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PSA revision > Gastro drugs > Flashcards

Gastro drugs Flashcards

1
Q

Dosage of Ranitidine

A

150mg BD or 300mg nocte

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2
Q

Dosage of Omeprazole

A

20-40mg OD

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3
Q

Dosage of Loperamide

A

Acute diarrhoea: 4mg then 2mg after each loose stool for up to 5 days, usual dose 6-8mg daily

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4
Q

Dosage of Mesalazine

A

1.2g-4.8g

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5
Q

Fybogel dose

A

1 sachet BD after meals

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6
Q

Lactulose dose

A

15ml BD in constipation
30-50ml TDS in hepatic encephalopathy

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7
Q

Macrogol dose

A

1-2 sachets daily

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8
Q

Senna dose

A

2-4 tablets ON

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9
Q

Mechanism of Ranitidine

A

Histamine H2 receptor antagonist in gastric parietal cell. This reduces stimulation of gastric acid secretion

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10
Q

Mechanism of omeprazole

A

PPI
H+K+ATPase pump at the secretory surface of gastric parietal cells
Inhibits final transport of H+ into gastric lumen, therefore inhibiting acid secretion

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11
Q

Mechanism of loperamide

A

Slows intestinal motility by targeting opioid mu receptors in the myenteric plexus of the large intestine (agonist), reducing tone of circular muscle

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12
Q

Mechanism of mesalazine

A

Aminosalicylate (5-aminosalicylic acid)
Inhibits COX enzymes in the colon, inhibiting mucosal production of arachidonic acid metabolites such as prostaglandins, Therefore reduces colonic inflammation

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13
Q

Mechanism of bulk-forming laxatives (e.g. ispaghula husk)

A

Polysacchiaride polymers, increase stool volume activating the stretch reflex, stimulating peristalsis

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14
Q

Mechanism of osmotic laxatives (e.g. lactulose, macrogol)

A

Draw water into the bowel. Accelerates transfer of gut contents through the small intestine

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15
Q

Mechanism of Senna

A

Stimulant. Increases electrolyte and water secretion by the GI mucosa and increase peristalsis. Directly stimulates the myenteric plexus

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16
Q

Cimetidine (H2 receptor antagonist) can cause what side effect in men?

A

Gynaecomastia and impotence

17
Q

Cimetidine should be avoided with which other medications?

A

Warfarine
Theophylline
Phenytoin
(it is a CP450 inh)

18
Q

What can PPIs and H2 receptor antagonists mask?

A

Gastric cancer symptoms - rule out red flag symptoms before starting

19
Q

What group of patients is PPIs and H2 agonists contraindicated in?

A

Pregnancy and breast feeding

20
Q

What interactions does omeprazole have?

A

Warfarin - increases anticoagulant effect
Clopidogrel - reduces antiplatelet effect

21
Q

What are some important side effects of omeprazole?

A

Rebound acid hypersecretion
Hepatitis
Interstitial nephritis
Blood disorders
C. diff
Hypomagnesaemia

22
Q

What electrolyte may you consider monitoring before and during prolonged PPI treatment?

A

Magnesium

23
Q

What is an important side effect of loperamide?

A

paralytic ileus

24
Q

What are some contraindications to loperamide?

A

Active colitis or any other condition where inhibition of peristalsis should be avoided
Should not be given to children below age 4

25
Q

What are important adverse effects of mesalazine?

A

Acute pancreatitis
Blood disorders including agranulocytosis
Lupus erythematosus-like syndrome (sulfasalazine)
Renal dysfunction (interstitial nephritis, nephrotic syndrome

26
Q

What haematological condition must you be careful with in prescribing sulfasalazine?

A

G6PD deficiency - observe closely for signs of haemolytic anaemia

27
Q

What conditions should you have caution in prescribing aminosalicylates to?

A

Elderly
Pregnancy
Breastfeeding
Asthma
Hepatic or renal impairment

28
Q

What are the interactions for aminosalicylates?

A

Lactulose - reduces 5-ASA efficacy
Azathioprine (increased risk of leucopenia)
Mercaptopurine (increased risk of leucopenia)
Digoxin (absorption may be reduced)

29
Q

What must you counsel patients on for aminosalicylates such as mesalazine?

A

To report any unexplained bleeding, bruising, sore throat, fever, malaise

Let them know that sulfasalazine can cause yellow-orange discolouration of skin, urine and other body fluids

30
Q

Which laxative do you have to use with caution with those who are lactose intolerant?

A

Lactulose

31
Q
A

PSA revision (4 decks)

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