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342 > gastrointestinal pharmacology - lower GI tracts > Flashcards

gastrointestinal pharmacology - lower GI tracts Flashcards

1
Q

what does the lower GI tract consist of - 4

A

small intestine
large intestine
mix of differentiated and stem cells
2kg of intestinal flora

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2
Q

what does the lining of the small intestine consist of

A

millions of microscopic projections called vili that inc sa for absorption of food particles

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3
Q

the intestinal walls contain __ and ___ receptors that allow intestine to response to food within it and propel food along

A

tension

stretch

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4
Q

drugs that affect motility of GI tract - 4

A

purgatives

agents that inc motility of GI smooth muscle

antidiarrhoel drugs (dec motility)

antispasmodic drugs (dec smooth muscle tone)

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5
Q

which type of drugs that affect motility of GI tract specifically treat constipation - 2

A

purgatives

agents that inc motility of GI smooth muscle

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6
Q

which type of drugs that affect motility of GI tract specifically treat diarrhoea - 2

A

antidiarrhoel drugs (dec motility)

antispasmodic drugs (dec smooth muscle tone)

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7
Q

constipation cause

A

dec movement of fecal matter along GI tract

dec freq of bowel movements

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8
Q

constipation general treatments - 2

A

usually dietary modification

if fails, laxatives used (unless obstruction of bowel) (also abuse of laxatives is number 1 cause of constipation)

morphine can contribute to constipation

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9
Q

laxatives types/ constipation pharmacological therapies - 4

A

bulking agents

osmotic laxatives

stimulant laxatives

faecal softeners

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10
Q

bulking laxative agents examples - 4

A

agar

bran

methylcellulose

ispaghula husk

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11
Q

bulking laxative agents admin

A

insoluble and non absorbable, non digestive so must be taken with lots of water unless will worsen constipation

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12
Q

saline and osmotic laxatives mechanism of action

A

fluid is drawn into bowel by osmotic force, increasing volume and triggering peristalsis

used to purge large intestine after surgery and poisioning

fast acing - 1-3 hours

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13
Q

saline and osmotic laxative agents are usually ___

A

nondigestible

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14
Q

saline and osmotic laxative agent example

A

non digestable sugars and alcogols e.g lactulose

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15
Q

lactulose

A

semi synthetic disaccharide, broken down by bacteria in GI tract to acetic and lactic acid which cause osmotic effect

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16
Q

saline and osmotic laxative salts examples - 5

A

milk of magnesia (Mh(OH)2)

epsom salt (MGSO4)

glauber’s salt (Na2SO4)

sodium phosphates (admin as enema)

sodium citrate (admin as enema)

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17
Q

saline and osmotic laxative other examples (not sugars, salts, or alcohols) - 2

A

polyethylene glycol and vitamic c

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18
Q

saline and osmotic laxative side effects - 2

A

flatulence
cramping

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19
Q

emollients

A

faecal softeners

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20
Q

emollient examples - 4

A

docusate sodium (surfactant and stimulant) suppositories

glycerin suppositories (mildly irritable, inc movement)

groundnut oil, peanut oil

liquid paraffin oral solution

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21
Q

liquid paraffin side effect - 2

A

anal seepage

granulomatosis of GI - which is necrotizing vasculitis

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22
Q

irritant/ stimulant laxatives mechanism of action

A

inc peristalsis, inc intestinal motility by stimulating enteric system nerves

irritate GI mucosa and pulls water into lumen

indicated for severe constipation where more rapid effect is required (6-8 hrs)

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23
Q

irritant/ stimulant laxatives/ cathartics examples - 4

A

castor oil

bisacodyl

lubiprostone

anthraquinones

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24
Q

lubiprostone

A

PGE1 derivative that srimulates chloride channels, producing chloride like secretions, helps fecal matter being propelled

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25
Q

anthraquinones examples - 3

A

plant derivatives senna
co-danthramer
co-danthrusate

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26
Q

co-danthramer
co-danthrusate

A

genotoxic in long term so only given as last resort in terminally ill patients

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27
Q

laxative abuse

A

most common cause of constipation

after laxative use, longer interval needed to refill colon post faeces expel, is misinterpreted as constiptation

enteral loss of water and salts causes release of aldosterone

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28
Q

laxative abuse - release of aldosterone effects

A

stimulates reabsorption in intestine, but inc renal excretion of K+ ions

double loss of K+ ions causes hypokalemia, which thus reduces peristalsis

constipation cycle continues

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29
Q

diarrhoea cause - 4

A

toxins

microorganisms

psychological factors like anxiety

antibiotic associated colitis

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30
Q

microorganisms that can cause diarrhoea - 5

A

salmonella

e.coli - common in travellers as good at surviving in stomach acid

campylobacter

clostridium difficile

algae

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31
Q

____ children die each year due to acute diarrhoea

A

1-2 million

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32
Q

approaches for treating severe acute diarrhoea - 3

A

maintain fluid/ electrolyte balance

use anti infective agents

use spasmolytic or other anti diarrhoeal agents

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33
Q

anti-diarrheal agents are

A

anti motility/ spasmolytic agents

aka reduce peristalsis by stimulating opioid receptors in bowel

allow time for more water to be absorbed by gut

firms stool consistency

34
Q

anti-diarrheal agent first line treatment

A

loperamide hydrochloride or imodium

35
Q

loperamide hydrochloride/ imodium mechanism of action

A

ant-diarrheal agent first line treatement

poor cns penetration

inc transit time and sphincter tone

antisecretory against cholera toxin and some e. coli toxin

36
Q

loperamide hydrochloride/ imodium side efefcts

A

overdose, can cause paralytic ileus (muscles of the intestines are temporarily paralyzed, preventing food from passing through) or CNS depression

37
Q

loperamide hydrochloride/ imodium admin

and halflife

A

4mg daily followed by 2 mg doses

T1/2 11 hrs

38
Q

other anti diarrheal agents that are less used than loperamide hydrochloride- 4

A

morphine ( 50 x less potent than first line treatment)

codeine

dipheoxylate (also an opioid)

racecadotril (adjunct to rehydration for uncomplicated acute diarrhoea)

39
Q

clostridium difficile infection

A

gram positive

colonises GI tract

major cause of diarrhoea and colitis in patients exposed to antibiotics

40
Q

clostridium difficile infection symptoms - 4

A

alteration of normal fecal flora

colonic colonization of C. difficile

growth and production of toxins e.g. toxin a and toxin b, damage lining of colon

infection can lead to formation of colitis and toxic megacolon

41
Q

clostridium difficile infection pharmacological treatment - 4

A

discontinue offending antibiotic

for c. difficile:
metronidazole (contraindicated in patients
with liver or renal impairment)

vancomycin (contraindicated in patients with liver or renal impairment)

bezlotoxumab

42
Q

antiflatulants

A

relive painful gas symptoms/ flatulence

43
Q

antiflatulant example

A

simethicone is a detergent contain gel

alters elasticity of mucous coated bubbles, causing them to break in large intestine

smaller bubbles = less pain

44
Q

simethicone admin

A

can be used in babies - no known side effects

oral admin

45
Q

there are two types of chronic bowel disease. what are they

A

irritable bowel disease ibs

inflammatory bowel disease ibd

46
Q

irritable bowel syndrome symptoms - 5

A

nausea

diarrhoea/ constipation

bloating

flatulence

abdominal pain/ discomfort

47
Q

irritable bowel syndrome - general info and prevalence

A

functional GI disorder

over >10% prevalence, common

oversensitivity of bowel

aetiology uncertain but brain-gut link

more common in women than men so potentially hormone linked but not menstrual linked so more research needed

can present different symptoms

48
Q

ibs treatments - 4

A

peppermint oil supplement

antispasmodic drugs

fibre in diet/ supplements

antidepressants

49
Q

peppermint oil supplement example in ibs

A

supplements containing L-menthol

relaxes GI smooth muscle by reducing calcium influx

50
Q

antispasmodic drugs example treating ibs

A

135 mg Mebeverine

51
Q

antidepressants example treating ibs - 2

A

TCAs

SSRIs

(but at lower doses than used for depression)

52
Q

inflammatory bowel disease

A

severe, progressive autoimmune inflammatory disorders

long term

can be associated with smoking but not always

usually people diagnosed before age
40

relatively rare

53
Q

what are the two types of ibd

A

ulcerative colitis

chron’s disease

54
Q

ulcerative colitis

A

diffuse mucosal inflammation that is limited to the colon

bloody diarrhea, colicky pain, urgency to peepee

55
Q

chron’s disease

A

inflammatory disease

can affect any part of GI tract

patchy transmural inflammation

abdominal pain diarrhea, weight loss, intestinal obstruction

56
Q

drugs treating ibd - 4

A

(just symptom management):
glucocorticoids to prolong remission and reduce inflammation

5-aminosalicytlates (5-ASAa)

immunosuppresant meds

(actually may treat):
biologics/ monoclonal antibodies

57
Q

non pharma treatments of IBD - 2

A

surgery to remove parts of bowel

fecal transplants to inc microbiota diversity- used following c. difficile infection

58
Q

bezlotoxumab

A

human monoclonal antitoxin antibody

binds to c. difficile toxin b and neutralises its activity

prevents recurrance, passive immunity

59
Q

examples of glucocorticoids for ibd treatment - 2

A

prednisolone

budenoside

60
Q

examples of aminosalicylates for ibd treatment - 2

A

sulfasalazine

mesalazine

61
Q

examples of immunosuppressants for ibd treatment

A

azathrioprine

62
Q

examples of monoclonal antibodies for ibd treatment - 2

A

infliximab

adalimumab

63
Q

prednisolone

budenoside

A

glucocorticoids

reduce inflammation

short term

ibd treatment

64
Q

sulfasalazine

mesalazine

A

aminosalicylates

inhibits prostaglandin production

ibd treatment

65
Q

azathrioprine

A

immunosuppressant

for severe cases

ibd treatment

66
Q

infliximab

adalimumab

A

monoclonal antibodies

expensive but good

against TNF-alpha

ibd treatment

67
Q

what drug can contribute to constipation

A

morphine can contribute to constipation

68
Q

how do faecal softeners/ emollients work

A

faecal softeners lubricate stool

dec surface tension in intestine, allowing intestinal fluid to penetrate matter

usually oil based

69
Q

how do bulk laxatives work

A

inc in bowel content/ stool bulk volume triggers stretch receptors in intestinal wall, causing peristalsis to propel bowel content forward

fibre acts as bulking

70
Q

how do stimulant laxatives work

A

inc peristalsis

71
Q

laxatives

A

inc bowel content movement through intestine

72
Q

when should loperamide hydrochloride not be amdinistered

A

severe abdominal pain/ inflammatory bowel condition

73
Q

what is ulcerative colitis

A

long-term condition where the colon and rectum (large intestine or large bowel) become inflamed.

74
Q

what is toxic megacolon

A

rare but life-threatening condition that occurs when the colon becomes inflamed and swollen, often due to a severe infection or colon disease

75
Q

dietary modification can be used to initially treat constipation. example of this?

A

fiber supplement - psyllium husk inc stool bulk, stimulates peristalsis

76
Q

flatulence meaning

A

the passing of gas from the intestines through the anus

77
Q

tricycline antidepressant for treating ibs example

A

amitriptyline - can modulate pain perception so helps

78
Q

shit we gaf - 5

A

constipation

diarrhoea

chronic bowel disorder - ibs or ibd

c. difficile infection

flatulence - gas hurty

79
Q

types of drugs we gaf - 10

A

purgatives - cons

agents that inc motility of GI smooth muscle - cons e.g. laxatives (bulking agents, osmotic, stimulant, faecal softeners)

emollients/ faecal softeners - cons

antidiarrhoel drugs (dec motility) - dia

antispasmodic drugs (dec smooth muscle tone) - dia

c. difficile infection antiinfections- dia

antiflatulance

ibs treatment - peppermint oil supplement, antispasmodic drugs fibre in diet/ supplements

ibd - immunosuppresant meds (just symptom management), (actually may treat):
biologics/ monoclonal antibodies

80
Q

examples of gaf drugs - 18

A

bulking agents - agar, bran, ispaghula husk

osmotic - milk of magnesium, lactulose, epsom salt

stimulant laxative - lubiprostone

anti diarrhoeal - loperamide hydrochloride or imodium

discontinue offending antibiotic

for c. difficile: metronidazole, vancomycin

–
antiflatulence - simethicone
–
ibs - antispasmodic Mebeverine, antidepressy ssri
–
ibd immunosuppressant - Methotrexate, glucocorticoids like budenoside
ibd monoclonal antibody - bezlotoxumab

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