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MD3002 > DRUGS > Flashcards

DRUGS Flashcards

1
Q

What is the (i) source (ii) target (iii) action of GASTRIN?

A

(i) G cells in antrum of stomach
(ii) parietal cells in body of stomach
(iii) increases H+ secretion and stimulates the growth of the gastric mucosa

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2
Q

What is the (i) source (ii) target (iii) action of CHOLECYSTOKININ (CKK)?

A

(i) I cells in duodenum and jejunum: neurons in ileum and colon
(ii) pancreas and gall bladder
(iii) increases enzyme secretion in pancreas and increases contraction in gall bladder

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3
Q

What is the (i) source (ii) target (iii) action of SECRETIN?

A

(i) S cells in small intestine
(ii) pancreas and stomach
(iii) in pancreas it increases HCO3- and fluid secretion by ducts and in stomach it decreases gastric acid secretion

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4
Q

What is the (i) source (ii) target (iii) action of GASTRIC-INHIBITORY PEPTIDE (GIP)?

A

(i) K cells in duodenum and jejunum
(ii) pancreas and stomach
(iii) exocrine pancreas = decreases fluid absorption, endocrine = increases insulin release. Decreases gastrin release in stomach

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5
Q

What is the (i) source (ii) target (iii) action of HISTAMINE?

A

(i) endocrine cells of gastric mucosa (esp H+ of stomach)
(ii) stomach
(iii) stimulates H+ secretion from parietal cells in stomach

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6
Q

What is the (i) source (ii) target (iii) action of ACh?

A

(i) cholinergic neurons
(ii) + (iii)
Smooth muscle = contraction of GI wall + relaxation of sphincters
Increases secretion in salivary glands, stomach and pancreas

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7
Q

What is the (i) source (ii) target (iii) action of NORADRENALINE?

A

(i) adrenergic neurons
(ii) smooth muscle and salivary glands
(iii) relaxes GI smooth muscle and increases secretion of salivary gladns

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8
Q

What is the (i) source (ii) target (iii) action of VASOACTIVE INTESTINAL PEPTIDE?

A

(i) enteric nervous system
(ii) smooth muscle, pancreas and intestine
(iii) relaxes smooth muscle and increases secretion of pancreas and intestines

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9
Q

What is the (i) source (ii) target (iii) action of SUBSTANCE P?

A

(i) Co-secreted with ACh
(ii) smooth muscle and salivary glands
(iii) contracts smooth muscle and increases secretion of salivary glands

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10
Q

What are the 4 ways to manage IBS?

A
  1. Drug/lifestyle (physical activity) changes approach
  2. Drug treatments approach
  3. Psychological approaches
  4. Complementary therapies approach
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11
Q

What are the (i) first line (ii) second line drug treatments for IBS?

A 
(i) antidiarrhoeal (loperamide)
laxatives (NOT lactulose)
antispasmodics
(ii) laxatives (linaclotide)
antidepressants (second line)
TCAs
SSRIs
(both anti-depressants)
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12
Q

What is the treatment for epithelial perforation?

A

Requires surgery

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13
Q

What types of infection does EPEC cause?

A

sporadic cases and outbreaks of infection in under 5s

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14
Q

What types of infection does ETEC cause?

A

“travellers” diarrhoea (occurs in 20-50% of travellers)

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15
Q

What type of infection does VTEC/EHEC cause?

A

sporadic cases and outbreaks of gastroenteritis

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16
Q

What type of infection does EIEC cause?

A

Food-borne infection in areas of poor hygiene (often persistent diarrhoea)

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17
Q

What type of infection does EAEC cause?

A

resource-poor countries

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18
Q

With regards to antibiotic associated diarrhoea, what is the cause with (i) tetracycline (ii) clindamycin?

A

(i) colonisation by staphlococcus aureus and candida spp.

(ii) suppresses gut microbiota and allows c. diff to multiply

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19
Q

What is the treatment for H.pylori associated gastritis?

A

1 week triple therapy of PPI (omeprazole) + clarithromycin + amoxycillin/metronidazole

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20
Q

When is cetuximab used for colon cancer?

A

only used where wildtype Kras

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21
Q

What is the treatment for Giardia Lamblia?

A

Mepacrine hydrochloride
Metronidazole
Tinidazole

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22
Q

What is the treatment for Cryptosporidium parvum?

A

Nitazoxanide

Spiramycin

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23
Q

What is the treatment for Entamoeba histolytica?

A

Metronidazole

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24
Q

What is ORS made of?

A

Glucose
Sodium chloride
Potassium Chloride
Trisodium citrate dihydrate

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25
Q

What are examples of anti-histamines? Give 3.

A

Cinnarizine
Cyclizine
Promethazine

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26
Q

What is the uses of anti-histamines? What are the potential side effects?

A

Useful in numerous cases of N/V; including motion sickness and vestibular disorders
Side effects = drowsiness and anti-muscarinic effects

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27
Q

What is an example of an anti-muscarinic? How does it work?

A

Hyoscine hydrobromide

- blockade of muscarinic receptor-mediated impulses from the labyrinth and from visceral afferents.

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28
Q

What is the uses and side effects of anti-muscarinics?

A

Useful in motion sickness

- side effects = constipation, transient bradycardia, dry mouth

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29
Q

Name the various types of dopamine antagonists.

A
  1. Phenothiazines
    - chlorpromazine
    - perphenazine
    - prochlorperazine
    - trifluoperazine
  2. Domperidone
  3. Metoclopramide
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30
Q

What are dopamine antagonists used for?

A

Act centrally as dopamine antags on the CTZ

- active against CTZ-triggered vomiting but not stomach induced vomiting

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31
Q

Name 4 examples of 5HT3 antagonists.

A
  1. Dolasetron
  2. Granisetron
  3. Ondansetron
  4. Palonosetron
32
Q

What are 5HT3 antagonists used for?

A

Block 5HT3 receptors in GI and CNS

- useful in managing N/V in patients receiving cytotoxics and in post-op N/V

33
Q

What are 2 named examples of neurokinin 1 receptor antagonists. What are they used for?

A

Aprepitant and Fosaprepitant

- adjunct to dexamethasone and a 5HT3 antagonist in preventing N/V associated with chemotherapy

34
Q

Give an example of a synthetic cannaboid. What are they used for? What is a common side effect?

A

Nabilone

  • used for N/V caused by chemo unresponsive to conventional anti-emetics
  • common SE = drowsy/dizzy
35
Q

Name an example of a steroid used as an anti-emetic. What can it be used for?

A

Dexamethasone

- used alone to treat vomiting from cancer chemotherapy, or in conjunction with other anti-emetics

36
Q

What are named examples of bulk-forming laxatives?

A

isphagula husk

methylcellulose

37
Q

What are named examples of stimulant laxatives?

A 
bisacodyl
dantron
docusate sodium
glycerol
senna
sodium picosulfate
38
Q

What are named examples of faecal softeners?

A

arachis oil

liquid paraffin

39
Q

What are named examples of osmotic laxatives?

A

lactulose
macrogols
magnesium salts
rectal phosphates

40
Q

What are named examples of peripheral opioid-receptor antagonists?

A

methylnaltrexone bromide

41
Q

What are the 4 steps in the approach for treatment of acute diarrhoea?

A
  1. Maintenance of fluid and electrolyte balance e.g. ORS
  2. Antimotility drugs e.g. codeine
  3. Antispasmodics e.g. hyoscine butylbromide, mebeverine
  4. Occasionally antibacterial agent is indicated e.g. systemic bacterial infection, shigellosis, slamonellosis
42
Q

What drugs are used to treat chronic diarrhoea?

A
  1. Antimotility agents - codeine, co-phenotrope, loperamide, morphine
  2. Adsorbents - Kaolin, light
  3. Bulk forming drugs - ispagula, methylcellulose, sterculia
43
Q

What are bulk forming drugs particularly useful in controlling?

A

Diarrhoea associated with diverticular disease

44
Q

How are gallstones treated?

A

80% of them are cholesterol

  • lap chole and modern endoscopic techniques mainly used
  • ursodeoxycholic acid to dissolve stones, only if mild symptoms and not amenable to other treatment
45
Q

Name a bile acid sequestrant, how it works and what it is used to treat.

A

Colestryamine

  • forms insoluble complex with bile acids in the intestine
  • relieves pruritus from partial biliary obstruction and primary biliary cirrhosis
  • also in some cases of diarrhoea (Crohn’s related)
  • also for hypercholesterolaemia
46
Q

What is used to treat nematodes?

A

Albendazole = most effective

- levamisole and piperazine rarely used

47
Q

What is praziquantel used to treat?

A

Hydatid disease
Cysticercosis
Schistosomiasis
Clonorchis, Fascioliasis and Paragnomiasis infection

48
Q

What are the side effects associated with praziquantel?

A

Dizzy, headache, drowsy and somnolescence, rarely seizures

  • abdominal cramps and nausea, diarrhoea
  • transient asymptomatic rise in transaminases
  • urticaria, rash and pruritis
49
Q

What is albendazole used to treat?

A
  1. Nematode infections - trichiuriasis, filariases, enterobius infection, ascariasis, hookworm, toxocariasis, stongyloidiasis
  2. Some protozoa - giardia
  3. Some cestodes - neurocysticercosis and hydatid disease
50
Q

What are the various potential side effects of albendazole?

A
  • Concentrated in semen and may be teratogenic
  • persistent sore throat
  • headaches, dizzy and seizures
  • acute liver failure
  • aplastic anaemia and marrow suppression
51
Q

What is piperazine used to treat? What is its side effects?

A

Treat ascariasis and enterobius infection

SE = GI tract upset and rarely hypersensitivity, dizziness

52
Q

What is pyrantel used to treat? When should it be avoided?

A

Treats hookworms and roundworms

  • avoid in pregnancy
  • can cause intestinal obstruction if there is a heavy worm load
53
Q

What is levamisole used to treat? What are the associated side effects?

A

Treat ascariasis and mixed ascaris hookworm infection

SE = abdo pain, nausea and vomiting

54
Q

What is diethyl carbamazine used to treat?

A

Filaria infection

55
Q

What is ivermectin currently being used for?

A

Eradication of lymphatic filariasis and onchocerciasis

56
Q

What is niclosamide used to treat? What are the associated side effects?

A

Tape worms

- dizzy, skin rashes, drowsy, perianal itching

57
Q

How is peptic ulcer disease managed?

A
  1. Reducing damage to mucosal surfaces
    - dietary advice
    - antacids
    - bismuth
  2. Killing H. pylori
  3. Reducing gastric acid
    - PPIs, H2 blockers
58
Q

What drugs are used to kill H.pylori?

A

PPI (omeprazole), ampicillin, and clarithromycin/metronidazole

  • if penicillin allergic then clarithromycin and metronidazole
59
Q

Name two histamine blockading drugs? Why are they important in the treatment of peptic ulcers?

A

Cimetidine + Ranitidine
- reduce gastric acid by reducing stimulation of oxyntic cells via histamine pathway therefore reducing gastric acid and permitting ulcer healing

60
Q

What are the side effects of cimetidine?

A
  • Dizziness
  • Cytochrome P450 inhibitor
  • Affects hormone metabolism leading to galactorrhea and gynaecomastia
  • interferes with tricyclines and serotonin reuptake inhibs
61
Q

What are the side effects associated with Ranitidine?

A

Malaise, dizziness, liver toxicity, increased risk of GI infection

62
Q

What drugs are used to treat H.pylori in a pt who has had previous exposure AND penicillin allergic?

A

PPI
Bismuth
Metronidazole
Tetracycline

63
Q

Failure of initial H. pylori treatment occurs in 1 in 5. What is the second line treatment used?

A

Either an alternative regimen or quadruple therapy (PPI+bismuth+2 antibiotics)

64
Q

With peptic ulcers, what is the protocol for pts in which symtoms recur after initial treatment?

A

Offer PPi to be taken at the lowest dose possible to control symptoms. Discuss using treatment on an ‘as-needed’ basis with people to manage their own symptoms

65
Q

What is the treatment for HAV? Is there a vaccine available?

A

No specific treatment
- maintain comfort and nutritional balance
- fluid and electrolyte replacement
YES vaccine is available

66
Q

What is the treatment for HBV?

A

Pegylated interferon

- nucleoside analogues such as oral lamivudine

67
Q

What is the treatment for HCV?

A 
Ribavirin + pegylated alpha interferon
Combination therapy
- sofosbuvir (nucleotide analogue)
- boceprevir (protease inhibitor)
- telaprivir (nucleoside analogue)
- daclatasvir (inhibits NS5A)
68
Q

How is HEV prevented?

A

Good sanitation and hygiene

- vaccine (Hecolin)

69
Q

What are the names of the various types of antibiotics that can be used to treat UTIs?

A
  • co-trimoxazole
  • nitrofurantoin
  • nalidixic acid
  • co-amoxiclav
  • trimethoprim
  • ciprofloxacin
70
Q

What is a named example of a loop diuretic? What is its mechanism of action?

A

Furosemide
- thick asc loop of henle to inhibit transport of NaCl out of tubule and increases delivery of Na into tubule, causing loss of H+ and K+

71
Q

What are the indications for loop diuretics? What are the side effects of loop diuretics?

A

Pulmonary oedema due to LVF, CHF, resistant hypertension (not first line) and oedema
SE = hypokalaemia, hypotension, urinary retention and gout

72
Q

What are the main examples of thiazide diuretics? How do they work?

A

Bendroflumethiazide, indapamide

- inhibit Na/Cl co transport preventing their reabsorption

73
Q

What are the indications for thiazide diuretics? What are the side effects?

A

Hypertension, mild heart failure, severe resistant oedema, nephrogenic diabetes insipidus
SE = metabolic and electrolyte disturbances
- increased cholesterol, glucose, uric acid and calcium
- decreased potassium, sodium, magnesium, BO
- metabolic alkalosis

74
Q

What are the 2 main types of potassium sparing diuretics? Give the MoA for each.

A
  1. Amiloride (and triameterene) act by blocking sodium channels controlled by aldosterone’s protein mediator
  2. Spironolactone (and elperenone) are antagonists at aldosterone receptor
75
Q

When are potassium sparing diuretics indicated? What are their side effects?

A

Alongside K+ losing diuretics to prevent K+ loss
Spironolactone for HF, Conn’s and secondary hyperaldosteronism
Side Effects = hyperkalaemia, GI upset, metabolic acidosis

76
Q

What is lichen sclerosus treated with?

A

Potent topical corticosteroids

MD3002 (14 decks)

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