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Question 1

Examples of aminosalicylates

Answer 1

Mesalazine

Sulfasalazine

Question 2

Mechanism of aminosalicylate action

Answer 2

Release 5-aminosalicylic acid (5-ASA) –> anti inflammatory and immunosuppressive effects on gut

Question 3

Aminosalicylate indications

Answer 3

Ulcerative colitis (1st line mesalazine) 
Rheumatoid arthritis (sulfasalazine)

Question 4

Contraindications aminosalicylate

Answer 4

Aspirin hypersensitivity

Question 5

Aminosalicylate side effects

Answer 5

GI upset
Headache
Blood disorder: leuocpenia, thrombocytopenia (report unexplained bleeding, bruising, infection)
Renal impairment 
Reversible oligospermia (sulfasalazine)

Question 6

Aminosalicylate interactions

Answer 6

PPIs increase gastric pH, lactulose lowers stool pH –> cab affect how quickly aminosalicylate is released

Question 7

Examples of antidiarrhoeals

Answer 7

Loperamide

Codeine

Question 8

Mechanism of loperamide

Answer 8

Opioid - agonist of mu receptors in GIT –> decrease peristaltic contractions of smooth muscle –> slower transit and increased anal sphincter tone –> increased time for water absorption

Question 9

Loperamide contraindications

Answer 9

Acute IBD, c. Diff colitis –> risk toxic megacolon and perforation
Dysentery

Question 10

Side effects loperamide

Answer 10

Constipation, cramps

Question 11

Examples of laxatives (what are the 3 types)

Answer 11

Bulk forming: ispaghula husk
Osmotic: lactulose
Stimulant: senna

Question 12

Mechanism of bulk forming laxatives

Answer 12

Act as fibre supplement

contain hydrophilic substance such as polysaccharide or cellulose that’s not absorbed/digested –> attracts water into stool –> increases mass –> stimulates peristalsis

Question 13

Mechanism of osmotic laxatives

Answer 13

Lactulose based on sugar/alcohol –> not absorbed/digested –> hold water in stool –> peristalsis

Also reduce ammonia absorption

Question 14

Mechanism of stimulant laxatives

Answer 14

Send increases water/electrolyte secretion from colonic mucosa –> increased volume –> peristalsis

Question 15

Indications of laxatives

Answer 15

Constipation

May be prescribed with opioids to prevent constipation

Question 16

Contraindications of laxatives

Answer 16

Intestinal obstruction (perforation risk)

Avoid bulk forming in ileus and faecal impaction
Avoid osmotic phosphate enemas in HF, ascites and electrolyte disturbance
Avoid stimulant rectal administration in haemorrhoids and anal fissures

Question 17

Laxative side effects

Answer 17

Diarrhoea

Distention, abdo discomfort/cramps, flatulence, nausea (should settle)

Bulk: rarely faecal impaction, intestinal obstruction
Phosphate enema: irritation, electrolyte disturbance

Question 18

Name an antiemetic

Answer 18

Metoclopramide

Question 19

How do metoclopramide work

Answer 19

D2 (dopamine) receptor antagonist - receptors in chemical trigger zone (area responsible for sensing emetogenic substances in blood) –> info sent to vomiting centre in medulla

Metoclopramide has a pro kinetic effect stimulating gastric emptying which has an antiemetic effect

Question 20

Indications for metoclopramide

Answer 20

N&v

Question 21

Contraindications metoclopramide

Answer 21

Children/young adults - extrapyramidal SE more likely

Gi obstruction/perforation

Question 22

Side effects metoclopramide

Answer 22

Diarrhoea

Extrapyramidal syndromes: muscle spasm, abnormal movement

Question 23

Interactions metoclopramide

Answer 23

Dont use with PD drugs (antagonises effects)

Antipsychotics increase risk of extrapyramidal SE

Question 24

Form of metoclopramide administration

Answer 24

Oral

IM/IV if vomiting