g a s t r o p h a r m Flashcards
what are PPI’s name 3 and their indication
omeprazole
lansoprazole
pantoprazole
proton pump inhibitors
activated in acidic pH, irreversibily inhibit proton, potassium ATPase of the parietal cell
what are the SE associated with PPI’s
GI disturbance
headache
describe interactions of PPI’s
PPI’s = P450 inhibitor
what caution is to be taken for PPI’s
- can mask sx of gastric Ca
2. stop 2 weeks before endoscopy
what are the adverse effects associated with PPI’s
- hyponatraemia
- hypomagnasaemia
- osteoporosis → increased risk of fractures
- microscopic colitis
- increased risk of Clostridium difficile infections
what drug type is Al hydroxide and describe the MOA
anti-acid
neutralised gastric acid
side effect of AlOH
constipation
what are the interactions for AlOH and caution
interferes with drug absorption so take separately
take when sx expected and when sx occur
what is Mg trisilicate
antacid
same as Al hydroxide
side effect = diarrhoea instead of constipation
same caution as Al hydroxide
what type of drug is ranitidine and what is its MOA
H2 receptor antagonist
reduced gastric parietal cell proton secretion
what are side effects and interactions of H2RA
cimetidine = P450 inhibitor SE = GI disturbance esp in cimetidine
what are the 4 groups of laxatives
- bulk laxatives
- stimulant
- osmotic
- stool softener
what is the contraindication to use of laxatives
bowel obstruction
give example of bulk laxative and MOA
ispaghula
increase faecal mass = increase peristalsis by triggering stretch receptors
give example of stimulant laxative and mode of action
docusate
senna
glycerin PR
increases intestinal motility
what drug type is gaviscon and MOA
alginate = reduces reflux by increasing viscosity of stomach contents, form raft on top of stomach contents
give examine and MOA of osmotic laxatives
lactulose
macrogol
phosphates pr
Mg salts
increase stool water content
example of stool softener and SE
liquid paraffin
SE = reduced ADEK vitamins
can have granulomatous reactions
what drug type is mesalazine, give another example
5-ASA = 5-aminosalicylate
another example = sulfalazine
what are the side effects of 5-ASA
sulfalazine has more SE
hepatitis
rash, urticaria
pulmonary fibrosis
contraindications of use of 5-ASA’s
caution in renal or hepatic impairment
other key points for 5 ASA’s
monitor FBC
topical use in distal disease
what is budesonide, when is it used
steroid
used to induce remission in ileal Crohn’s
what are the key points about budesonide
high first pass metabolism so reduced systemic effects
more potent than pred
give examples of anti TNF drugs
and SE
infliximab
etanercept
severe infections, TB, CNS demyelination
contraindications for anti TNF drugs
and key points
TB
screen for TB before parental use and give hydrocortisone to reduce SE
describe how GORD is managed, review sx, lx, rx
refer to pharm notes
remember rx factors, sx, lx
how is PUD managed
same as GORD
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
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
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
h. pylori how does it cause ulcer
leads to atrophy of gastric mucosa via inflammation
which drugs should be stopped before H pylori testing
PPIs and cimetidine → false –ve C13 breath tests
and antigen tests stop >2wks before.
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
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
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
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
management of perianal disease in crohn’s
Occurs in ~50%
Ix: MRI + EUA Rx
Oral Abx: metronidazole
Immunosuppression ± infliximab Local surgery ± seton insertion
what drugs are used to maintain remission in crohns
1st line: azathioprine or mercaptopurine 2nd line: methotrexate
3rd line: Infliximab / adalimumab
indications for surgery in crohn’s
indications Abscess or fistula Perianal disease Chronic ill health Carcinoma
no improvement after acute severe UC attack
Discussion between pt, physician and surgeon
Medical: ciclosporin, infliximab or visilizumab
Surgical
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
drugs used to maintain remission in UC
- 5-ASA PO sulfalazine or mesalazine
- azathioprine
- infliximab
indications for surgery in UC
Chronic symptoms despite medical therapy
Carcinoma or high-grade dysplasia
what abx increase risk of c.diff
cephalosporins
clindamycin
as well as PPI’s
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
