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semester 4 - CPT & Prescribing > 18. GI Pharmacology > Flashcards

18. GI Pharmacology Flashcards

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1
Q

what are the two types of peptic ulceration?

A

Gastric and duodenal ulcers

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2
Q

What are peptic ulcers?

A

Peptic ulcers are defects in the gastric or duodenal mucosa that extend through the muscularis mucosa

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3
Q

What are the symptoms of peptic ulcers?

A

Epigastric pain after meals - location of pain not reliable guide to ulcer location
• Soon after meals (gastric ulcer
• 2-3 hours after (duodenal)

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4
Q

What are the complications of peptic ulcers?

A
  • haemorrhage
  • perforation (peritonitis)
  • scarring and obstruction (of gastric outlet)
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5
Q

What are the risk factors for peptic ulcers?

A

• H- pylori infection
• NSAIDs - inhibit protective action of prostaglandin
• Acid essential for ulceration and inability of
normal [acid] to inhibit further acid is a significant factor
• Early gastric emptying
• Smoking and alcohol delay healing

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6
Q

describe the factors that affect acid secretion

A
  • proton pump pumps H+ out of parietal cell and K+ in
  • acetylcholine and gastrin, through the release of calcium ions, activate protein kinase which stimulates the proton pump
  • histamine binds to g protein coupled receptors and activate adenylyl cyclase which converts ATP to cAMP which activates protein kinase
  • prostaglandin inhibit action of adenylyl cyclase
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7
Q

What is the goal of treatment for peptic ulcers?

A

Eliminate underlying cause, relieve symptoms, heal ulcers and treat complications (bleeding)

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8
Q

what are the action of alginates and antacids?

A

• antacids – Buffering stomach acid
alginic acid – increase stomach content viscosity and reduce reflux
• Often taken as compound preparations

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9
Q

name of a drug containing alginates and antacids?

A

Gaviscon

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10
Q

give more detail on preparation of Gaviscon

A

Alginic acid – sodium alginate + aluminium hydroxide/magnesium carbonate - antacids

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11
Q

adverse effects of Gaviscon?

A

Magnesium salts can cause diarrhoea and aluminium salts can cause constipation

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12
Q

warnings, contraindications for Gaviscon?

A
  • Na+ and K+ containing preparations should be used with caution in renal failure
  • High [sucrose] in some preparations - hyperglycaemia in DM
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13
Q

Δ important drug interactions of gaviscon?

A
  • Can reduce absorption of many drugs so doses should be separated
  • Increased urine alkalinity can increase aspirin excretion
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14
Q

action of Proton pump inhibitors (PPI)?

A

• Irreversibly inhibit the H+/K+ ATPase in gastric parietal cells
Final stage in the pathway – very significant reduction in acid secretion

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15
Q

examples of Proton pump inhibitors (PPI)?

A

Lansoprazole

Omeprazole

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16
Q

adverse effects of Proton pump inhibitors (PPI)?

A
  • GI disturbance – abdominal pain, constipation diarrhoea
  • Headache, dizziness
  • Drowsiness/confusion
17
Q

warnings, contraindications of Proton pump inhibitors (PPI)?

A
  • Mask symptoms of gastro-oesophageal cancer

* Osteoporosis – fracture risk - reduced absorption of calcium

18
Q

Important drug interactions of Proton pump inhibitors (PPI)?

A
  • Omeprazole CYP inhibitor – reduced clopidogrel action

* PPIs can increase effects of warfarin and phenytoin - monitor

19
Q

aim when prescribing Proton pump inhibitors (PPI)?

A

Shortest effective duration at lowest effective dose

20
Q

what is often prescribed alongside Proton pump inhibitors (PPI)?

A

Often prescribed along side long term NSAID (due to risk of ulceration) or steroid

21
Q

Action of H2 receptor antagonists?

A
  • Inhibition of H2 receptors – local histamine release contributes to proton pump activation
  • Other routes to pump inhibition mean only partial reduction in acid secretion
22
Q

example of H2 receptor antagonists?

A

Ranitidine

23
Q

adverse effects of H2 receptor antagonists?

A

generally well tolerated - diarrhoea, headache

24
Q

warnings, contraindications of H2 receptor antagonists?

A

Mask symptoms of gastro-oesophageal cancer, careful renal impairment as excreted renally

25
Q

Important drug interactions of H2 receptor antagonists?

A

Few common DDIs – (reduced exposure to some antivirals and protein kinase inhibitors)

26
Q

why is there Current large scale recall on most ranitidine containing products and what is given instead?

A

due to possible carcinogenic contaminant

- lansoprazole typically first alternative upon patient review

27
Q

when should H pylori be considered?

A

Consider for all patients with duodenal or gastric ulcers not associated with NSAID or unresponsive to lifestyle PPI and antacids

28
Q

how is H pylori tested?

A

urea breath test - given urea labelled with carbon 12. urease produced by h pylori converts urea to CO2 which is breathed out

29
Q

How is H pylori treated

A

•One week triple therapy
PPI + two antibacterial agents
• Lansoprazole + clarithromycin + amoxicillin
OR
Lansoprazole + clarithromycin + metronidazole
where allergic to amoxicillin

30
Q

what are Amionsalicylates used for?

A

Used as a first line treatment in ulcerative colitis (UC) - anti inflammatory action

31
Q

example of Amionsalicylates ?

A

Mesalazine

32
Q

action of Amionsalicylates ?

A

Release of 5-aminosalsylic acid

Topical action at the colon (enteric coated tablets limit gastric breakdown)

33
Q

role of Mesalazine in rheumatoid arthritis?

A

• mesalazine has no role in rheumatoid arthritis
• sulfasalazine has more side effects so used infrequently for UC but sulfa group good for
rheumatoid arthritis

34
Q

adverse effects of Amionsalicylates ?

A

GI disturbance – nausea, dyspepsia

leukopenia - rare

35
Q

warnings, contraindications of Amionsalicylates ?

A

are salicylates like aspirin – similar hypersensitivity

36
Q

Important drug interactions of Amionsalicylates ?

A

Enteric coated tablets may break down quicker in presence of PPI (because of ↑pH)

semester 4 - CPT & Prescribing (25 decks)

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