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Year 3 - Drug Profiles > GI > Flashcards

GI Flashcards

1
Q

What drug class is Gaviscon?

A

antacid and alginate

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2
Q

How do antacids work?

A

they buffer the stomach acid to raise the pH of the stomach contents

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3
Q

how do alginates work?

A

increase the viscosity of stomach contents and form a floating raft to form a barrier between the gastric contents and the GOJ

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4
Q

what are the indications to take Gaviscon (antacids/alginates)?

A
  1. GORD

2. dyspepsia

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5
Q

what are the contra-indications to taking Gaviscon (antacids/alginates)?

A

Frequent alcohol use, severe dehydration, renal impairment

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6
Q

what are the side effects to Gaviscon?

A

normally well tolerated

can cause: Nausea, constipation, diarrhoea (from magnesium), headache

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7
Q

what are possible interactions of alginates?

A

they bind to other drugs and can reduce absorption

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8
Q

what are the possible interactions of antacids?

A
  1. can reduce serum concentrations of other drugs e.g. ACEi, some abx, PPIs etc
  2. increase excretion of aspirin and lithium
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9
Q

What class of drug is Ranitidine?

A

H2 antagonist

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10
Q

How do H2 antagonists work?

A

Reduce gastric acid output by blocking histamine H2-receptors

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11
Q

what are the indications for taking Ranitidine?

A
  1. Peptic ulcer disease -gastric and duodenal ulcers (including NSAID related ulcers)
  2. GORD
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12
Q

what are the contra-indications for taking Ranitidine?

A

hepatic and renal impairment (metabolised by liver and excreted by kidneys)

can disguise symptoms of gastric cancer

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13
Q

what are the side-effects of Ranitidine?

A

Diarrhoea, headache, dizziness

rarely: hepatitis, cholestatic jaundice, bradycardia

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14
Q

what are the possible interactions of Ranitidine?

A

increases plasma conc and side effects of Loperamide

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15
Q

how quickly is Ranitidine eliminated from the body?

A

Half-life: 2.5 hours (oral with normal renal function)

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16
Q

Why take H2 antagonists over PPIs?

A

although H2 antagonists are just shit PPIs (less complete acid suppression) they have a quicker onset. this can be useful pre-operation especially.

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17
Q

What class of drug are Lansoprazole and Omeprazole?

A

PPIs

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18
Q

How do PPIs work?

A

they reduce gastric acid secretion by irreversibly inhibiting H+/K+ ATPase in gastric parietal cells. aka the proton pump bringing in H+

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19
Q

what are the indications to take PPIs?

A
  1. Peptic ulcer/NSAID ulcers
  2. dyspepsia/ GORD
  3. eradication of H. Pylori (in combo with abx)
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20
Q

what are the conta-indications to taking PPIs?

A

disguise symptoms of gastric cancer
increase risk of fracture (warning in osteoporosis)

(hepatic impairment, interstitial nephritis, C diff colitis)

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21
Q

what are the side effects to PPIs?

A

GI disturbance (nausea, vomiting, abdo pain, flatulence, diarrhoea, constipation), headache

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22
Q

what are the possible interactions with PPIs?

A

P450 enzyme inhibitor

reduce effect of clopidogrel
Diazepam, warfarin and phenytoin (prolongs elimination)
citalopram; atazanavir; dasatinib; tenofovir; methotrexate (increase blood levels and effects)

23
Q

How are PPIs eliminated?

A

Eliminated mainly in urine as broken down metabolites

24
Q

What class of drug is Loperamide?

A

Antimotility drug - anti-diarrhoeal agent

25
Q

How does Loperamide work?

A

agonist of opiod receptors in GI tract

  • decreases peristaltic movements
  • increases anal tone

allows more water to be absorbed from stool as longer in the bowel

26
Q

what are the indications to take Loperamide?

A

diarrhoea

27
Q

what are the contra-indications to taking Loperamide?

A

avoid in UC - greater chance of toxic megacolon
C. diff infection for same reason
acute bloody diarrhoea - can be caused by E. coli and taking Loperamide increases chance of developing HUS

28
Q

what are the side-effects of Loperamide?

A

Nausea, flatulence, headache, dizziness

29
Q

what are the possible interactions with Loperamide?

A

when taking other opioids there is risk of toxicity eg codeine phosphate

30
Q

what are the three types of laxative?

A

bulk forming eg methyl cellulose
osmotic eg lactulose
stimulant eg Senna

31
Q

how do stimulant laxatives work?

A

most common type

increase water and electrolyte secretion which increases colonic volume and increases peristalsis

32
Q

what are the indications to take laxatives?

A

general: constipation, faecal impaction
osmotic: hepatic encephalopathy (stops absorption of ammonia)

33
Q

what are the side effects of laxatives?

A

abdominal pain and cramping
diarrhoea
nausea
hypokalaemia

34
Q

what are the contra-indications to taking laxatives?

A

Intestinal obstruction (could induce perforation) and undiagnosed abdo pain

osmotic: can cause big fluid shifts. careful in Heart failure, ascites, electrolyte imbalance

35
Q

what are the interactions with laxatives?

A

Digoxin, diuretics, increase effect of warfarin

36
Q

what class of drug are Mesalazine (better one) and Sulfalazine?

A

aminosalicylates

37
Q

how do aminosalicylates work?

A

release 5-aminosalicylic acid - this has antiinflammatory and immunosuppressant actions topically on the gut

38
Q

what are the indications to take mesalazine?

A

mild UC

39
Q

what are the contraindications to take mesalazine?

A

aspirin hypersensitivity, hepatic impairment

40
Q

what are the side-effects of mesalazine?

A 
GI upset (Diarrhoea, nausea, vomiting, abdo pain)
rarely cause leucopenia and thrombocytopenia and renal impairment
41
Q

what are the possible interactions of mesalazine?

A

PPIs - may cause premature release of capsule content

42
Q

what class of drug are metaclopramide and domperidone?

A

antiemetic - Dopamine receptor antagonist

43
Q

how does metaclopramide (D2 receptor antagonist) work?

A

promotes relaxation of gut and stomach

Binds to dopamine receptors in CNS preventing nausea and vomiting triggered by most stimuli

44
Q

what are the indications to take metaclopramide?

A

nausea and vomiting (esp in context of reduced gut motility)

45
Q

what are the contra-indications of metaclopramide?

A

avoid in children and young adults (more common extrapyrimidal side effects)
GI obstruction/perforation

46
Q

what are the side-effects of metaclopramide?

A

diarrhoea, Extrapyramidal effects (drug induced movement disorders including acute and tardive symptoms) - domperidone does not cuase this - does not cross blood brain barrier

hyperprolactinaemia, galactorrhoea, gynecomastia, menstrual changes, dry mouth

47
Q

what are the possible interactions with metaclopromide?

A

antipsychotics - inc risk of extrapyramidal
antagonise effect of dopamine based parkinson drugs

paracetamol and aspirin (increase rate of absorption)

48
Q

what class of drug is cyclizine?

A

antiemetic - Histamine receptor antagonist

49
Q

what are the indications for taking cyclizine?

A

nausea and vomiting (esp with motion sickness and vertigo)

50
Q

how does cyclizine work?

A

Histamine is main receptor in vomiting centre of the brain along with Ach. Cyclizine blocks both

51
Q

what are the side effects of cyclizine?

A

drowsiness
dry mouth and throat
tachycardia + palpitation

52
Q

what are the contra-indications to taking cyclizine?

A

sedating effect - avoid in hepatic encephalopathy

prostatic hypertrophy - can cause urinary retention (anticholinergic side-effects)

53
Q

what are the interactions of cyclizine?

A

opioids/benzodiazepines - increased sedation

54
Q

when is ondansetron useful?

A

sickness in chemotherapy

Year 3 - Drug Profiles (9 decks)

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