g a s t r o p h a r m Flashcards

1
Q

what are PPI’s name 3 and their indication

A

omeprazole
lansoprazole
pantoprazole

proton pump inhibitors

activated in acidic pH, irreversibily inhibit proton, potassium ATPase of the parietal cell

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2
Q

what are the SE associated with PPI’s

A

GI disturbance

headache

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3
Q

describe interactions of PPI’s

A

PPI’s = P450 inhibitor

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4
Q

what caution is to be taken for PPI’s

A
  1. can mask sx of gastric Ca

2. stop 2 weeks before endoscopy

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5
Q

what are the adverse effects associated with PPI’s

A
  1. hyponatraemia
  2. hypomagnasaemia
  3. osteoporosis → increased risk of fractures
  4. microscopic colitis
  5. increased risk of Clostridium difficile infections
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6
Q

what drug type is Al hydroxide and describe the MOA

A

anti-acid

neutralised gastric acid

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7
Q

side effect of AlOH

A

constipation

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8
Q

what are the interactions for AlOH and caution

A

interferes with drug absorption so take separately

take when sx expected and when sx occur

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9
Q

what is Mg trisilicate

A

antacid
same as Al hydroxide
side effect = diarrhoea instead of constipation
same caution as Al hydroxide

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10
Q

what type of drug is ranitidine and what is its MOA

A

H2 receptor antagonist

reduced gastric parietal cell proton secretion

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11
Q

what are side effects and interactions of H2RA

A
cimetidine = P450 inhibitor 
SE = GI disturbance esp in cimetidine
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12
Q

what are the 4 groups of laxatives

A
  1. bulk laxatives
  2. stimulant
  3. osmotic
  4. stool softener
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13
Q

what is the contraindication to use of laxatives

A

bowel obstruction

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14
Q

give example of bulk laxative and MOA

A

ispaghula

increase faecal mass = increase peristalsis by triggering stretch receptors

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15
Q

give example of stimulant laxative and mode of action

A

docusate
senna
glycerin PR

increases intestinal motility

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16
Q

what drug type is gaviscon and MOA

A

alginate = reduces reflux by increasing viscosity of stomach contents, form raft on top of stomach contents

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17
Q

give examine and MOA of osmotic laxatives

A

lactulose
macrogol
phosphates pr
Mg salts

increase stool water content

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18
Q

example of stool softener and SE

A

liquid paraffin

SE = reduced ADEK vitamins
can have granulomatous reactions

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19
Q

what drug type is mesalazine, give another example

A

5-ASA = 5-aminosalicylate

another example = sulfalazine

20
Q

what are the side effects of 5-ASA

A

sulfalazine has more SE

hepatitis
rash, urticaria
pulmonary fibrosis

21
Q

contraindications of use of 5-ASA’s

A

caution in renal or hepatic impairment

22
Q

other key points for 5 ASA’s

A

monitor FBC

topical use in distal disease

23
Q

what is budesonide, when is it used

A

steroid

used to induce remission in ileal Crohn’s

24
Q

what are the key points about budesonide

A

high first pass metabolism so reduced systemic effects

more potent than pred

25
give examples of anti TNF drugs | and SE
infliximab etanercept severe infections, TB, CNS demyelination
26
contraindications for anti TNF drugs and key points
TB screen for TB before parental use and give hydrocortisone to reduce SE
27
describe how GORD is managed, review sx, lx, rx
refer to pharm notes remember rx factors, sx, lx
28
how is PUD managed
same as GORD
29
describe H pylori eradication therapy
PAC 500  PPI: lansoprazole 30mg BD  Amoxicillin 1g BD  Clarithromycin 500mg BD PMC 250  PPI: lansoprazole 30mg BD  Metronidazole 400mg BD  Clarithromycin 250mg BD
29
describe H pylori eradication therapy
PAC 500  PPI: lansoprazole 30mg BD  Amoxicillin 1g BD  Clarithromycin 500mg BD PMC 250  PPI: lansoprazole 30mg BD  Metronidazole 400mg BD  Clarithromycin 250mg BD
30
describe the pathophysiology of H. pylori. how the organism is suited to survive
flagella = motility via chemotaxis to colonise under mucosa exotoxins = cause gastric mucosal injury urease = neutralise gastric acid and ammonia causes gastric mucosa injury lipopolysaccharides = adhere to host cells and cause inflammation outer proteins that allow it to adhere to host cell
31
h. pylori how does it cause ulcer
leads to atrophy of gastric mucosa via inflammation
32
which drugs should be stopped before H pylori testing
PPIs and cimetidine → false –ve C13 breath tests | and antigen tests  stop >2wks before.
33
failure in H. pylori is due to? how can this be reduced
95% success  Mostly due to poor compliance  Add bismuth  Stools become tarry black
34
in crohn's disease what is the acute management
Resus: Admit, NBM, IV hydration Hydrocortisone: IV + PR if rectal disease Abx: metronidazole PO or IV Thromboprophylaxis: LMWH Dietician Review  Elemental diet  Consider parenteral nutrition Monitoring  Vitals + stool chart  Daily examination
35
if improving vs not improving after acute severe crohn's attack what should be done
Improvement → oral therapy  Switch to oral pred (40mg/d) No Improvement → rescue therapy  Discussion between pt, physician and surgeon  Medical: methotrexate ± infliximab  Surgical
36
what supportive and drugs are used to induce remission in crohns
Supportive  High fibre diet  Vitamin supplements ``` Oral Therapy  1st line  Ileocaecal: budesonide  Colitis: sulfasalazine  2nd line: prednisolone (tapering)  3rd line: methotrexate  4th line: infliximab or adalimumab ```
37
management of perianal disease in crohn's
Occurs in ~50% Ix: MRI + EUA Rx  Oral Abx: metronidazole  Immunosuppression ± infliximab  Local surgery ± seton insertion
38
what drugs are used to maintain remission in crohns
1st line: azathioprine or mercaptopurine  2nd line: methotrexate  3rd line: Infliximab / adalimumab
39
indications for surgery in crohn's
``` indications  Abscess or fistula  Perianal disease  Chronic ill health  Carcinoma ```
40
no improvement after acute severe UC attack
Discussion between pt, physician and surgeon  Medical: ciclosporin, infliximab or visilizumab  Surgical
41
what drugs are used to induce remission in UC
Oral Therapy  1st line: 5-ASAs  2nd line: prednisolone  3rd line: ciclosporin or infliximab Topical Therapy: mainly left-sided disease  Proctitis: suppositories  More proximal disease: enemas or foams  5-ASAs ± steroids (prednisolone or budesonide) Additional Therapy: steroid sparing  Azathioprine  Infliximab: steroid-dependent pts
42
drugs used to maintain remission in UC
1. 5-ASA PO sulfalazine or mesalazine 2. azathioprine 3. infliximab
43
indications for surgery in UC
Chronic symptoms despite medical therapy  Carcinoma or high-grade dysplasia
44
what abx increase risk of c.diff
cephalosporins clindamycin as well as PPI's
45
what is the treatment for c.diff
10 days oral vancomycin if not severe - check WCC = first line first episode second line = oral fidoxomicin oral vancomycin with IV metronidazole if life threatening = third line recurrent within 12 weeks = oral fidaxomicin