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Applied Pharmacology > Gastrointestinal Drugs > Flashcards

Gastrointestinal Drugs Flashcards

1
Q

What are Proton Pump Inhibitors indicated in?

A
  • Peptic Ulcers
  • Acid
  • Dyspepsia
  • H. Pylori
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2
Q

What is the MOA of Proton Pump Inhibitors?

A
  • Irreversibly inhibit H/K-ATPase in gastric parietal cells which reduces gastric acid secretion.
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3
Q

What are the main Side effects of Proton pump Inhibitors:

A
  • GI upset
  • Headaches
  • Long term = hypomagnesaemia
  • osteoporosis
  • Increases Gastric pH which may reduce the body’s host against defence.
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4
Q

What are PPIs contraindicated in?

A
  • May disguise symptoms of gastro-oesophageal cancer
  • In elderly, can increase risk of fracture due to risk of osteoporosis.
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5
Q

What are the key interactions of Proton Pump Inhibitors?

A
  • Omeprazole can reduce the antiplatelet effect of clopidogrel by decreasing its activation
  • Lansoprazole and Pantoprazole have a lower propensity to interact with clopidogrel (thus preferred when prescribing alongside clopidogrel).
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6
Q

What are H2 receptor Antagonists indicated in?

A
  • NSAID-associated ulcers
  • Gastric and duodenal ulcers
  • Dyspepsia and GORD
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7
Q

What is the MOA of H2 receptor antagonists?

A
  • reduce gastric acid secretion
  • Proton pump of gastric parietal cell produces acid by secreting H+ into stomach lumen in exchange for K+, which is regulated by histamine
  • Blocks histamine H2-receptors on the gastric parietal cells which inhibits release of H+ by the proton pump, via a 2nd messenger system  reduces gastric acid secretion
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8
Q

What are the main sides effects of H2 receptor antagonists?

A
  • Bowel disturbances (diarrhoea and Constipation)
  • headaches
  • Dizziness
  • Hypotension
  • dark Urine
  • alopecia
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9
Q

whom is H2 receptor antagonists contraindicated in?

A
  • renal impairment (low dose)
  • may disguise symptoms of oesophageal cancer.
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10
Q

What are 2 examples of PPIs?

A

Omeprazole
lanzoprazole

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11
Q

What is an example of H2 receptor antagonist?

A
  • Ranitidine
  • (-tidine)
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12
Q

What is an example of an antacid?

A
  • Gaviscon
  • Sodium bicarbonate
  • Calcium carbonate
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13
Q

What is the main indications of antacids?

A
  • Dyspepsia
  • heartburn
  • GORD
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14
Q

What is the MOA of antacids?

A
  • alkali to neutralise stomach acid
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15
Q

What are the side effects of antacids:

A

Diarrhoea, constipation, Flatulence, cramps, nausea, vomitting

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16
Q

What is the MOA of alginates?

A
  • Increase viscosity of stomach contents which reduces the reflux of stomach acid into oesophagus
  • After reacting with stomach acid, they form a floating ‘raft’ which separates gastric contents from the gastro-oesophageal junction to prevents mucosal damage
  • May also inhibit pepsin production
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17
Q

What are some examples of alginates:

A
  • Magnesium salts
  • Aluminium salts
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18
Q

What are the main side effects of each alginate salt?

A
  • Magnesium salts- diarrhoea
  • Aluminium salts- constipation
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19
Q

Whom is antacids contraindicated in?

A
  • Compound alginates should not be given with thickened milk preparations to children as it can cause bloating and discomfort
  • Na/K containing preparations used with caution in: Fluid overload and Hyperkalaemia (e.g. renal failure)
  • Sucrose preparations can worsen hyperglycaemia in diabetic patients
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20
Q

What drugs do Antacids interact with?

A
  • The divalent cations in compound alginates can bind to other drugs which reduces their absorption

To ensure drug is absorbed ensure dose separated by 2 hours with:
- ACE-inhibitors
- Some antibiotics (e.g. tetracyclines, cephalosporins)
- Bisphosphonates
- Digoxin
- Levothyroxine
- PPIs

Increases the alkalinity of urine meaning it can increase excretion of:
- Aspirin
- Lithium

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21
Q

What is Loperamide used for?

A
  • Diarrhoea
  • IBS
  • viral gastroenteritis
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22
Q

What are the main side effects of Loperamide?

A
  • Constipation
  • cramps
  • Flatulence
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23
Q

Who is Loperamide contraindicated in?

A
  • acute ulcerative colitis
  • acute bloody diarrhoea
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24
Q

What are antiemetics used for?

A
  • treatment of nausea and vomitting.
  • prophylaxis
25
Q

What are the 4 classes of antiemetics?

A
  • H1 receptor antagonist
  • D2 receptor antagonist
  • 5HT3 receptor antagonist
  • Anti-muscarinic
26
Q

Give an example of a H1 receptor antagonist?

A
  • Cyclizine
27
Q

Give an example of a D2 receptor antagonist?

A

Metoclopramide

28
Q

Give an example of a 5HT3 receptor antagonist?

A
  • Ondansetron
29
Q

Give an example of an Anti-muscarinic drug?

A

Hycosine Hydrobromide

30
Q

What is the MOA of D2 antagonist?

A
  • Acts in the brain and the gut
  • Inhibits D2 receptors in the chemoreceptor trigger zone which is responsible for sensing emetogenic substances in the blood, therefore effective in nausea and vomiting caused by CTZ stimulation.
  • Prokinetic effect: increases LOS and gastric tone which promotes gastric emptying, then contributes to their antiemetic action in conditions associated with reduced gut motility
31
Q

What are the main side effects of D2 receptor antagonists?

A
  • diarrhoea
  • movement abnormalities/ tremours
  • seizures
  • low mood
32
Q

What is Metoclopramide contraindicated in?

A
  • Should not be prescribed for more than 5 days to reduce the risk of extrapyramidal effects

Avoid in:
- Neonates
- Children
- Young adults
- Intestinal obstruction
- Perforation
- Parkinson’s disease

33
Q

What drugs does D2 receptor antagonists interact with?

A
  • antipsychotics
  • dopaminergic agents especially in parkinson’s disease.
34
Q

What is the MOA of H1 receptor antagonist?

A

Blocks the H1 receptor and muscarinic Ach receptors which triggers nausea in the brain.

35
Q

Side effects of H1 receptor antagonists:

A
  • depression
  • drowsy
  • dry mouth
36
Q

What is the MOA of Antimuscarinic in IBS:

A
  • reduces motility
  • reduces glandular secretions
  • reduced sphincter
  • causing muscle dilation
37
Q

What are the 4 types of laxatives?

A
  • Bulk Forming
  • Stimulant
  • Osmotic
  • Feacal Softeners
38
Q

Name a bulk-forming laxative?

A

Ispaghula

39
Q

Name a stimulant laxative:

A
  • Senna
  • Bisacodyl
40
Q

Name a osmotic Laxative:

A

Lactulose

41
Q

Name a Feacal Softening Laxative:

A

Docusate

42
Q

What is the MOA of bulk forming Laxative:

A
  • retains fluid in the stool causing an increase in feacal mass which triggers peristalsis and soft stools.
43
Q

What are the indications for bulk-forming laxatives?

A
  • a low faecal mass
44
Q

Whom are the bulk-forming laxatives contraindicated in?

A
  • elderly and frail
45
Q

What are the side effects of using bulk-forming laxatives:

A
  • bloating
  • flatulence
46
Q

Which is the most rapid form of laxative?

A

Stimulant- takes 6-12 hours to work

Faecal softeners- 12-72 hours to work

47
Q

What is the MOA of stimulant laxatives?

A
  • increases the intestinal motility which via stimulation of nerves via peristalsis.
  • Increases water and electrolyte secretion from the colonic mucosa causing an increase in the volume of colonic content and stimulates peristalsis.
48
Q

What are some side effects of stimulant laxatives?

A
  • cramps
  • diarrhoea
  • malanosis coli
49
Q

What is Stimulant laxative indicated in?

A

A slow transit

50
Q

What is Osmotic laxative indicated in?

A
  • Pellet stools
51
Q

Whom is Osmotic laxative contraindicated in?

A
  • IBS
  • Constipation
  • Faecal impactation
  • bowel preparations for procedures
  • hepatic encephalopathy
52
Q

What is the MOA of Osmotic laxative?

A
  • increase in H2O in the large intestine by drawing fluid from body/ retaining the fluid.
53
Q

What are the common side effects of Osmotic laxatives?

A
  • nausea
  • dehydration
  • flatulence
  • bloating
  • cramps
54
Q

What are Faecal softeners (laxatives) indicated in?

A
  • Hard stools
55
Q

What is the MOA of Faecal softners?

A
  • Reduces the surface tension of stools to increase penetration of intestinal fluid into the faecal mass
  • use alongside another laxative.
56
Q

What is the side effects of Faecal softeners?

A
  • cramps
  • diarrhoea
57
Q

When is giving laxative to patients contraindicated?

A

Intestinal obstruction

58
Q

How do you treat Helicobacter Pylori?

A
  • Omeprazole + Amoxicillin + (Clarithromycin OR Metronidazole) for 7 days
59
Q

How do you treat C. Difficile:

A
  • Vancomycin 1st line

Applied Pharmacology (7 decks)

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