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3rd Year Drugs > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

Name PPIs

A

Omepraziole
Lansoprazole
Pantoprazole

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2
Q

Indications of PPIs

A

1) Duodenal and gastric ulcers
2) Eradicating H. Pylori - in combination with antibitoics
3) Zollinger-Ellison Syndrome
4) GORD
5) Stircturing and erosive oesophagitis

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3
Q

What is Zollinger-Ellison syndrome?

A

A rare condition in which one or more tumours forms in the pancreas or the duodenum

These tumours secrete lots of gastrin - a hormone that causes your stomach to produce too much acid

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4
Q

Side effects of PPIs

A

Headache, diarrhoea, abdo pain (most common)

Nausea, flatulence, dry mouth (less common)

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5
Q

Managing the adverse effects of PPIs

A

Side effecst usually mild
Analgesia for headache
Report excessive diarrhoea

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6
Q

Action of PPIs

A

Inhibit gastric acid by blocking H+/K+ enzyme of the gastric parietal cell

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7
Q

Contraindications of PPIs

A

Hypersensitivity
Pregnancy and lactation
Caution in older adults and patients with liver disease

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8
Q

Interactions of PPIs

A

1) Omeprazole inhibits cytochrome P450
2) Lansoprazole is a weak inducer of cytochrome P450

Omeprazole and clarithromycin –> increased serum concentration of both drugs

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9
Q

Name some antacids

A

Gaviscon

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10
Q

Indications of antacids

A 
1) Hyperaciditiy problems e.g.
Heartburn
GORD
Sour Stomach
Peptic Ulcers
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11
Q

What are the 4 types of antacids

A

1) Aluminium
2) Calcium
3) Magnesium
4) Sodium Carbonate

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12
Q

What is the additional use of aluminium antacids

A

It treats hyperphosphataemia

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13
Q

Adverse effects of each type of antacids

A

Aluminium - constipation, intestinal impaction

Calcium - rebound hyperacidity

Magneisum - severe diarrhoea

Sodium Carbonate - Systemic Alkalosis

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14
Q

Contraindication of antacids

A

Severe abdominal pain with no known cause
During lactation

Na: Patients with CV problems e.g. hypertesnion
Ca: Patients with renal calculi or hypercalcaemia
Al: Gastric outlet obstructions
Mg + Al: Decreased kidney function

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15
Q

Side effecst of antacids

A

Magnesium and Sodium = diarrhoea

Aluminium and calcium = constipation

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16
Q

Interactions of antacids

A

1) They increase gastric pH - hence reduce the absorption of weakly acidic drugs
2) Absorbs/binds to drug surface - decrases the absorption of tetracycline
3) Increases urinary pH changing the rate of drug elimination
4) Decreases pharmacological effect of: corticosteroids, Iron, digoxin, chlorpromazine, ranitidine, tetracyclines, isonizaid

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17
Q

Name H2 antagonists

A

Ranitidine/Zantac
Cimetidine/Tagamet
Nizatadine + Famotidine/ Pepcid

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18
Q

Indications of H2 antagonists

A

Gastric + duodenal ulcers
Gastric hypersecretion + GORD
Prevent stress related ulcers

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19
Q

Adverse reactions of H2 antagonists

A 
Dizziness
Somnolence
Headache
Confusions
Hallucinations
Diarrhoea
Impotence
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20
Q

Managing adverse reactions of H2 antagonists

A

Most are mild and transient
May requied help with walking/self care
Skin rash, fever, bleeding, hallucinations should be reported immediately

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21
Q

Actions of H2 antagonists

A

Inhibit histamine action at stomach
Reduces gastric acid secretion
Reduces total pepsion
Decreased acid allows gastric ulcers to heal

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22
Q

Contraindications of H2 antagonists

A

Hypersensitivity
Renal/hepatic impairment
Caution in older people due to causing confusion
Caution in pregnancy and lactation

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23
Q

Interactions

A

1) Antacids + metoclopramide decreases if concurrent
2) Cimetidine + digoxin: causes low digoxin levels
3) Alkylating drug or antimetabolite - causes low WBC
4) Cimetidine + morphine: Increased risk of respiratory depression
5) Increased toxicity of oral anticoagulants, phenytoin, lidocaine, quindine, theophylline

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24
Q

Name amino-salicylates

A

Mesalazine/Asacol
Sulfasalazine

Anti-inflammatories

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25
Indications of amino-salicylates
1) Mild/moderate UC - helps prevent further episodes | 2) Maintenance of remission of Crohn's ileocolitis
26
Contraindications
``` Allergy Decreased kidney function Decreased liver function Blood clotting abnormalities Chilren under 12 Avoid sulfasalazine in G6PD deficiency + men who want to stay fertile ```
27
Side effects
``` Nausea Abdo Pain Vomiting Diarrhoea Dizziness Flatulence Headache Rashes (including toxic dermal necrolysis) ```
28
Action of amino-salicylates
Readily absorbed from the small intestine - attached to a resin to ensure release in the large bowel Act on cells lining the small and large intestine - changes the way they release chemicals (stops UC) Mesalazine blocks COX + inhibits prostaglandin production in action - allowed damaged intesting to occur
29
Interatcions of aminosalicylates
1) Indigestion remedies - can affectt ablet coating preventing mesalazine elease 2) Lactulase medication altering stool pH - prevent mesalazine wokring 3) Risk when used with azathioprine/mercaptopurine --> increased risk of side effects on blood cells
30
eliminations of aminosalicylates
Faeces
31
Name some laxatives
Senokot | Movicol
32
What are the 4 different types of laxatives
1) Bulking agents 2) Stool softeners 3) Osmotic laxatives 4) Stimulant laxatives
33
How do bulking agent laxatives work
Absorb mor fluid Bigger stools Gives you the urge to pass stool Works in 12-24 hours
34
How do stool softener laxatives work
Soften the stool Easier to pass Only work if you drink enough water WOrk in 24-48 hours
35
How do osmotic laxatives work
These are things such as milk/lactulose Holds fluid in the intestine Draws fluid into the intesting form the tissues Makes the stool softer and easier to pass Works in up to 2 days
36
How do stimulant laxatives work
E.g. Dulcolax and Senokot SPeeds up stool through the intestine by stimulation the nerve Regular use not recommended as this changes the tone and feeling in the large intesting and can leed to dependences They work in 8-12 hours
37
What type of laxative is movicol
An osmotic laxative
38
Contraindication of laxatives
Bowel obstructoin | Crohns/UC
39
Side effects of laxatives
1) Osteopenia - regular use changes ability to absorb vitamin D/calcium 2) Bulk forming lacatives --> can make symtpoms worse is you have severe constipation = abdo bloating and discomfort without clearing faeces that are further downt he gut
40
Interactiosn of laxatives
Antacids containing Aluminum or magnesium
41
What order should you prescribe laxatives
Bulk 1st line --> then osmotic --> then stimulant Take any laxative with lots of water
42
How should patient take amino-salicylates
Take tablets whole with lots of water
43
Name some anti-diarrhoeal agents
Loperamide (immodium) Atropine (Motofen) Diphenoxylate with atropine (Lomotol)
44
Indications
Treats diarrhoea
45
Adverse reactions of anti-diarrhoead agents
``` Unusual for loperamide but include: Dry mouth skin rash Dizziness Abdominal Discomfort ```
46
Advesre reactins of diphenoxylate (Lomotil) anti-diarrhoea agent
It is a narcotic rlaeted drug It has sedative and euphoric effects It is commbined with atropine to discourge its abuse
47
What is atropine
Atropine is an anti-cholinergic drug | The side effects of this mean its combined with diphenoxylate
48
Managing the adverse reaction of anti-diarrhoeal agents
Monitor fluid intake/outtake Replace electrolytes in severe diarrhoea Mild soap for perianal irritaiton
49
What are the actions of anti-diarrhoeal agents
They decrease intestinal persitalsis Potentially antagoniszing ACh release in the intramural nuerve plexus They are poorly absorbed and act directly on the bowel
50
Contraindications of anti-diarrhoeal agents
Diarrhoea associated with organisms that can harm the intestinal mucosa (e.g. E. Coli, Shigella, Salmonella) Pseudomembranous Colitis Under 2 years age
51
Caution in using anti-diarrhoeal agents
Pregnancy + lactation IBD Severe liver disease
52
Interactinos of anti-diarrhoeal agents
Additive CNS depression with alcohol Additive cholinergic effects when other drugs have antihcholinergic properties (e.g. antihistamine/depressants) With monoamine oxidase inhibitors - increased hypertesive crisis
53
Is vomiting a somatic or autonomic response
It is somatic Dopamine excites the CTZ - the CTZ activates the vomiting centre causing = emesis ONLY USE ANTIEMETICS WHEN THE CAUSE OF COMITING IS KNOWN
54
Several types of anti-emetics
1) Antichonlinergics 2) Antihistamines 3) Dopamine antagonists 4) Phenothiazine 5) Neuroinine antagonists 6) Cannabinoids 7) 5-hydroxytryptamine receptor antagonists
55
What is hyoscine
an anticholinergic anti-emetic
56
What is promethiazine
an antihistamine anti-emetic
57
What is metoclopramine
a dopamine agonist anti-emetic
58
what is prochlorperazine
a phenzothiazine anti-emetic
59
What is aprepitant
A neurokinen antagonist anti-emetic
60
What is nabilone
A cannabinoid anti-emetic
61
What is ondansetron
What is 5-hydroxytryptamine receptor antagonist anti-emetic
62
Indications fo anti-muscarininc anti-emetics e.g. hyoscine
1) Motion sickness - useful in single doses. Its side ffects make it inappropriate for long term use it is also an alternative to anti-histaimnes and phenothiazines for the treatment of vertigo and nausea associated with Meniere's disease
63
Side effcts of anti0muscaring anti-emetic e.g. hyoscine
Drowsiness Dry mouth Blurred vision Urinary retention
64
Indications of dopamine antagonists anti-emetic e.g. metaclopramide
Post-op nausea Radiationi sickness Allows diagnostic radiology of small intestine
65
Adverse effects of dopamine antagonist anti-emetics e.g. metaclopramide
Usually mild - but more common in women and young people ``` Extra-pyramidal effects (1%) Akathisia - movement disorder Oculogenic crises Torticolis - a crick in the neck Opisthontons - spasm of muscles Parkinsonian features ``` Treat with benzothriopine or diazepam
66
Action of dopamine antagonist anti-emetics
They increase ACh at post-ganglionic terminals Central dopamine antagonist Incrased doses block 5-HT3 receptor (serotonin receptors)
67
Pharacokinetcs of dopamine antagonists anti-emetics
Well absorbed orally 75% excreted as metablites in urine Half life is 4 hours
68
Drug interactions of dopamine antagonists anti-emetics
Metacloprimade potentiates extra-pyramidal effects of phenzothiazines butryruptenes Increase absorption of tetracyclines, aspirin, paracetamol
69
How does domperidone a dopamine receptors agaonists differ from metocloparmide
It doesn't cross the BBB Seldom causes extra-pyramidal effects It can be given with levodopa to counter their emetogenic effect
70
How do phenothiazine anti-emetics work
Act on thte CTZ useful against radiaiton-induced vomiting Least effective against motion sickness Risk of extra-pyramidal effects e.g. dyskinesia and restlessness
71
How do 5HT3 receptor antagonist anti-emetics work e.g. ondansetron
Treat acute nausea due to chemo or post op | Their site of action is unclear
72
How do cannabinoid anti-emetics e.g. nabilone work
Prevent vomiting due to cytotxic therapy Acts on cortical centrea affecting descending vomiting pathways
73
Adverse effects of anti-emetics
``` Sedation Confusion Hypotension Loss of coordination Dry mouth ```
74
Indiciations of anti-histaminic anti-emetics
Motion sickness Vertigo due to labyrinthe disroders They also have additional anticholinergic effects
75
Limitations of anti-histaminic anti-emetics
modest efficicay and common dose related side effects | Antimuscarainic effects may be caused
76
When to use cyclisine
oral or injection for opiate-induced vomiting | Safe in prgancny
77
Which antihistamine anti-emetic is more sedative
Promethazine
78
What antihistamine anti-emetic should we use in vertigo
Betahistine Also treates Meniere's and hearing loss
79
what is Clinnazine
An Antihistamine and calcium antagonist anti-emetic acts on the labyrinthe to treat motion sickness and vertigo
80
Name some miscellaneous anti-emetics
1) Glucocorticosteroids --> anti-emetic when with cytotoxic therapy as dexamethasone improves 5HT3 antagonists 2) Benzodiazpines --> give before cytotoxic treatment to reduce vomiting

3rd Year Drugs (10 decks)

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