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TREATMENTS > GI DRUGS > Flashcards

GI DRUGS Flashcards

1
Q

mechanism of PPI

A

decrease HCl secretion and decrease pepsin

irreversibly inhibit parietal cells H/K ATPase in apical/canilicular membrane

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2
Q

adverse effects of PPI

A 
increased risk bony fracture in elderly
abdo pain/nausea
increased risk of C.diff
interacts with P450 potentiates warfarin 
decreases cloidogrel 
stop before endoscopy as can mask cancer
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3
Q

how to they reach stomach

A

prodrug absorbed in small intestine and delivered to stomach in active form

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4
Q

use of PPI

A

H.pylori eradication
prevent/treat Peptic ulcers
Dyspepsia + GORD symptom relief
Zollinger Ellison syndrome

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5
Q

Antimotility drugs

A

loperamide and codeine phosphate (opioid agonists for receptors in CNS)

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6
Q

what conditions are anti-motility drugs used

A

IBS

gastritis

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7
Q

adverse effects of anti-motilities

A

constipation, flatulence and abdominal cramping

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8
Q

contraindications of loperamide

A

no children less than 4
c.diff
acute UC (Risk of toxicmegacolon)
acute bloody diarrhoea eg. dysentry

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9
Q

action of H2RAs

A

block histamine from ECL so decrease cAMP and PKA

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10
Q

use of H2RAs

A

GORD symptom relief and dyspepsia

PUD (PPI preferred)

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11
Q

when may H2RAs be used over PPI

A

pre op as they work faster

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12
Q

side effect of cimetidine

A

gynaecomastia and potentiate warfarin

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13
Q

what are alginates eg Gaviscon/peptac/mucogel (AlOH/MgOH)

A

increased pH of gastric juice and inactive pepsin

buffers (alginates increase gastric juice viscosity)

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14
Q

what is Gavisocon used to treat

A

dyspepsia and GORD

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15
Q

role of antimuscarinics eg. Hyoscine butyl bromide

A

blocks M3 Ach receptors: decreased muscle spasms, decreased peristalsis, decreased secretions

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16
Q

when is hyoscine butyl bromide given

A

IBS

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17
Q

Side effect of hyoscine butyl bromide

A

blurred vision, consitpation, dry mouth, tachycardia, urine retention

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18
Q

caution antimuscarinics in?

A

cardiac arrhythmias, angle closure glaucoma

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19
Q

3 types of laxative

A

stimulant, bulk, osmotic

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20
Q

action of bulk laxatives eg. ispagula husk

A

hydrophilic indigestible in small intestine, attract water into stool increased bulk = increased peristalsis, improved consistency

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21
Q

use of bulk laxatives

A

mild/chronic diarrhoea eg IBS, diverticular disease

constipation + faecal impaction

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22
Q

when should bulk laxatives be avoided

A

intestinal obstruction and ileum (use Senna instead) do not use after surgery

23
Q

side effects of bulk laxatives

A

abdo pain and distention, ensure good hydration

24
Q

when are osmotic laxatives: citrate and phosphate enemas used

A

for rapid bowel evacuation

25
Q

action of osmotic laxative lactose

A

by osmosis water attracted to stool and increase peristalsis

26
Q

when is osmotic laxatives used

A

hepatic encephalopathy
bowel surgery prep/before endoscopy
consitpation + faecal impaction (use stimulant laxatives first)

27
Q

when should osmotic laxatives not be used

A

intestinal obstruction

28
Q

when should phosphate enemas be cautioned

A

HF and ascites as can cause fluid shift

29
Q

When are stimulant laxatives used eg. Senna, biscocdyl, glycerol suppository

A

constipation
use suppository for faecal impaction
avoid in intestinal obstruction can perforate
avoid rectal preps in anal fissures and haemorrhoids
offered to people taking opioid analgesia

30
Q

side effects of Senna

A 
reverse melanosis coli 
irreversible atonic colon
diarrhoea
 cramping 
abdo pain
31
Q

Aminosalcylates (5-ASA) eg. mesalazine action

A

anti-inflammatory and immune suppression

active in disral colon

32
Q

when is mesalazine used

A

1st line UC

33
Q

side effect of mesalazine

A

GI upset + headache

34
Q

what is enema mesalazine> suppository advantage

A

extends to sigmoid colon

35
Q

when is suppository > mesalazine advantage

A

better musosal headache

36
Q

when is D2 Dopamine receptor antagonise eg. metoclopramide/doperidone used

A

GORD if not PPI response
Vomitting due to emergency hormone contraception
N+V

37
Q

when is doperidone used

A

drug/chemo induced N+V (CINV)

38
Q

what does D2D receptor antagonists act on

A

CTZ (chemoreceptor trigger zone)

detects emetrogic substances in blood eg. chemo

39
Q

action of doperidone

A

antagonist activity 5HT3
agonist activity at 5HT4
doesn’t cross BBB

40
Q

side effects of D2 receptor antagonists

A

metrclopramide: avoid in children, extrapyramidal effects: spastic tortacolis, motor restlessness, uculogynic crises

41
Q

H1 RA eg. cyclizine action

A

competitive inhibitor of H1 receptors in VC can cause sedation
block M1 Ach vestibular apparatus

42
Q

when is cyclizine used

A

motion sickness
vertigo
post op sickness PONV

43
Q

2 anti motion sickness drugs

A

cyclizine, hyoscine hydrobromide

44
Q

when should cyclizine be avoided

A

risk of hepatic encephalopathy and prostatic hyperplasia

avoid in driving, heavy machinery as can cause sedation

45
Q

adverse effects of cyclizine

A

sedation
transient tachycardia
dry mouth
drowziness

46
Q

action of phenothiazines eg. procloperazine

A

competitive antagonist of D2, H1 and M1 in VC, vestibular system and peripherally in gut

47
Q

use of procloperazine

A

vertigo N+V
chemo induced (use doperidone first)
psychiatric disorders

48
Q

avoid procloperazine in

A

liver disease and prosthetic hyperplasia

49
Q

adverse effects of procloperazine

A

drowsiness, postural hypotension, D2 block, parkonism, long QT

50
Q

action of 5HT3 eg. ondansetran

A

competitive antagonist of 5HT3 (inotropic) receptors
act on CTZ, NTS and visceral afferens
5HT released from enterochaffin cells in gut stimulate vagal afferent that via NTS activate CTZ

51
Q

use of 5HT3 receptor antagonists

A

chemo and radon N+V
post op N+V
IBS

52
Q

adverse effects of 5HT3 receptor antagonists

A

long QT
constipation
diarrhoea
bleeding

53
Q

contraindications of 5HT3 RA

A 
stricture
toxic megacolon 
ischaemic colitis 
intestinal obstruction 
crohns 
diverticulits 
UC
intestinal obstruction 
sever prolonged consipation

TREATMENTS (2 decks)

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