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MET3a > Drugs and the gut > Flashcards

Drugs and the gut Flashcards

1
Q

What does 5ASA stand for?

A

5 aminosalicylic acid

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2
Q

Examples of 5ASA and their sites

A

Sulphasalazine (colon)
Mesalazine (small bowel and colon)
Olsalazine (colon)
Balsalazide (colon)

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3
Q

Site of release when 5ASA is given orally

A

Depends on formulation (coating and azo bond)

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4
Q

Indication for 5ASA

A

Mild/moderate UC
Colonic Crohns
Maintenance UC = prevents recurrence of inflammation and possibly colorectal cancer

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5
Q

MOA of 5ASA

A

Unknown
Poorly absorbed
Reactive oxygen species scavengers
Modulates prostaglandin and leukotriene synthesis from arachidonic acid
Modulates cytokine profile
PPARgamma agonist (peroxisome proliferator activated receptor gamma)

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6
Q

5ASA route

A

Proctitis = suppository
Left sided = enema
Pan = oral

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7
Q

5ASA side effects

A 
Rare
nephrotoxicity
rash
worsening of colitis
pancreatitis
percarditis
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8
Q

Examples of corticosteroids

A

Hydrocortisone
Prednisolone
Budesonide

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9
Q

Classes of corticosteroids

A

Glucocorticoid

Low mineralocorticoid

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10
Q

Budesonide uses

A

topical
first pass metabolism
fewer systemic side effects

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11
Q

Indication for corticosteroids

A

induction of remission

never for maintenance

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12
Q

MOA of corticosteroids

A 
Immunosuppressive
Glucocorticoid receptors 
Regulates transcription of 100s of genes
Reduces IL1, TNFa, IL8
Reduces NO
Prevent leucocyte migration
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13
Q

Routes of administration for corticosteroids

A

According to site and severity of IBD

  • oral
  • IV
  • enema
  • suppository
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14
Q

SE of corticosteroids

A
  • HTN
  • DM
  • central obesity
  • osteoporosis, myopathy
  • acne, bruising
  • cataracts
  • depression, psychosis, euphoria, insomnia
  • pituitary/adrenal suppression
  • GF (children)
  • sepsis in Crohns, candida
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15
Q

Duodenal peptic ulcer disease cause

A

H pylori

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16
Q

Gastric peptic ulcer disease cause

A

H pylori

NSAIDs & steroids

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17
Q

Tx for peptic ulcer disease

A

H pylori eradication

Anti secretion therapy

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18
Q

Examples of drugs for anti-secretion therapy

A 
Omeprazole
lansoprazole
pantoprazole
rabeprozole
esomeprazole
ranitidine
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19
Q

Class of drugs for anti-secretory therapy

A

PPIs

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20
Q

MOA of PPIs

A

histamine receptor 2 antagonists

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21
Q

Indications for ant-secretory therapy

A

PUD
GORD
Prevention of ulcers in patients on NSAIDs
Zollinger-Ellison syndrome

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22
Q

Routes of administration for anti-secretion therapy

A

Oral

IV

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23
Q

Side effects of anti secretion therapy

A

Diarrhoea
Headache
Increased risk of C. difficile
Weak inhibitors of cytochrome P450 (so need to be careful with some drugs)

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24
Q

Which drugs do you need to be careful of with anti-secretory therapy

A

Phenytoin
Warfarin
Theophylline
(as anti-secretaries are weak inhibitors of cytochrome P450)

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25
Q

Emetic pathways

A

Medulla
Afferents = labyrinth, vagus, systemic circulation
Efferents = oesophagus, stomach, abdominal wall

26
Q

Examples of anti-emetics

A

Cyclizine
Metoclopramide
Odansetron

27
Q

Cyclizine indications

A

Vertigo
motion sickness
post op nausea and vomiting

28
Q

Class of cyclizine

A

H1r antagonist

Anticholinergic

29
Q

MOA of cyclizine

A

CTZ labyrinth

30
Q

SE of cyclizine

A

Drowsiness
Dry mouth
Urinary retention

31
Q

Indications for metoclopramide

A

Anti emetic
Gastroparesis
PONV

32
Q

Class of metoclopramide

A

D2r antagonist

5 HT4r agonist

33
Q

MOA of metoclopramide

A

CTZ

Increases gastric emptying

34
Q

SE of metoclopramide

A

Restlessness

Dystonic reactions

35
Q

Ondansetron indications

A

Refractory
PONV
Chemotherapy

36
Q

Class for ondansetron

A

5HT3 antagonist

37
Q

MOA of ondansetron

A

Vagus
CTZ
Peripheral efferents

38
Q

SE of ondansetron

A 
Constipation
Headache
Flushing
Reduce HR
BP
39
Q

Azathioprine and mercatopurine

A

oral
immunosuppressive
maintenance of remission

40
Q

Side effects of thiopurines

A 
Bone marrow suppression
Hepatitis, pancreatitis
Lethargy, headache, nausea, rash
Viral infections
Lymphoma
41
Q

Rigorous monitoring needed for thiopurines

A

Blood count
LFTs
Drug level
Check TPMT status before

42
Q

Examples of laxatives

A 
Fybogel
Senna
Arachis oil
Lactulose
Movicol/macrogol
43
Q

Osmotic laxatives

A

Lactulose

Movicol

44
Q

Class of fybogel

A

Bulk laxative

45
Q

Class of senna

A

Stimulant laxative

46
Q

Class of arachis oil

A

stool softener

47
Q

MOA of fybogel

A

Increases stool mass

stimulates peristalsis

48
Q

SE of fygogel

A

Wind bloating

49
Q

Senna MOA

A

Increases colonic motility

50
Q

SE of senna

A

cramps

low K+

51
Q

MOA of arachis oil

A

Lubricates oil

52
Q

SE of arachis oil

A

peanut allergy

53
Q

MOA of lactulose

A

disaccharide not absorbed

draws fluid into gut lumen

54
Q

SE of lactulose

A

wind cramps

55
Q

MOA of movicol

A

not absorbed

draws fluid into gut lumen

56
Q

Biological treatments in IBD administration route

A

IV or SC

Except tofacitinib = oral

57
Q

SE of biologics in IBD

A

Opportunistic infections = TB
Hypersensitivity reactions
Loss of response due to development of ABs

58
Q

What to be sure to do when giving biologics in IBD

A

Pre treatment screening

Monitor = efficacy, side effects, drug levels, anti-drug antibodies

59
Q

Induction of remission IBD Tx principles

A 
FIRST LINE
5ASA 
Corticosteroids
Ciclosporine (UC)
3RD LINE
Biologics
60
Q

Maintenance of remission IBD Tx principles

A 
FIRST LINE
5ASA
SECOND LINE
Thiopurines
MTX
THIRD LINE
Biologics

MET3a (38 decks)

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