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Pharmacology Semester 2 > Digestive > Flashcards

Digestive Flashcards

1
Q

True choleretics

A

Phenobarbital

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2
Q

Hydrocholeretics

A

Ox bile extract, dehydrocholica acid, cynalra scolimus

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3
Q

Choleretics

A

drug which stimulate production of bile by the liver

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4
Q

Cholagogues/cholecystokinetics

A

decrease biliary stasis by stimulating flow of bile into duodenum

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5
Q

Real cholagogues

A

magnesium sulphate, olive oil, sunflower oil, yolk

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6
Q

Hydrocholeretics and cholagogues are administered in

A

biliary dyskinesia (contraindicated in gallstones)

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7
Q

Phenobarbital

A

anticonvulsant and sedative-hypnotic induces CYP450 to decrease serum bilirubin, used in neonatal hyperbilirubinemia, cholestasis, CONTRAINDICATIONS respiratory problem, lactation period

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8
Q

Hydrocholeretics

A

increase volume of diluted bile, do not stimulate secretion of biliary constituents, excreted through bile they act by an osmotic mechanism, stimulate antitoxic function of liver (choleric and cholecystokinetic), laxative, spasmolytic, anti-inflammatory effects. INDICATIONS : acute/chronic cholecystitis, liver cirrhosis, constipation

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9
Q

Gallstones

A

cholesterol component, not soluble in water, poorly soluble in bile, precipitation of biliary salts in biliary cholesterol supersaturation, risk factors are female, fat, fair, forty, fertile, family. Modifying bile composition, drugs dissolve gallstones prevent precipitation and favor dissolving. Pharmacological/surgical treatment prevent complications

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10
Q

Ursodeoxycholic acid

A

Replaces endogenous biliary acids (hydrophobic) with hydrophilic and nontoxic ones, suppresses cholesterol secretion and inhibits intestinal absorption of cholesterol, bile acids used gradually to dissolve small stones, no influence on calcium. INDICATIONS: biliary lithiasis with cholesterol (radiotransparent, small gallstones), primary biliary cholangitis (delated liver transplant). ADVERSE EFFECTS diarrhea, skin rash, CONTRAINDICATIONS cholecystitis, obstruction of biliary tract, biliary contraction disorder, pregnancy first trimester/;actating. At least 6 (to 24) months of treatment, success rate 60% after 6 months but resurrect is common, expensive and reserved for those unfit for surgery

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11
Q

Bilichol

A

decrease endogenous production of cholesterol, prevents formation of gall stones, increases biliary flow and antispastic, inhibits HMG-CoA reductase, desaturates bile. I: biliary duct dyskinesia, cholecystitis, chlelythiasis; 1-2 camps. 3 times/day, before meal

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12
Q

Rowachol

A

almost like Bilichol, but only in cholelythiasis

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13
Q

Constipation

A

hard/dry stool in elderly, sedentary, pregnancy, hypothyroidism, (diverticulitis, colorectal cancer, hernia, hemorrhoids, anal fissues), neurological (Parkinson, multiple sclerosis, spinal lesion).

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14
Q

Drugs responsible for constipation

A

opioids, anticholinergics, tricyclic antidepressants, neuroleptics, antihistaminic, spasmolytics

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15
Q

Laxative administration

A

before initiation: rich fiber diet, 1,5 to 2L liquid, physical exercise, empty intestinal content before colonoscopy and surgical interventions, painful anal lesions, avoid vascular complications due to increased intra-abdominal pressure, food/drug intoxications

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16
Q

Result of laxatives

A

normal stool, usually after 8-12 hours, sometimes days, high doses have a purgative effect, only 5-10% absorbed from GI tract, locally through different mechanisms, forbidden in ileum, abdominal pain, without detected cause, acute intestinal diseases. Caution in pregnancy and lactation period.

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17
Q

Purgatives

A

eliminate intestinal content through semisolid first then liquid stool with latency of 2-6 hours

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18
Q

Misuse/chronic administration of lazatives

A

dependence (reduced peristalsis), hydroelectric imbalance (hypokalemia, hyponatremia with secondary hypoaldosteronism) hypokalemia more sever with loop diuretics, thiazides, glucocoticoids, amphotericin b

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19
Q

Bulk forming agents- fibers - plant based foods

A

methylcellulose, psyllium seeds

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20
Q

Hyperosmotic agents

A

polyethylene glycol (peg macrogol), lactulose, magnesium or sodium salts

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21
Q

Laxatives and Purgatives

A

bulk forming agents, hyper osmotic agents, stool softeners, stimulant agents, new laxatives

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22
Q

Stool softeners

A

docusate, mineral oil

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23
Q

Stimulant agents

A

Senna, bisacodyl, castor oil

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24
Q

New laxatives

A

prucaloprid, linaclotid, methynaltrexone

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25
Methylcellulose, psyllium seeds
resist enzymatic digestion, work locally by absorbing water, swelling and increasing bulk of stool, stimulating peristalsis and defecation, latency 12-36 hours, I: constipation (main therapy), AE: abdominal cramps, flatulence (fermentation), risk of ileum (not enough liq) CI: intestinal atony, obstruction, immobility; no laxative dependence, may take a few days to act fully
26
Polyethylene Glycol (Macrogol)
not absorbed, local osmotic pressure retains water in colon, laxative effect at low doses and purgative at high doses; I: chronic constipation (predictable effect, directly related to dose and adm. of electrolytes, long administration possible), before colonoscopy/intestinal surgery; AE: flatulence(rare)
27
Lactulose
synthetic disaccharide (galactose +fructose) not absorbed, having laxative effect through osmosis, broken by colonic bacteria to lactic, acetic, and organic acids, decrease local pH, reduce ammonia absorption, beneficial effect in PT with liver disease (prevent encephalopathy); I: elderly, liver encephalopathy; AE: abdominal pain, flatulence, diarrhea
28
Sodium/Magnesium sulphate
decrease viscosity of feces by inc. water content; I: rare (before radiology/surgery, though enema (30 min latency) or oral (2-5 hour latency), Sodium sulphate (Glauber salt) was used before as purgative in intoxication but not anymore due to adm of activated charcoal, see adverse effects and contraindications in lecture
29
Docusate, mineral oil
stool softeners, lubricate and soften stool by adding water and fats, risk of lipid aspiration pneumonia
30
Irritant purgative agents
irritant action increases accumulation of water and electrolytes in lumen of colon and enhances peristalsis by local reflexes
31
Senna
irritant purgative, partially absorbed (risk of uterine contraction), passes in milk (diarrhea in baby), 8-10 hour latency, pro kinetic and secretory properties, laxative tea. I: constipation (second line, short adm.), AE: abdominal cramps (each dose), electrolyte imbalance, melanosis coli (reversible, no carcinoma risk), laxative dependence, dehydration, atony of bowel (chronic use), CI: pregnancy, lactation, obstruction
32
Bisacodyl
6-8 hours (oral) and 30-60 minutes (suppository), small doses decreases water abs in intestine, large doses increases water absorption in intestine; I: constipation (surgery, myocardial infarction, stroke), hemorrhoids, anal tissues, before diagnostic procedures; AE: abdominal pain (each dose), electrolyte imbalance, bowel atony (adm more than 1o days)
33
Castor Oil
riconoleic acid irritates small intestine mucosa, increasing peristalsis, latency 1-3 Hours, I:empty bower before surgery/diagnostic (not first choice); AE: bad taste, abdominal pain, diarrhea, hydroelectric imbalance; CI: obstruction, intoxication (increases absorption), pregnancy (uterine contraction)
34
Prucaloprid
new laxative, 5ht4 antagonist with pro kinetic effect; I: women with chronic constipation who do not respond to conventional laxatives (or intolerance)
35
Linaclotid
new laxative, agonist of guanitlcyclase C, stimulates intestinal secretion of water and chloride; I: irritable colon syndrome w/constipation, chronic constipation (small doses), well tolerated (no adv. effects)
36
Methylnaltrexone
new laxative, peripheral opioid antagonist, without inhibiting central analgesia, advantage over Naltrexone; I: constipation caused by opioids (palliative tmt.) AE: intestinal perforation (increased in association with chemotherapy)
37
Diarrhea
elimination of 3 or more semisolid/liquid stools per day, symptom, only treated if etiology isk know. Acute: self limiting read more
38
Symptomatic antidiarrheal drugs
Opioids (Opium, morphine, loperamide), Antidiarrheal microorganisms (saccharomyces boulardii), mucoprotecting agents (diosmectite), anticholinergic drugs (atropine)
39
Etiologic antidiarrheal drugs
Ciprofloxacin (C. jejune, Salmonella, shigella, v. cholerae), Metronidazole (C. difficile), Ampicillin (L. Monocytogenes), Vancomycin (S. aureus)
40
Opioids
reduce peristalsis, increase sphincter tone by stimulating opiod receptors in bowel, elimination of toxins/infectious factors inhibited (strict ind.), CI in ulcerous colitis/enterocolitis caused by antibiotics
41
Loperamide
opioid, well abs. oral, first hepatic passage with poor bioavailability, does not pass through BBB, no analgesic effect, no risk of dependence decrease in peristalsis allows absorptions of fluids and consolidation of stool. AE: constipation, CI: ileus, constipation, Children, diarrhea (w/fever/blood), ulcerous, pseudomembranous colitis.
42
Opium tincture
opioid, I: ileostomy, colonostomy; AE: high risk of dependence, CI: intestinal occlusion/subocclusion, ulcerous colitis, toxic dilation of colon.
43
Saccharomyces Boulardii
antidiarrheal microorganism, dried yeast, contains living microorganisms, forbidden with hot or cold drinks, bind to pathogenic bacteria (slows growth), decrease enterotoxic effects of E. coli and C. difficile, I: acute diarrhea, traveller's diarrhea, AE: allergy, stool testing (false positive), CI: severe diarrhea, immunodepressed, children
44
Diosmectite
mucus protecting agent, natural aluminosilicate that increases viscosity and quantity of mucus layer and neutralizes pathogens (virus, bacteria, biliary salt, chemical agent); I: acute diarrhea, irritable bowel, well tolerated, even in children
45
Drugs for infl. bowel (ulcerative colitis, Crohn's)
resolve acute episodes and prolong remissions, treatment also involves correction of any nutritional deficiency and surgery (complications)
46
Corticosteroids
anti-inflammatory drugs, act by inhibiting synthesis of prostaglandin and leukotriene, used systemically in severe acute attacks (prednisolone, hydrocortisone), locally (enema) for less severe acute attacks involving large bowel, maintenance therapy
47
Azathioprine, ciclosporin
anti-inflammatory, used occasionally
48
infliximab
anti-inflammatory, monoclonal antibody, inhibit action of inflammatory cytokine TNF-a, I: refractory Crohn's, rheumatoid arthritis
49
Aminosalicylates Classification
Sulfasalazine (complex of suphonamide, sulfapyridine, 5-ASA); Mesalazine (5-ASA), Olsalazine (two molecules of 5-ASA)
50
Aminosalicylates
5-ASa is the active drug that blocks prostaglandins and leukotriene synthesis by inhibiting COX enzyme and lipooxygenase; I: ulcerative colitis, Crohn's disease, rheumatoid arthritis, see adverse effects, can be adm orally, rectally, enema
51
gastric ulcers
read in lecture
52
Antiaggressive drugs - Antacids
Aluminium salts, magnesium salts, calcium salts, sodium salts
53
Antisecretory drugs - Histamine receptor antagonists
Cimetidine, ranitidine, famotidine, nizatidine, roxatidine
54
Antisecretory drugs - Proton pump inhibitors
Omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole
55
Antisecretory drugs - Anticholinergic drugs
pyrenzepine
56
Antisecretory drugs - prostaglandin agonists
misoprostol
57
Protective drugs - coating agents
bismuth salts, sucralfate
58
Antihelicobacter pylori drugs - Antibiotics
amoxicillin, clarithromycin, tetracycline
59
Anti H.pylori chemotherapeutics
metronidazole, tinidazole, furazolidone
60
Anti H.pylori protective drugs
bismuth salts
61
Anti H. Pylori antisecretory drugs
omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole
62
Antacids
read more
63
Aluminium and magnesium salts
aluminum compounds cause constipation, magnesium compounds cause diarrhea, toxicity can occur in patients with renal failure.
64
Sodium bicarbonate
dyspepsia, not recommended because it can cause systemic alkalosis in large amounts
65
histamine receptor agonists
read
66
Cimetidine
read
67
Ranitidine, famotidine, nizatidine
No CNS effects, no inhibition of drug metabolism, no antiandrogenic effect
68
Proton pump r
read
69
pyrenzipine
read
70
Misoprostol
read
71
Coating agents
increase protection of mucosa, form protective coating over ulcer crater allowing healing underneath, stimulate local prostaglandin release
72
Bismuth salts
only oral, minimum absorption and local effect, protection of mucosa, activity against H. Pylori, I: duodenal ulcer, GORD, diarrhea; AE: metallic taste, black stool, ecephalopathy
73
Sucralfate
read
74
Treatment against H pylori
read
75
Antiemetic drugs - dopamine receptor antagonists - substituted benzamides
metoclopramide
76
Antiemetic - dra - benzimidazol derivative
domperidon
77
Antiemetic - dra - phenothiazines
prochroperazine, thiethylperazine
78
Antiemetic - dra - butirophenone
droperidol, haloperidol
79
Antiemetic - antihistamine H1
dimenhydrinat, hydroxyzine, meclisine, promethazine
80
Antiemetic - anticholinergic drugs
scopalamine
81
Antiemetic - 5ht3 receptor antagonists
granisetron,ondansetron,tropisetron,palonosetron
82
Antiemetic - canabinoid
nabilone, dronabinol, cannbidiol
83
Antiemetic - neurokinin 1 antagonists
aprepitant, fosaprepitant
84
Metoclopramide
read
85
Domperidon
similar to metoclopramide but less likely to cause extrapyramidal
86
Prochlorperazine
read
87
Droperidol
temporarily withdrawn from market in 2008 because of severe CV side effects (arrhythmia, cardiac arrest)
88
Antihistamines H1
act on H1 receptors in vomiting center, weak anticholinergic and sedating effect; I: motion sickness, vestibular disease (inappropriate in elderly); AE: sedation, atropine effects
89
Scopalamine
anticholinergic, act on vomiting center and GI tract directly; I: motion sickness, AE: dry mouth, confusion, fatigue, agitation, one patch applied to hairless area of skin behind ear 5-6 hours before travel, can prevent sickness for up to 3 days
90
5HT3 receptor antagonists
block serotonin receptors in CNS and digestive; I: severe nausea and vomitting after chemotherapy, radiotherapy, postoperatively; AE: constipation, headache, in cases where other drugs ineffective
91
Canabinoids
act on CB1 distributed through CNS and PNS, also in enterochromfinlike cells and vagus; I: control delayed chemotherapy - induced nausea and vomiting, superiority compared to DOPA antagonists
92
Neurokinin 1 Antagonist
aprepitant is a selective human substance P and NK1 receptor antagonist that inhibits chemotherapy induced nausea and vomiting centrally in chemoreceptor trigger zone, antidepressant, anxiolytic; I: prophylaxis of acute and delayed phases of chemotherapy induced nausea and vomiting; AE: loss of appetite, headache , administered together with glucocorticoid and a 5ht3 receptor antagonist,

Pharmacology Semester 2 (7 decks)

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