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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
What are examples of anti-histamines? Give 3.
Cinnarizine Cyclizine Promethazine
26
What is the uses of anti-histamines? What are the potential side effects?
Useful in numerous cases of N/V; including motion sickness and vestibular disorders Side effects = drowsiness and anti-muscarinic effects
27
What is an example of an anti-muscarinic? How does it work?
Hyoscine hydrobromide | - blockade of muscarinic receptor-mediated impulses from the labyrinth and from visceral afferents.
28
What is the uses and side effects of anti-muscarinics?
Useful in motion sickness | - side effects = constipation, transient bradycardia, dry mouth
29
Name the various types of dopamine antagonists.
1. Phenothiazines - chlorpromazine - perphenazine - prochlorperazine - trifluoperazine 2. Domperidone 3. Metoclopramide
30
What are dopamine antagonists used for?
Act centrally as dopamine antags on the CTZ | - active against CTZ-triggered vomiting but not stomach induced vomiting
31
Name 4 examples of 5HT3 antagonists.
1. Dolasetron 2. Granisetron 3. Ondansetron 4. Palonosetron
32
What are 5HT3 antagonists used for?
Block 5HT3 receptors in GI and CNS | - useful in managing N/V in patients receiving cytotoxics and in post-op N/V
33
What are 2 named examples of neurokinin 1 receptor antagonists. What are they used for?
Aprepitant and Fosaprepitant | - adjunct to dexamethasone and a 5HT3 antagonist in preventing N/V associated with chemotherapy
34
Give an example of a synthetic cannaboid. What are they used for? What is a common side effect?
Nabilone - used for N/V caused by chemo unresponsive to conventional anti-emetics - common SE = drowsy/dizzy
35
Name an example of a steroid used as an anti-emetic. What can it be used for?
Dexamethasone | - used alone to treat vomiting from cancer chemotherapy, or in conjunction with other anti-emetics
36
What are named examples of bulk-forming laxatives?
isphagula husk | methylcellulose
37
What are named examples of stimulant laxatives?
``` bisacodyl dantron docusate sodium glycerol senna sodium picosulfate ```
38
What are named examples of faecal softeners?
arachis oil | liquid paraffin
39
What are named examples of osmotic laxatives?
lactulose macrogols magnesium salts rectal phosphates
40
What are named examples of peripheral opioid-receptor antagonists?
methylnaltrexone bromide
41
What are the 4 steps in the approach for treatment of acute diarrhoea?
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
What drugs are used to treat chronic diarrhoea?
1. Antimotility agents - codeine, co-phenotrope, loperamide, morphine 2. Adsorbents - Kaolin, light 3. Bulk forming drugs - ispagula, methylcellulose, sterculia
43
What are bulk forming drugs particularly useful in controlling?
Diarrhoea associated with diverticular disease
44
How are gallstones treated?
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
Name a bile acid sequestrant, how it works and what it is used to treat.
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
What is used to treat nematodes?
Albendazole = most effective | - levamisole and piperazine rarely used
47
What is praziquantel used to treat?
Hydatid disease Cysticercosis Schistosomiasis Clonorchis, Fascioliasis and Paragnomiasis infection
48
What are the side effects associated with praziquantel?
Dizzy, headache, drowsy and somnolescence, rarely seizures - abdominal cramps and nausea, diarrhoea - transient asymptomatic rise in transaminases - urticaria, rash and pruritis
49
What is albendazole used to treat?
1. Nematode infections - trichiuriasis, filariases, enterobius infection, ascariasis, hookworm, toxocariasis, stongyloidiasis 2. Some protozoa - giardia 3. Some cestodes - neurocysticercosis and hydatid disease
50
What are the various potential side effects of albendazole?
- Concentrated in semen and may be teratogenic - persistent sore throat - headaches, dizzy and seizures - acute liver failure - aplastic anaemia and marrow suppression
51
What is piperazine used to treat? What is its side effects?
Treat ascariasis and enterobius infection | SE = GI tract upset and rarely hypersensitivity, dizziness
52
What is pyrantel used to treat? When should it be avoided?
Treats hookworms and roundworms - avoid in pregnancy - can cause intestinal obstruction if there is a heavy worm load
53
What is levamisole used to treat? What are the associated side effects?
Treat ascariasis and mixed ascaris hookworm infection | SE = abdo pain, nausea and vomiting
54
What is diethyl carbamazine used to treat?
Filaria infection
55
What is ivermectin currently being used for?
Eradication of lymphatic filariasis and onchocerciasis
56
What is niclosamide used to treat? What are the associated side effects?
Tape worms | - dizzy, skin rashes, drowsy, perianal itching
57
How is peptic ulcer disease managed?
1. Reducing damage to mucosal surfaces - dietary advice - antacids - bismuth 2. Killing H. pylori 3. Reducing gastric acid - PPIs, H2 blockers
58
What drugs are used to kill H.pylori?
PPI (omeprazole), ampicillin, and clarithromycin/metronidazole - if penicillin allergic then clarithromycin and metronidazole
59
Name two histamine blockading drugs? Why are they important in the treatment of peptic ulcers?
Cimetidine + Ranitidine - reduce gastric acid by reducing stimulation of oxyntic cells via histamine pathway therefore reducing gastric acid and permitting ulcer healing
60
What are the side effects of cimetidine?
- Dizziness - Cytochrome P450 inhibitor - Affects hormone metabolism leading to galactorrhea and gynaecomastia - interferes with tricyclines and serotonin reuptake inhibs
61
What are the side effects associated with Ranitidine?
Malaise, dizziness, liver toxicity, increased risk of GI infection
62
What drugs are used to treat H.pylori in a pt who has had previous exposure AND penicillin allergic?
PPI Bismuth Metronidazole Tetracycline
63
Failure of initial H. pylori treatment occurs in 1 in 5. What is the second line treatment used?
Either an alternative regimen or quadruple therapy (PPI+bismuth+2 antibiotics)
64
With peptic ulcers, what is the protocol for pts in which symtoms recur after initial treatment?
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
What is the treatment for HAV? Is there a vaccine available?
No specific treatment - maintain comfort and nutritional balance - fluid and electrolyte replacement YES vaccine is available
66
What is the treatment for HBV?
Pegylated interferon | - nucleoside analogues such as oral lamivudine
67
What is the treatment for HCV?
``` Ribavirin + pegylated alpha interferon Combination therapy - sofosbuvir (nucleotide analogue) - boceprevir (protease inhibitor) - telaprivir (nucleoside analogue) - daclatasvir (inhibits NS5A) ```
68
How is HEV prevented?
Good sanitation and hygiene | - vaccine (Hecolin)
69
What are the names of the various types of antibiotics that can be used to treat UTIs?
- co-trimoxazole - nitrofurantoin - nalidixic acid - co-amoxiclav - trimethoprim - ciprofloxacin
70
What is a named example of a loop diuretic? What is its mechanism of action?
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
What are the indications for loop diuretics? What are the side effects of loop diuretics?
Pulmonary oedema due to LVF, CHF, resistant hypertension (not first line) and oedema SE = hypokalaemia, hypotension, urinary retention and gout
72
What are the main examples of thiazide diuretics? How do they work?
Bendroflumethiazide, indapamide | - inhibit Na/Cl co transport preventing their reabsorption
73
What are the indications for thiazide diuretics? What are the side effects?
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
What are the 2 main types of potassium sparing diuretics? Give the MoA for each.
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
When are potassium sparing diuretics indicated? What are their side effects?
Alongside K+ losing diuretics to prevent K+ loss Spironolactone for HF, Conn's and secondary hyperaldosteronism Side Effects = hyperkalaemia, GI upset, metabolic acidosis
76
What is lichen sclerosus treated with?
Potent topical corticosteroids

MD3002 (14 decks)

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