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Pharm > Gastric motility drugs > Flashcards

Gastric motility drugs Flashcards

1
Q

Mechanisms of gastric motility control

A

Neuronal - enteric plexus
Hormonal - endocrine cells in mucosa
Myogenic - interstitial cells of cajal

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2
Q

Mechanism of emesis

A

Pyloric sphincter contracts
Cardia and oesophagus relax
Abdo wall and diaphragm contract to propel gastric contents
Glottis closes and soft palate elevates to protect trachea

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3
Q

Where is the vomiting centre

A

Part of postrema on floor of 4th ventricle

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4
Q

What triggers the vomiting centre

A 
Pain
Smell
Pregnancy
Rotational movement
Raised ICP
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5
Q

Classes of antiemetics and an example of each

A 
Dopamine antagonist - domperidone, metoclopramide,
Serotonin antagonist - ondansetron
Antimuscurinics - hyoscine
Histamine antagonist - cyclizine 
Benzodiazepines - lorazepam
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6
Q

Site of action of domperidone

A

Postrema

Stomach (speeds up emptying)

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7
Q

Site of action of metoclopramide

A

Postrema
Stomach (speeds up emptying)
Inhibits vagal afferents from GI

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8
Q

Site of action of ondansetron

A

Postrema

Inhibits vagal afferents from GI

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9
Q

Indications for domperidone

A

Acute N+V

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10
Q

Main side effect of domperidone

A

Galactorrhoea

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11
Q

Route of domperidone

A

Oral or rectal (not first line for acute vomiting)

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12
Q

Indications for ondansetron

A

Acute N+V
Prophylactic for post op N+V
Radiation sickness
Chemo

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13
Q

What can increase effects of ondansetron

A

Single dose corticosteroid

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14
Q

Side effects of ondansetron

A

Headaches
Constipation
Flushing

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15
Q

Indications for metoclopramide

A

GI causes for N+V
Migraine
Post op N+V

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16
Q

Contraindications for metoclopramide

A

Parkinson’s disease as crosses BBB and causes dystonia

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17
Q

Indications for hyoscine

A

Motion sickness

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18
Q

Side effects of hyoscine

A

Anticholinergic side effects

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19
Q

Indications for cyclizine

A

Acute N+V

20
Q

Side effects of cyclizine

A

QT prolonging

Sedation

21
Q

Conservative management of constipation

A

Increase fluid intake
High fibre diet
Manage potential underlying cause e.g diabetes

22
Q

Drug classes for soft faeces constipation

A

Stimulant laxatives

23
Q

Drug classes for hard faeces constipation

A

Bulk laxatives
Osmotic laxatives
Faecal softeners

24
Q

Example of bulk laxative

A

Ispaghula

Fybogel

25
Q

MoA of bulk laxatives

A

Non degradable fibre so attracts H20 into lumen which distends gut
Stretch activates receptors which stimulates peristalsis

26
Q

Indications for bulk laxatives

A

Chronic constipation (takes few days for effect)
IBS
Pregnancy

27
Q

Contraindications for bulk laxatives

A

Adhesions

Ulceration

28
Q

Side effects of bulk laxatives

A

Flatulence

29
Q

Example of faecal softener

A

Glycerol

30
Q

Indications for faecal softeners

A

Chronic constipation
IBS
Pregnancy
Adhesions

31
Q

Contraindications for faecal softeners

A

Anal fissures

Haemorrhoids

32
Q

Examples of osmotic laxatives and how long they take to work

A

Mg/Na salts - give urgent relief
Movicol - few hours
Lactulose - 48 hours

33
Q

Indications for lactulose

A

Hepatic encephalopathy as decreases ammonia

34
Q

MoA of stimulant laxatives

A

Excite sensory nerve endings leading to H20 retention and peristalsis

35
Q

Indications for stimulant laxatives

A

When need rapid relief:
Faecal impaction
Surgery prep

36
Q

Examples of stimulant laxatives

A

Senna
Castor oil
Sodium picosulphate

37
Q

Consequences of repeated senna use

A

Colonic atony
Hypokalaemia
Melanosis coli (precancerous pigmentation of colon)

38
Q

Classes of anti-diarrhoea drugs and an example

A

Anti-motility - loperamide
Bulk forming - ispaghula
Fluid absorbants (very rarely used)

39
Q

MoA of loperamide

A

Opiate analogue

Decreases bowel motility and increases anal tone

40
Q

Indication for loperamide

A

Chronic diarrhoea (over 2 weeks)

41
Q

Contraindications for loperamide

A

IBD (risk of toxic megacolon)

42
Q

MoA of bulk forming anti diarrhoea drugs

A

Increase H20 absorption in gut

43
Q

Indications for bulk forming anti diarrhoea drugs

A

IBS

Ileostomy patients

44
Q

Describe mebeverine

A

Relieves intestinal muscle spasms in IBS

Useful in combo with bulk forming agent

45
Q

Describe linaclotide

A

Activates CFTR to treat constipation in IBS

Pharm (20 decks)

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