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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
Emetic pathways
Medulla Afferents = labyrinth, vagus, systemic circulation Efferents = oesophagus, stomach, abdominal wall
26
Examples of anti-emetics
Cyclizine Metoclopramide Odansetron
27
Cyclizine indications
Vertigo motion sickness post op nausea and vomiting
28
Class of cyclizine
H1r antagonist | Anticholinergic
29
MOA of cyclizine
CTZ labyrinth
30
SE of cyclizine
Drowsiness Dry mouth Urinary retention
31
Indications for metoclopramide
Anti emetic Gastroparesis PONV
32
Class of metoclopramide
D2r antagonist | 5 HT4r agonist
33
MOA of metoclopramide
CTZ | Increases gastric emptying
34
SE of metoclopramide
Restlessness | Dystonic reactions
35
Ondansetron indications
Refractory PONV Chemotherapy
36
Class for ondansetron
5HT3 antagonist
37
MOA of ondansetron
Vagus CTZ Peripheral efferents
38
SE of ondansetron
``` Constipation Headache Flushing Reduce HR BP ```
39
Azathioprine and mercatopurine
oral immunosuppressive maintenance of remission
40
Side effects of thiopurines
``` Bone marrow suppression Hepatitis, pancreatitis Lethargy, headache, nausea, rash Viral infections Lymphoma ```
41
Rigorous monitoring needed for thiopurines
Blood count LFTs Drug level Check TPMT status before
42
Examples of laxatives
``` Fybogel Senna Arachis oil Lactulose Movicol/macrogol ```
43
Osmotic laxatives
Lactulose | Movicol
44
Class of fybogel
Bulk laxative
45
Class of senna
Stimulant laxative
46
Class of arachis oil
stool softener
47
MOA of fybogel
Increases stool mass | stimulates peristalsis
48
SE of fygogel
Wind bloating
49
Senna MOA
Increases colonic motility
50
SE of senna
cramps | low K+
51
MOA of arachis oil
Lubricates oil
52
SE of arachis oil
peanut allergy
53
MOA of lactulose
disaccharide not absorbed | draws fluid into gut lumen
54
SE of lactulose
wind cramps
55
MOA of movicol
not absorbed | draws fluid into gut lumen
56
Biological treatments in IBD administration route
IV or SC | Except tofacitinib = oral
57
SE of biologics in IBD
Opportunistic infections = TB Hypersensitivity reactions Loss of response due to development of ABs
58
What to be sure to do when giving biologics in IBD
Pre treatment screening | Monitor = efficacy, side effects, drug levels, anti-drug antibodies
59
Induction of remission IBD Tx principles
``` FIRST LINE 5ASA Corticosteroids Ciclosporine (UC) 3RD LINE Biologics ```
60
Maintenance of remission IBD Tx principles
``` FIRST LINE 5ASA SECOND LINE Thiopurines MTX THIRD LINE Biologics ```

MET3a (38 decks)

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