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Alimentary Clinical medicine > Alimentary pharmacology > Flashcards

Alimentary pharmacology Flashcards

1
Q

what main drug types are used for acid suppression and give an example of a drug for each.

A

H2 receptor antagonists e.g. Ranitidine
alginates e.g. Gaviscon
Proton pump inhibitors e.g. Omeprazole
Antacids e.g. Mallox

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2
Q

how does gaviscon treat reflux?

A

it forms a viscous gel that floats on the stomach contents and reduces reflux

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3
Q

how does H2 receptor antagonists rescue acid production?

A

blocks histamine receptor therefore reducing acid secretion

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4
Q

how does PPI’s reduce acid secretion?

A

block the proton pump

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5
Q

how does antacids treat heart burn or reflux?

A

they neutralise the acid

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6
Q

what are some of the problems associated with a PPI such as omeprazole?

A

GI upset
Predisposition to clostridium difficile
Hypomagnesaemia
B12 deficiency

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7
Q

what are the 2 main drugs which affect biliary secretions?

A

cholestyramine

ursodeoxycholic acid

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8
Q

how does cholestyramine work?

what is the problem with this drug?

A

reduces bile salts by binding with them in the gut and excreting them as insoluble complex’s
problem - may affect absorption of fat soluble vitamins such as vitamin K

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9
Q

how does ursodeoxycholic acid work?

A

inhibits the enzyme involved in formation of cholesterol

this alters the amount of cholesterol in bile and slowly dissolves non calcified stones

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10
Q

what is the main drug which is used in the treatment of gallstones?

A

ursodeoxycholic acid

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11
Q

what are the main conditions which ursodeoxycholic acid treat?

A

gallstones

primary biliary cirrhosis

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12
Q

what are the different drug types which affect gut motility?

give an example for each of these.

A

pro kinetics e.g. domperidone
anti-motility e.g. loperamide
anti-spasmodics e.g. buscopan and peppermint oil
laxatives e.g. isphagula, lactulose, senna, archacis oil

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13
Q

what is the action of pro kinetics?

A

increase gut motility and increase gastric emptying

increase parasympathetic control of smooth muscle and sphincter control via Ash

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14
Q

how does loperamide work?

A

(also known as immodium)
work via opiate receptors in GI tract to decrease Ach release.
this decreases smooth muscle contraction and therefore increase anal sphincter tone.

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15
Q

what type of anti-spasmodic is buscopan and how does it work?

A

anti-cholinergic muscarinic antagonist

inhibits smooth muscle contraction in gut wall therefore = relaxation

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16
Q

what type of anti-spasmodic is peppermint oil and how does it work?

A

calcium channel blocker

reduces ca required for smooth muscle contraction

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17
Q

what are the 4 types of laxative?

A

bulk e.g. isphagula
osmotic e.g. lactulose
stimulant e.g. senna
softness e.g. arachis oil

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18
Q

what are the problems with laxatives?

A
  • can cause obstruction
  • need for other measures (with osmotic laxatives they won’t work if you don’t have adequate fluid intake)
  • misuse
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19
Q

what are the main drug types/names used for IBS-C?

A

pro kinetics
anti spasmodics i.e. buscopan and peppermint oil
laxatives

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20
Q

what are the main drug types/names used for IBS-D?

A

anti-motility i.e. Loperamide

anti-spasmodics i.e. buscopan and peppermint oil

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21
Q

what is a problem with loperamide?

A

has a few central opiate effects as it is not well absorbed across the blood brain barrier

22
Q

what are the main drug types for treating inflammatory bowel disease and give an example of each.

A

aminosalicylates e.g. mesalazine and omezalazine
steroids
immunosuppressants e.g. azathioprine and methotrexate
biologics (anti TNFalpha antibodies) e.g. infliximab

23
Q

how does biologics such as infliximab work to reduce inflammation?

A

infliximab is a anti TNF alpha antibody.

it prevents the action of TNF which is a pro inflammatory cytokine

24
Q

how does immunosuppressants such as azathioprine work to reduce inflammation?

A

prevents the formation of purines required for DNA synthesis therefore prevents immune cell proliferation

25
Q

what are the problems associated with the use of immunosuppressants such as azathioprine for the treatment of IBD?

A

adversely affects bone marrow
hypersensitivity
organ damage (lung, liver and pancreas)

26
Q

what are the problems associated with aminosalicylates for the treatment of IBD?

A

GI upset
blood dyscrasis
renal impairment

27
Q

what are the problems associates with the use of steroids?

A

osteoporosis
cushing features i.e. weight gain, diabetes, hypertension
increased susceptibility to infection
addison crisis with sudden withdrawal

28
Q

what are the contraindications for anti TNF alpha antibodies?

A

TB
MS
serious infection
pregnancy/breast feeding

29
Q

What are the adverse effects of biologics such as infliximab which is used for the treatment of IBD?

A

risk of infection (esp. TB)
infusion reaction i.e. fever, rash
anaemia, thrombocytopenia, neutropenia
demyelination (disseminated malignancy)

30
Q

what are the main pharmacodynamic changes in a patient with chronic liver disease?

A

exaggerated response
reduced response
increased toxicity

31
Q

why is the distribution of drugs in someone with chronic liver disease affected?

A

chronic liver disease causes a patient to have low albumin

low albumin = decreased binding and increased free drug concentration

32
Q

what classification is used to determine the extent of liver disease?

A

child-pugh classification

33
Q

when prescribing drugs to a patient who has chronic liver disease, what do you have to take care with/avoid?

A

drugs which are hepatotoxic such as methotrexate and azathioprine
drugs which may worsen the non-liver aspects of liver disease (encephalopathy) such as benzodiazepines

34
Q

what particular drugs should you avoid if a patient has chronic liver disease?

A

Warfarin
Aspirin/NSAIDS
Opiates/benzodiazepines

35
Q

what are the risk actors for getting GI adverse effects from drugs?

A 
age 
female 
alcohol consumption
genetics
malnourishment
36
Q

what drug type can cause changes to gut bacteria?

and what are the effects that changing gut bacteria can have?

A

anti biotics

  • reduction in vitamin K absorption = increased prothrombin time
  • require gut bacteria to convert inactive drugs into active, therefore if its disturbed it may impact the effectiveness of the oral contraceptive pill
  • overgrowth of pathogenic bacteria such as clostridium difficile
37
Q

what drug types can cause peptic ulceration and GI bleeding?

A

low dose aspirin
NSAIDS
Warfarin

38
Q

what drug types can cause diarrhoea / constipation?

A 
constipation = anticholinergics, NSAIDS, antimicrobials
diarrhoea = NSAIDS, opioids, cholinergics
39
Q

what are the 2 types of drug induced liver injury?

A

Type A - intrinsic hepatotoxicity (predictable, dose related)

Type B - idiosyncratic hepatotoxicity (unpredictable, not dose dependant)

40
Q

what are the adverse effects of aminosalicylates?

A

GI upset
blood dyscrasia
renal impairment

41
Q

what are the adverse effects of steroids?

A

osteoporosis
cushings - weight gain, hypertension, diabetes
increased susceptibility to infection
addison crisis with sudden withdrawal

42
Q

what are the adverse effects of anti-TNF alpha antibodies?

A 
risk of infection esp. TB
infusion reactions - rash, fever 
anaemia
thrombocyopenia 
neutropenia 
demyelination - disseminated malignancy
43
Q

what are the adverse effects with proton pump inhibitors?

A

GI upset
predisposition to clostridium difficile
hypomagnesaemia
B12 deficiency

44
Q

in patients with chronic liver disease, what is the problem with the metabolism of drugs?

A

they have an increased gut bacteria therefore metabolise drugs quicker so higher dose is needed
Liver disease may reduce first pass metabolism

45
Q

what are the risk factors for experiencing GI adverse effects from drugs?

A 
age 
female 
alcohol consumption 
genetics
malnourishment
46
Q

how does antibiotics affect the gut and what effects does this have?

A

Antibiotics cause changes to gut bacteria
Gut bacteria converts inactive drugs to active ones (i.e. the pill) therefore this results in certain drugs not being effective
Reduces vitamin K absorption = increased prothrombin time
Overgrowth of pathogenic bacteria i.e. C.difficile

47
Q

what are the two types of drug induced liver hepatotoxicity?

A

intrinsic - dose related, predictable (type A)

idiosyncratic - unpredictable, not dose related (type B)

48
Q

in the child Pugh classification of severity of liver disease, what are the values for groups A, B and C?

A 
A = > 7
B = 7-9
C = >9
49
Q

which drugs are hepatotoxic?

A

methotrexate

azathioprine

50
Q

what drug may worsen the non liver aspects of liver disease?

A

opiates/ benzodiazepines

encephalopathy

51
Q

what type of drug can worsen ascites and how?

A

NSAIDS

due to fluid retention

Alimentary Clinical medicine (23 decks)

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