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Pharmacology 1 > drugs acting on the gastrointestinal tract > Flashcards

drugs acting on the gastrointestinal tract Flashcards

1
Q

name 3 upper gastrointestinal tract disorders

A
  1. indigestion (dyspepsia)
  2. Gastro Oesophageal Reflux Disorder (GORD or GERD America)
  3. Ulcers
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2
Q

what are the main symptoms of indigestion?

A
  • discomfort or pain in stomach
  • bloating, burping, nausea
  • heartburn
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3
Q

what are the main causes of indigestion?

A
  • overeating
  • pregnancy
  • ulcers
  • anxiety/stress
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4
Q

what are the main symptoms of gastro oesophageal reflux disorder?

A
  • heartburn - pain in middle of chest
  • sour mouth - contents of stomach coming back up
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5
Q

what are the main causes of gastro oesphageal reflux?

A
  • overeating
  • pregnancy
  • certain drugs
  • ulcers
  • anxiety/stress
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6
Q

what is an ulcer?

A

area where damage has occured to mucosal membrane of oesophagus, stomach or duodenum

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7
Q

what are the symptoms of an ulcer?

A
  • pain
  • bleeding
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8
Q

what are the causes of ulcers?

A
  • bacterial infection - h.pylori
  • NSAIDS
  • smoking
  • Zollinger-Ellison syndrome
  • anxiety/stress
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9
Q

name three types of drugs that are used to treat indigestion, GORD and ulcers

A
  1. antacids
  2. antisecretory drugs and mucosal protectants
  3. antibiotics (ulcers only)
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10
Q

name four different types of antisecretory and mucosal protectant drugs that are used to treat indigestion, GORD and ulcers

A
  1. Histamine H2 antagonists
  2. Proton pump inhibitors
  3. Chelates and complexes
  4. Prostaglandins and analogues
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11
Q

what is the mechanism of action for antacids?

A
  • act locally to neuralise stomach acid → pH now less acidic, pepsin activity reduced
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12
Q

in what form are anatcid preparations available and what might they contain?

A

liquid or tablet - containing calcium, aluminium or magnesium salts

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13
Q

name 6 antacid prepartions - including 2 with simeticone and 2 with alginates

A

maalox®

rennies®

with simethicone - asilone®, altacite plus®

with alginates - gavison®, gastrocote®

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14
Q

what is the mechanism of action of simeticone found in some antacids?

A

alters surface tension of small bubble to allow formation of large bubble whihc are easier to release

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15
Q

explain the mechanism of action of alginates found in some antacids

A

react with gastric juices to form a raft that floats on top and protect oesophagus from stomach acid

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16
Q

what directions would you give to patients taking antacids?

A
  • take 1hr before or after food
  • aluminium may cause constipation
  • magnesium may cause diarrhoea
  • sleep on left hand side
  • may change stool colour
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17
Q

what would need to be considered by the person prescribing antacids?

A
  • electrolyte imbalance - monitor for calcium, phosphate, magnesium and aluminium levels
  • low sodium and sugar free versions - important in patients with hypertension, diabetes or liver/kidney impaired
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18
Q

what is the mechanism of action for H2 anatagonists?

A
  • blocks H2 receptors on perietal cells in stomach → reduces acid production in stomach
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19
Q

name four H2 anatagonists

A
  1. cimetidine (tagamet®)
  2. famotidine (pepcid®)
  3. nitatidine (axid®)
  4. ranitidine (zantac®)
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20
Q

explain the mechanism of action of proton pump inhibitors

A
  • in acidic pH drug forms two reactive molecules which bind permenantly to proton pump → proton pump never pumps acid again
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21
Q

name 5 proton pump inhibitors (PPIs)

A
  1. lansoprazole (zoton®)
  2. esomeprazole (nexium®)
  3. omeprazole (losec®)
  4. pantoprazole (protium®)
  5. rabeprazole (pariet®)
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22
Q

when and how should PPIs be given?

A

give 30mins before food - do not crush or chew tablet

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23
Q

PPIs can interfere with the metabolism of certain drugs - name 3

A
  1. diazepam
  2. phenytoin
  3. warfarin
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24
Q

PPIs interfere withe absorption of some drugs - name 3

A
  1. digoxin
  2. ketoconazole
  3. ampicillin
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25
Q

can antacids be taken with H2 antagonists?

A

no

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26
Q

what would you check for in patients taking H2 antagonists?

A
  • blood in stools
  • dizziness
  • headache
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27
Q

why must particular attention be given when prescribing cimetidine?

A

can retard the metabolism of other drugs such as - warfarin, phenytoin, theophylline

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28
Q

what is H.pylori?

A

a gram negative bacteria causingb inflammation of the stomach lining

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29
Q

in which condition is h/pylori routinely treated?

A

stomach ulcers

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30
Q

what treatment would be used for stomach ulcers?

A

2 antibiotics plus reduction in acid secretion - ‘triple therapy’ for 7-14 days

31
Q

which antibiotics would be be used to treat ulcers?

A
  • clarythromycin
  • amoxycillin
  • metronidazole
  • tetracycline

plus PPI or H2 antagonist

32
Q

what precautions should be takien and what side effects may occur with antibiotics?

A

amoxycillin - penicillin allergy

clarythromycin and metronidazole - abnormal taste

metronidazole - avoid alcohol

amoxycillin - diarrhoea

clarythromycin, metronidazole, tetracycline - GI upset

33
Q

what is the mechanism of action of synthetic prostaglandin E1?

A
  • protective - prostaglandins prevent acid production and stimulate mucous release
34
Q

what are the clinical uses for synthetic prostaglandin E1 ?

A

NSAID induced ulcers - NSAIDS inhibit COX-1 which produces prostaglandins

35
Q

who should misoprostol not be given to?

A

pregnant women - causes premature labour/spontantous abortion

36
Q

what side effects are associated with misoprostol?

A
  • diarrhoea
  • abdominal pain
37
Q

what is sucralfate? and what is its action?

A

sucralfate - chelate

action - reacts with acid to form sticky paste - acts locally in stomach to coat ulcers

38
Q

for how long does sucralfate last?

A

about 6hrs

39
Q

what are the side effects of sucralfate?

A
  • constipation
  • nausea / vomiting
  • metallic taste
40
Q

why are antispasmodics used in the GI tract and what is their clinical use?

A

reduce gut motility - relax smooth muscle

uses - irritable bowel syndrome and diverticular disease

41
Q

what is the site of action of antispasmodics?

A

intestines

42
Q

name 4 antispasmodics that act on the muscarinic receptors

A
  1. dicyclomine hyrdochloride (kolanticon®)
  2. hyoscine butylbromide (buscopan®)
  3. probantheline
  4. bromide (pro-banthine®)
43
Q

what side effects are associated with antispasmodics that act on the muscarinic receptors

A
  • constipation
  • dry mouth
  • confusion (in elderly)
44
Q

name three othe antispasmodics used to treat irritable bowel syndrome and diverticular disease

A

alverine citrate (spasmonal®)

mebeverine hydrochloride (colofac®)

peppermint oil (mintec, colpermin®)

45
Q

what is the site of action for gut motility stimulants?

A
  • intestines
  • stomach sphincters
46
Q

describe the mechansim of action of gut motility stimulants

A
  • dopamine (D2) receptor antagonist →
  • increased peristalsis
  • relaxes phloric sphincter (increases gastric emptying)
  • increases action of oesophageal sphincter
47
Q

what are the clinical uses of gut motility stimulants?

A
  • nausea and vomiting
  • irritable bowel
  • dyspepsia
  • oesphageal reflux
48
Q

name two gut motility stimulants

A
  1. metoclopramide (maxlon®)
  2. domperide (motilium®)
49
Q

what are the side effects of gut motility stimulants?

A
  • movement disorders
  • confusion
  • restlessness
50
Q

name two lower GI tract disorders

A
  1. constipation
  2. acute diahorrea
51
Q

what influences bowel patterns?

A
  • diet
  • fluid intake
52
Q

what are the main causes of acute diarrhoea?

A
  • poor hygiene
  • food poisioning (infection)
53
Q

what is the first line of treatment for acute diarrhoea?

A

oral rehydration therapy

54
Q

name two oral rehydration therapies

A
  1. dioralyte®
  2. electrolade®
55
Q

what does oral rehydration therapy contain? and how does it work?

A
  • contains glucose, water, electrolytes
  • stimulates absorption of water and electrolytes
56
Q

what are anti diarrhoeals used for?

A
  • to treat acute diarrhoea
57
Q

what is the site of action of anti diarrhoeals?

A
  • large/small intestine
58
Q

name 3 anti diarrhoeals

A
  1. loperamide (immodium®)
  2. co-phenotrope (diphenoxylate and aptropine)
  3. kaolin and morphine (kaolin acts locally as an absorbant)
59
Q

what is the mechanism of action of anti diarrhoeals?

A
  • opiod-related drugs
  • reduce peristalsis in small and large intestine
  • reduce explosive contraction of colon
60
Q

what are the side effects of anti diarrhoeals?

A
  • nausea and vomiting
  • drowsiness
  • constipation
  • abdominal discomfort
  • fast HR

*caution with alcohol, some painkillers and sedatives

61
Q

what should be monitored when administering anti diarrhoeals?

A
  • electolyte balance and fluid intake
  • GI reactions
  • CNS effects
62
Q

what are laxatives used for?

A

treatment of constipation

63
Q

name three different classes of laxative

A
  1. bulk forming
  2. stimulant
  3. osmotic
64
Q

what is the mechanism of action of bulk forming laxatives?

A
  • increase faecal mass
  • stimulate peristalsis
65
Q

name three bulk forming laxatives

A
  1. ispaghula hulk (fybogel®)
  2. methylcellulose (celevac®)
  3. sterculia (normacol®)
66
Q

what could patients be advised when taking bulk forming laxatives?

A
  • taking a few days to work
  • need to maintain/increase fluid intake
67
Q

what is the action of stimulant laxatives?

A
  • increase peristalsis
  • moves stool through large bowel

* for acute use only* can cause lazy bowel

68
Q

name 4 stimulant laxatives

A
  1. bisacodyl
  2. dantron
  3. senna (sennokot®)
  4. sodium picosulfate
69
Q

what are the side effects and cautions to look out for when administering stimulant laxatives?

A
  • rapid action (6-12hrs)
  • can cause abdo pain and cramps
  • watch for abuse in anorexia
70
Q

what are osmotic laxatives and how do they work?

A
  • large sugar/magnesium and sodium salts
  • poorly soluble - not easily absorbed so draw water into gut
  • makes stool softer and easier to pass
71
Q

name 5 osmotic laxatives

A
  1. lactulose
  2. macrogols (movicol®)
  3. magnesium salts
  4. phophates (carbolox®)
  5. sodium salts (microlax®)

4 and 5 - rectal use only

72
Q

what are the side effects of osmotic laxatives?

A
  • abdominal cramps
  • wind
  • diarrhoea
73
Q

how long do osmotic laxatives take to work?

A
  • lactulose and macrogols - 2-3days
  • magnesium salts - more rapid
74
Q

can you take osmotic laxatives if you are lactose intolerant?

A

no - avoid

Pharmacology 1 (11 decks)

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