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Alimentary System > Clinical Pharmacology of the Alimentary System > Flashcards

Clinical Pharmacology of the Alimentary System Flashcards

1
Q

What is the most common symptom of malignancy in terms of altered bowel habit?

A

Diarrhoea

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2
Q

What are the main drug classes used in treatment of alimentary disease?

A 
Acid suppressing 
Drugs affecting GI motility 
Laxatives
Drugs for IBD 
Drugs affecting intestinal secretions
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3
Q

Give an example of a drug used for acid suppression in alimentary disease

A

Antacids
H2 receptor antagonists
Proton pump inhibitors

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4
Q

give an example of a drug used to affect GI motility in alimentary disease

A

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

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5
Q

Give an example of a drug type used for IBD

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

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6
Q

What do antacids contain that neutralises gastric acid?

A

Magnesium or aluminium

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7
Q

How do alginates help acid reflux?

A

They form a viscous gel which floats on the stomach contents and reduces reflux

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8
Q

What do H2 receptor antagonists block?

A

Histamine receptors

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9
Q

In what diseases are H2 receptor antagonists indicated?

A

GORD

Peptic ulcer disease

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10
Q

How can H2 receptor antagonists be administered?

A

Orally or intravenously

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11
Q

In what diseases are proton pump inhibitors indicated?

A

GORD

Peptic ulcer disease

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12
Q

How can proton pump inhibitors be administered?

A

Orally or intravenously

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13
Q

When would triple therapy including a proton pump inhibitor be indicated?

A

For treatment of peptic or duodenal ulcers associated with H. pylori

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14
Q

Proton pump inhibitors can cause a predisposition to what?

A

Clostridium difficile infection
Hypomagenesaemia
B12 deficiency

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15
Q

What do prokinetic agents increase?

A

Gut motility and gastric emptying

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16
Q

When would prokinetic agents be indicated?

A

GORD
Gastroparesis
(constipation)

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17
Q

Give an example of a prokinetic agent

A

Anti-emetics
Laxatives
e.g Metoclopramide, Domperidone

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18
Q

Give an example of a drug which can be used to treat diarrhoea i.e. which decrease motility

A

Loperamide

Opiates

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19
Q

What is the mechanism of action of drugs which decrease gut motility?

A

Via opiate receptors in the GI tract to decrease ACh release and smooth muscle contraction and increase anal sphincter tone

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20
Q

What are the mechanisms of action of anti-spasmodics?

A

Anti-cholinergic muscarinic antagonists
Direct smooth muscle relaxants
Calcium channel blockers

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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 reducing spasm

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22
Q

Give the different types of laxative and an example of each

A

Bulk - Isphagula
Osmotic - Lactulose
Stimulant - Senna
Softeners - Arachis oil

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23
Q

How do laxatives work?

A

By increasing the bulk of fluid drawn into the gut

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24
Q

What cause of constipation do you need to rule out before prescribing laxatives?

A

Obstruction - giving laxatives when constipation is due to obstruction could cause rupture, megacolon etc.

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25
Q

Give an example of an aminosalicylate

A

Mesalazine
Olzalazine
Sulfasalazine

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26
Q

Aminosalicylates are first line treatment in

A

inflammatory bowel disease

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27
Q

Where are aminosalicylates metabolised?

A

In the liver

28
Q

When should aminosalicylates be avoided?

A

If the patient is allergic to salicylates

29
Q

How can corticosteroids be administered?

A

Orally
Intravenously
Rectally

30
Q

Give an adverse effect of corticosteroids

A 
Diabetes 
Osteoporosis 
Hypertension 
Cushing's disease 
Increased risk of infection
31
Q

If a patient on corticosteroids becomes acutely unwell, should you withdraw or increase their corticosteroid dose?

A

Increase (double)

32
Q

How do immunosuppressants work?

A

Prevent formation of purines which are required for DNA synthesis, so reduces immune cell proliferation

33
Q

Adverse effects of immunosuppressants mainly relate to

A

bone marrow suppression

34
Q

How to biologics work?

A

Prevent action of TNF-alpha which is a key cytokine in inflammatory response

35
Q

What are the contra-indications for immunosuppressant use?

A

Current TB, or other serious infection
Multiple sclerosis
Pregnancy or breast feeding

36
Q

Give an adverse effect of immunosuppressants

A

Increased risk of infection, particularly TB
Infusion reaction causing fever and itch
Anaemia
Thrombocytopenia
Neutropenia
Malignancy

37
Q

Give an example of a drug affecting biliary secretion

A

Cholestyramine

Ursodeoxycholic acid

38
Q

How does cholestyramine work?

A

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

39
Q

Other than bile salts, what might cholestyramine affect?

A

Absorption of other drugs (should be taken separately)

Fat soluble vitamin absorption

40
Q

Ursodeoxycholic acid is used to treat

A

gallstones and primary biliary cirrhosis

41
Q

Gastrointestinal or liver disease can affect the processes of drug;

A

Absorption
Distribution
Metabolism
Excretion

42
Q

Drug absorption is affected by

A

pH
gut length
transit time

43
Q

The rate of drug absorption in GI/liver disease is more affected than

A

the total drug absorption

44
Q

Drug distribution can be affected by

A

low albumin levels

45
Q

Drug metabolism is affected by;

A

liver enzyme concentration

gut wall metabolism

46
Q

What percentage of adverse drug reactions does GI upset account for?

A

20-40%

47
Q

What drugs are commonly responsible for diarrhoea/constipation?

A 
Cholinergics 
NSAIDs 
Antimicrobials 
Opiates 
Anticholinergics
Opiates
48
Q

Give an example of a mechanism affected by drugs causing diarrhoea/constipation

A

Osmotic
Secretory
Transit time
Protein absorption

49
Q

25% of drug induced diarrhoea is due to

A

antimicrobials

50
Q

GI bleeding/ulceration accounts for what percentage of hospital admissions due to adverse drug reactions?

A

6.5%

51
Q

What drugs, taken by a high percentage of the elderly population, are common causes of GI bleeding/ulceration?

A

Low dose aspirin
NSAIDs
Warfarin

52
Q

Changes to gut bacteria is mainly due to

A

antibiotics

53
Q

Give an adverse effect of changes in gut bacteria due to antibiotics

A

Loss of OCP activity
Reduced vitamin K absorption
Overgrowth of pathogenic bacteria

54
Q

What are the features of intrinsic hepatotoxicity (type A ADR)?

A

Predictable
Dose dependent
Acute
e.g. paracetamol overdose

55
Q

What are the features of idiosyncratic hepatotoxicity (type B ADR)?

A

Unpredictable
Not dose dependent
Can occur at any time
May be part of a hypersensitivity reaction
Can be due to the drug itself or an active metabolite

56
Q

What are the most common types of drug induced liver injury?

A

Hepatitis

Cholestasis

57
Q

What are the risk factors for drug induced liver injury?

A 
Age 
Female 
Alcohol consumption 
Genetic
Malnourishment
58
Q

When prescribing for a patient with liver disease, what needs to be considered?

A

Risk factors of drug induced liver injury

Severity of liver disease

59
Q

What classification can be used to assess the severity of liver disease in a patient?

A

Child-Pugh classification

60
Q

The Child-Pugh score separates liver disease into what three classifications, and which has the worst prognosis?

A

A - score < 7
B - score 7-9
C - score > 9

C has the worst prognosis

61
Q

In prescribing for a patient with liver disease, care should be taken to avoid drugs which;

A

Can be toxic due to changes in pharmacokinetics
Are hepatotoxic
May worsen non-liver aspects of disease e.g. ascites

62
Q

Drugs prescribed to patients with liver disease should have what kind of therapeutic index?

A

Wide therapeutic index

63
Q

Give an example of a drug which should be avoided in patients with liver disease

A

Methotrexate
Azathioprine
Bensodiazepines

64
Q

Caution should be taken when prescribing what kind of drugs to patients with liver disease?

A 
Warfarin/anticoagulants 
Aspirin 
NSAIDs 
Opiates 
Benzodiazepines
65
Q

When can you find information about risks with specific drugs in liver disease?

A

British National Formulary (BNF)

Alimentary System (29 decks)

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