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GIHEP > 17. Upper GI Pharmacology > Flashcards

17. Upper GI Pharmacology Flashcards

1
Q

Which cells release pepsinogen?

A

Chief cells

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2
Q

What is mucous production stimulated by?

A

Prostaglandins

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3
Q

What cells produce gastrin?

A

G cells

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4
Q

What stimulates the production of gastrin?

A

AAs and peptides

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5
Q

What is the function of gastrin?

A

Binds to CCK-B receptors on parietal cells

Increase pepsinogen and gastric motility

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6
Q

What receptors does ACh work on in the stomach?

A

M3 on parietal cells

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7
Q

What cells secrete histamine?

A

Mast cells or enterochromaffin cells

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8
Q

What factors increase the secretion of histamine?

A

Gastrin and ACh

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9
Q

What factors decrease acid secretion?

A

Prostaglandins E2 and I2

Somatostatin

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10
Q

What is the treatment for peptic ulcers if a patient is not taking NSAIDs?

A

Test for h.pylori
+ 1 week eradication
- PPI 4-8 weeks

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11
Q

What is the treatment for peptic ulcers if a patient is taking NSAIDs?

A

Stop NSAID if possible
Test for h.pylori
+ 8 weeks PPI then 1 week eradication
- PPI 8 weeks

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12
Q

How is H. pylori eradicated?

A

Triple therapy:
Amoxicillin and clarithromycin/metronidazole
plus a PPI
for 1 week

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13
Q

Name a PPI

A

Omeprazole

prodrug which is metabolically active at a low pH

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14
Q

How does omeprazole work?

A

Blocks H+/K+ ATPase, ie no H+ for HCl acid

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15
Q

What method of dosing is used for PPIs?

A

‘Step down’ start with a high dose and reduce it

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16
Q

What are the side effects of PPIs?

A

C.diff
Low magnesium
B12 deficiency

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17
Q

What are the indications for PPIs?

A

PUD, GORD
Prophylaxis if taking NSAIDs
Zollinger Ellison Syndrome

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18
Q

Name 2 H2 receptor antagonists

A

Cimetidine

Ranitidine

19
Q

How does cimetidine work?

A

Blocks the effects of histamine, ACh and gastrin on parietal cells
> reduced pepsin secretion

20
Q

What are the side effects of cimetidine?

A

Interact with CYP450
Antiandrogenic
Ranitidine doesn’t have these effects
Both cause drowsiness

21
Q

Name 3 cytoprotective agents

A

Misoprostol
Sucralfate
Bismuth

22
Q

What is the MOA of misoprostol?

A

Synthetic prostaglandins: increase mucous production, decrease secretion by acting on parietal cells

23
Q

Which group is misoprostol used for?

A

High-risk groups taking NSAIDs

24
Q

What are the side effects of misoprostol?

A

Diarrhoea and uterine contractions (contraindicated in pregnancy)

25
Q

What is the MOA of sucralfate?

A

Binds to base of ulcer and increases prostaglandins and bicarb

26
Q

What side effect is associated with sucralfate?

A

Bezoar formation which can cause gastric blockage

Avoid by making sure well hydrated

27
Q

What is the MOA of bismuth?

A

Increase prostaglandin synthesis and bicarb and inhibits h.pylori
Used in triple therapy if allergy or resistance

28
Q

What are antacids?

A

Weak bases used to neutralise gastric acid
Used for symptom relief
Eg. sodium bicarb, calcium carbonate, magnesium, aluminium

29
Q

What is the MOA of Gaviscon?

A

Rafting agent: floats on top of acid so it doesn’t enter the oesophagus
Alginate

30
Q

What is the treatment for GORD?

A

Lifestyle modification
PPIs first line
H2 antagonist if needed
Antacids/alginates for mild symptoms

31
Q

Name 2 D2 antagonists used as anti-emetics

A

Metoclopramide

Domperidone

32
Q

What is the MOA of metoclopramide?

A

Dopamine receptor antagonist

Reduce smooth muscle relaxation at D2 receptor and inhibits ACh which increases gastric emptying

33
Q

What side effects are associated with metoclopramide?

A

Extrapyramidal: tremors, seizures

34
Q

What side effects are associated with domperidone?

A

Doesn’t cross BBB so no extrapyramidal

Ventricular arrhythmia and sudden cardiac death

35
Q

What regulatory mechanisms are associated with vomiting?

A 
Cholinergic
Histamine
Dopamine
Serotonin
Cannabinoid
36
Q

What are anticholinergics and antihistamines used for?

A

Motion sickness

37
Q

What side effect is associated with anti-histamines?

A

Sedation

38
Q

What are dopamine receptor antagonists, serotonin receptor antagonists and cannabinoids used for?

A

Reduce vomiting caused by chemo

39
Q

Name 2 dopamine receptor antagonists

A

Phenothiazides

Butyrophenones

40
Q

Name a serotonin receptor antagonist

A

Ondansetron

41
Q

What are the side effects associated with serotonin receptor antagonists?

A

Constipation and headache

42
Q

Name a cannabinoid

A

Nabilone

43
Q

What side effects are associated with cannabinoids

A

Drowsiness, psychotic reactions

GIHEP (30 decks)

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