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Gastrointestinal Pathology > Clinical Pharmacology > Flashcards

Clinical Pharmacology Flashcards

1
Q

Drugs for acid suppression

A

Antacids
Alginates
H2 receptor antagonists
Proton pump inhibitors

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2
Q

What drugs affect GI motility?

A

Anti-emetics
Anti-muscarinics/other anti-spasmodics
Anti-motility

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3
Q

Drugs used to treat IBD

A

Aminosalicylates
Corticosteriods
Immunosuppressants
Biologics

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4
Q

What drugs affect intestinal secretions?

A

Bile acid sequestrants

Ursodeoxycholic acid

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5
Q

Features of antacids

A

Neutralise gastric acid

Taken when the symptoms occur

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6
Q

Example of an antacid

A

Maalox

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7
Q

Example of an alginate

A

Gaviscon

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8
Q

How do alginates work?

A

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

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9
Q

How do H2RA work?

A

Block histamine receptor and therefore reduce acid secretion

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10
Q

Example of a H2RA

A

Ranitidine

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11
Q

What is H2RAs indicated in?

A

GORD

Peptic ulcer disease

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12
Q

How do PPIs work?

A

Irreversibly block proton pump and therefore reduce acid secretion

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13
Q

What are PPIs indicated in?

A

GORD
Peptic ulcer disease
In triple therapy for H pylori

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14
Q

Example of a PPI

A

Omeprazole

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15
Q

S/Es/Complications of PPI use

A

GI upset
Predisposition to C diff
Hypomagnesia
B12 deficiency

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16
Q

What do prokinetic agents do?

A

Increase gut motility and gastric emptying

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17
Q

Examples of drugs that decrease motility

A

Loperamide (immodium)

Opiods

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18
Q

What can anti-spasmodics be used in?

A

IBS

Renal colic

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19
Q

How do drugs that decrease motility of the gut work?

A

Via opiate receptors in GI tract to decrease ACh release

  • increased smooth muscle contraction
  • increased anal sphincter tone
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20
Q

Types of anti-spasmodics

A
  1. Anti-cholinergic muscarinic antagonists
  2. Direct smooth muscle relaxants
  3. CCBs (peppermint oil)
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21
Q

How do anti-cholinergic muscarinic antagonists work?

A

Inhibit smooth muscle contraction in the gut wall, producing muscle relaxation and reduction spasm

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22
Q

How do CCBs work as anti spasmodics?

A

Reduce calcium required for smooth muscle contraction

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23
Q

Types of laxatives and an example of each

A

Bulk (Isphagula)
Osmotic (lactulose)
Stimulant (senna)
Softeners (arachis oil)

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24
Q

How do laxatives work?

A

By increased bulk or

Drawing fluid into the gut

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25
Q

Adverse effects of aminosalicylates for IBD

A

GI upset
Blood dyscarias
Renal impairment

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26
Q

Examples of aminosalicylates for IBD

A

Mesalazine

Olsalazine

27
Q

Complications of corticosteriods for IBD

A

Osteoporosis
Cushings
Increased susceptibility to infection
Addisonian crisis with abrupt withdrawal

28
Q

Example of an immunosuppressant used for IBD

A

Azathioprine

29
Q

How do immunosuppressants work in IBD?

A

Prevents the formation of purines required for DNA synthesis so reduces immune cell proliferation

30
Q

S/Es of immunosuppressants in IBD

A

Bone marrow suppression
Azathioprine hypersensitivity
Organ damage (lung, liver, pancreas)
Numerous drug interactions

31
Q

Examples of biologics used in IBD

A

Anti-TNFa antibodies e.g. infliximab

32
Q

How do biologics work in IBD?

A

Prevents action of TNFa (key cytokine in inflammatory response)
Addresses inflammatory response but not underlying disease process so course of disease after discontinuation is unclear

33
Q

Contraindications to infliximab

A

Current TB / other serious infections
MS
Pregnancy/breast feeding

34
Q

S/Es of infliximab

A 
Risk of infection, particularly TB
Infusion reaction (fever, itch)
Anaemia
Thrombocytopenia
Neutropenia 
May cause demyelination 
Pleurodynia 
Malignancy
35
Q

Definition of pleurodynia

A

Severe pain in the muscles between the ribs or in the diaphragm

36
Q

Examples of other biologics to control IBD

A

Certolizumab
Adalimuab
Natalizumab

37
Q

How does cholestyramine work?

A

Reduces bile salts by binding with them in the gut and then excreting them as an insoluble complex

38
Q

S/Es of cholestyramine

A

May affect absorption of other drugs

May affect fat soluble vitamin absorption - so may decrease vit K levels

39
Q

What is ursodeoxycholic acid used to treat?

A

Gallstones

Primary Biliary cirrhosis (PBC)

40
Q

How does ursodeoxycholic work?

A

Inhibits an enzyme involved in the formation of cholesterol, altering the amount of bile and slowly dissolving non-calcified stones

41
Q

Processes of a drug

A

Absorption
Distribution
Metabolism
Excretion

42
Q

How could the absorption of a drug be altered due to the GI tract?

A

Ph
Gut length
Transit time e.g. digoxin, warfarin

43
Q

How could the distribution of a drug be altered due to the GI tract?

A

Low albumin

44
Q

How could the metabolism of a drug be altered due to the GI tract?

A

Liver enzymes
Increased gut bacteria
Gut wall metabolism (first pass metabolism)
Liver blood flow

45
Q

How may the excretion of a drug be altered due to the GI tract?

A

Biliary excretion (increased toxicity if hepatobiliary disease)

46
Q

What drugs can cause diarrhoea / constipation?

A

Cholinergics
Antimicrobials
Opiates
Anticholinergics

47
Q

Which type of drug in particular is associated with diarrhoea as an adverse effect?

A

Antimicrobials

48
Q

What type of drug in particular can cause changes to the gut bacteria?

A

Antimicrobials

49
Q

What drug in particular can antibiotics effect? Why?

A

OCP
Relies on metabolism/circulation by gut bacteria
Antibiotics kill of the gut bacteria so reduce metabolism/circulation and therefore reduces the effectiveness of the OCP

50
Q

Effects of using antimicrobials on the gut

A

Diarrhoea
Reduced OCP effectiveness
Reduced vit K absorption (increased prothrombin time)
Overgrowth of pathogenic bacteria (C diff)

51
Q

Types of drug induced liver injury

A

Intrinsic hepatotoxicity

Idiosyncratic hepatotoxicity

52
Q

Differences between intrinsic and idiosyncratic hepatotoxicity

A

Intrinsic - predictable, dose dependent, acute

Idiosyncratic - unpredictable, non dose dependent, may occur at any time

53
Q

Risk factors for liver disease

A 
Elderly 
Female
Alcohol consumption 
Genetics
Malnourishment
54
Q

What drugs can cause acute hepatitis?

A

Paracetomal
Isoniazid
Ritonavir
Troglitazone

55
Q

What drugs can cause chronic hepatitis?

A

Diclofenac
Methyldopa
Minocycline
Nitrofurantoin

56
Q

What drugs can cause acute cholestasis?

A

ACE inhibitors
Co-amoxiclav
Chloropromazine
Erythromycins

57
Q

What drugs can cause non alcoholic steatohepatitis?

A

Amoidarone

Tamoxifen

58
Q

What drugs can cause fibrosis/cirrhosis of the liver?

A

Methotrexate

59
Q

What drugs can cause veno occlusive disease?

A

Cyclophosphamide

60
Q

What classification is used to classify the severity of liver disease?

A

Child-Pugh Classification

61
Q

What types of drugs should you take care in prescribing in liver disease?

A

Drugs which can be toxic due to changes in pharmacokinetics
Hepatotoxic drugs
- methotrexate
- azathioprine
Drugs which may worsen the non liver aspects of liver disease (e.g. encephalopathy) e.g. benzodiazepines

62
Q

Why should care be taken if prescribing warfarin/anti-coagulants?

A

Clotting factors are already low in liver disease

63
Q

NSAIDs in liver disease

A

Can worsen ascites due to fluid retention

64
Q

Opiates/benzodiazepines in liver disease

A

May precipitate encephalopathy by increasing sedation

Gastrointestinal Pathology (26 decks)

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