

A

D2 antagonist
Oral, Rectal
Doesn’t cross BBB
Extensive 1st Pass Metabolism

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10
Q

How do 5HT antagonists work?

When used?

A

They work on the area postrema and periphery
They prevent vagal stimulation
Post Op
Chemotherapy

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11
Q

ADRs of 5HT antagonists?

A

Headaches
Constipation
Flushing

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12
Q

Example of a 5HT antagonist

A

Ondansteron

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13
Q

How do Histamine antagonists work?
When used?
Example?

A

Acute Cases e.g. MI

Cyclozine

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14
Q

How do ACh antagonists work?

When used?

A

Use in travel sickness
Short Half Life
Take 30 mins to take effect

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15
Q

ADRs of Histamine Antagonists?

A

Drowsiness

Long QT

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16
Q

ADRs of ACh antagonists?

A

Can become tolerant
Can cause systemic anti-muscarinic effects
Constipation
Bradycardia

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17
Q

What drugs do you use to treat constipation?

A

Bulk Forming Laxatives
Osmotically Active
Stool Softeners
Stimulants

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18
Q

How do you remember the 4 Constipation Drugs?

A

BOSS

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19
Q

Which treatments do you use if stool is found to be hard

A 
Bulk Forming 
Stool Softener (Faecal Softeners)
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20
Q

What laxative should you use if there is soft stool?

A

Stimulants

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21
Q

What lifestyle recommendations would you make to someone with constipation?

A 
Fibre
Five a Day
Fluid
Alter Medication
Exercise
22
Q

What conditions can cause constipation?

A

Pregnancy
Parkinsons
Diabetes
Dehydration

23
Q

Which Drug do you not use if dehydrated?

A

Bulk Forming Agents - ispagula

24
Q

Bulk Forming Agents - MoA?

A

Insoluble vegetable fibre, not absorbed, distends the intestine, stretch receptors causing peristalsis
It also draws H20 into the bowel, to distend as well

25
Q

Bulk Forming Agents - When?

A

In pregnancy - it is safe!

Takes a few days to work and bring bowel function back to normal

26
Q

Bulk Forming Agents - ADRs?

A

Flatulence

27
Q

Bulk Forming Agents - Example

A

Ispagula

28
Q

Bulk Forming Agents - Contraindications

A

Obstruction
Dehydration
Ulceration

29
Q

Faecal Softeners - MoA and Example

A

Stay in the bowel, lubricate and soften stool
Glycerol
Arachnis Oil

30
Q

Faecal Softeners - When use?

A 
If cannot tolerate fibre
Very Safe
Haemorrhoids
Adhesions
Anal Fissures
31
Q

Faecal Softeners - Contraindicated

A

In Obstruction

32
Q

Faecal Softeners - Why not very good?

A

Not always effective

Normally suppository

33
Q

Osmotically Active Laxatives - MoA?

A

Mg or Na Salts draw water into the bowel, distends the bowel causing peristalsis

34
Q

Osmotically Active Laxatives - When use?

A

Instant relief needed
Before Surgery
Before Colonoscopy

35
Q

Osmotically Active Laxatives - PK

Examples?
When use?

A

Very Potent
Fast Acting

Lactulose - liver failure
Macrogols - helps dehydration

36
Q

Osmotically Active Laxatives - ADRs

A

Can cause obstruction

37
Q

Stimulant Laxatives - MoA

A

Irritate the bowel mucosa, stimulates peristalsis and H2O to go into the bowel

38
Q

Stimulant Laxatives - Examples?

A

Senna

Castor Oil

39
Q

Stimulant Laxatives - When Use?

A

Overnight - takes 6/8 hours

Rapid Treatment

40
Q

Stimulant Laxatives - Contraindicated

A

Not Long Term - melanosis coli

Hypokalaemia

41
Q

Stimulant Laxatives - ADRs

A

Obstruction
Cramps
Atony
Hypokalaemia

42
Q

How do you treat diarrhoea?

A 
Drug treatments treat the symptoms not the cause
If can:
Treat underlying cause
Lifestyle Advice - no caffeine 
Manage fluids and electrolytes
43
Q

What drug classes would you treat diarrhoea with?

A

Anti-motility - opioids
Bulk Forming Agents
Bile Acid Sequestants
Pancreatic Enzymes

44
Q

Anti-Motility Drugs - MoA?

Examples?

A

Act on Opioid receptors on the bowel to reduce movement

Codeine, Imodium

45
Q

Anti-Motility Drugs - Containdicated

A

IBD - Causes Toxic Megacolon

46
Q

Anti-Motility Drugs - Positives?

A

Increase Anal Tone

Reduce Reflex to Defaecate

47
Q

Anti-Motility Drugs - When use?

A

Chronic Diarrhoea

48
Q

Bulk Forming Agents, why use in diarrhoea?

A

Creates a more formed stool

49
Q

When do you use Bulk Forming Agents?

A

IBS
Ileostomy
Diverticular Disease

50
Q

When would you use a bile acid sequesterant?

A

In Crohns Disease

If Bile Salt Induced

PPE (25 decks)

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