GI

Question 1

Examples of antiemetics

Answer 1

Domperidone

Metoclopramide

Question 2

Mechanism of action of antiemetics

Answer 2

Blocks D2 Receptor = pro kinetic effect

Question 3

Indications for use of antiemetics

Answer 3

Prophylaxis of nausea and vomiting mainly due to reduced gastric motility

Question 4

Contraindications of antiemetics

Answer 4

Children and young adults as the side effects are more common. Try and avoid

Do not use in: GI obstruction or perforation

Question 5

Side effects of antiemetics

Answer 5

Domperiodone: Diarrhoea
Metoclopramide: Extrapyramidal symptoms (movement abnormalities)

Question 6

Mesalazine and sulfazaline are examples of what type of drug?

Answer 6

Aminosalicylates

Question 7

Active compound in aminosalicylates

Answer 7

5-ASA

Question 8

Indications for use of aminosalicylates

Answer 8

1. UC: mesalazine is 1st line treatment

2. RA: Sulfazaline as combo therapy

Question 9

Which aminosalicylate is a DMARD

Answer 9

Sulfazaline

Question 10

Side effects of aminosalicylates

Answer 10

GI disturbances
Headache
Blood disorders
Renal impairment 
Reduction in sperm production

Question 11

Contraindications in aminosalicylates

Answer 11

Aspirin sensitivity

Question 12

Interactions with mesalazine

Answer 12

Any drug which changes pH may uncoat the drug before it hits the target area

Question 13

What should patients be told to look out for when on an aminosalicylate

Answer 13

Changes indicative of blood disorders i.e. bruising, bleeding, skin changes

Question 14

Which antidiarrhoeal drug should be prescribed when no alagesia is required?

Answer 14

Loperamide

Question 15

Examples of antidiarrhoeal drugs other than loperamide

Answer 15

Codeine phosphate

Atropine

Question 16

Mechanism of action of loperamide

Answer 16

Acts on opioid receptors to increase non propulsive movement but reduce peristaltic movement

Results in slower transit of the bowel contents and more time for water to be absorbed. Also increases anal sphincter tone

Question 17

Indications for use of loperamide

Answer 17

Diarrhoea treatment when non pharmacological methods don’t work or in IBS

Question 18

Side effects of loperamide

Answer 18

GI disturbance related to the mechanism

Risk of opioid toxicity

Question 19

Contraindications of antidiarrhoeals

Answer 19

1. C. diff
2. Dysentery
3. UC

Question 20

Mechanism of action of PPIs

Answer 20

Inhibit the H+/K+ATPase pump in gastric cells

Question 21

Indictions for use of PPIs

Answer 21

1. Relief of dyspepsia
2. H. pylori eradication in combination with Abx
3. PUD
4. GORD

Question 22

Contraindications of use of PPIs

Answer 22

1. Check red flags for cancer before and during the treatment
2. Increase fracture risk

Question 23

Side effects of PPIs

Answer 23

1. GI Disturbance
2. Headache
3. Hypomagnesamia

Question 24

Which PPIs should be prescribed with clopidogrel

Answer 24

NOT Omeprazole

Question 25

Examples of antacids

Answer 25

KOH + MgCO3 Sodium alginate + KHCO3 CaCO3

Question 26

Mechanism of action of antacids

Answer 26

1. Antacid part of the nomination therapy buffers stomach acid 2. Alginate part increases viscosity of stomach acid and creates a barrier raft

Question 27

Indications for use of antacids

Answer 27

1. GORD to provide symptomatic relief | 2. Dyspepsia to provide temporary relief

Question 28

Contraindications of antacid use

Answer 28

Don't give to those taking thickened preparations as it can cause abdominal discomfort

Question 29

Interactions of antacids

Answer 29

Dication action can interfere with actions of: 1. Abx 2. Bisphosphonates 3. Levothyroxine 4. Digoxin 5. ACE inhibitors 5. PPIs Increase excretion of lithium and aspirin

Question 30

Side effects of Antacids

Answer 30

Little Mg salts can cause diarrhoea Al salts can cause constipation

Question 31

Examples of laxatives

Answer 31

Senna Glycerol Supp Docusate Sodium Mg/K/Na Sulphate

Question 32

Mechanism of action of laxatives

Answer 32

1.Promote H20 and electrolyte excretion from the colon which increases volume in the colon and stimulates peristaltic movement 2. Pro peristaltic movement by different mechanisms: - senna is digested and the products are pro kinetic - glycerol supps. have a local effect and soften stool - docusate does both

Question 33

Indications for use of laxatives

Answer 33

1. Constipation | 2. Faecal impaction

Question 34

CIs of laxatives

Answer 34

Do not use in patients with a bowel obstruction due to risk of perforation Avoid supps. in haemorrhoids/anal fissure

Question 35

Side effects of laxatives

Answer 35

1. Abdominal bloating and cramping 2. Diarrhoea 3. Prolonged use can lead to pigmentation of the bowel wall

Question 36

Examples of H2 Antagonists

Answer 36

Anything ending in -idine: - ranitidine - famotidine - nizatidine

Question 37

Mechanism of action of H2As

Answer 37

Block the H2 receptors on gastric cell K/H pumps which is controlled by histamine, and therefore inhibit gastric acid secretion

Question 38

Why are H2As second line treatment of PUD

Answer 38

They do not fully inhibit gastric acid secretion because other things can stimulate proton pumps

Question 39

Indications for use of H2As

Answer 39

1. PUD 2nd | 2. GORD and dyspepsia for relief of symptoms

Question 40

Cis of H2As

Answer 40

1. They can disguise symptoms of gastric cancer | 2. Reduce dose in renal impairment

Question 41

Side effects of H2As

Answer 41

Headache Dizziness Bowel disturbance