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Drugs (from scott's notes) > GI drugs > Flashcards

GI drugs Flashcards

1
Q

Name two antacids? SEs? Interactions?

A

Mg trisilicate - diarrhoea
Al hydroxide - constipation

Can both interfere with drug absorption so take separately

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2
Q

Name 3 PPIs? MOA? SEs? Interaction? Caution?

A

Omeprazole
Lansoprazole
Pantoprazole

Activated in acidic pH
Irreversibly inhibit H+/K+ ATPase
More effective cf. H2RAs

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of Clostridium difficile infections

PPIs are P450 inhibitors

Caution: May mask symptoms of gastric Ca.

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3
Q

Name 2 H2 receptor antagonists? MOA? SEs? Interactions? Caution?

A

Cimetidine

reduces gastric parietal cell H+ secretion

GI disturbance

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4
Q

Misoprotol MOA? SE? Uses?

A

prostaglandin analogue, acts on parietal cells to reduce H+ secretion

diarrhoea v common

Mainly used to prevent NSAID-assoc.
Peptic ulcer disease
Often in combination c¯ NSAID

Diclofenac + misoprostol = Arthrotec: helps to relieve the pain and swelling of rheumatoid arthritis and osteoarthritis, and may help to protect patients at risk of irritation or ulceration of the stomach or intestines

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5
Q

Name 4 types of laxative? examples of each? MOAs? CI of laxative use?

A

Bulk-laxatives - Bran ispaghula - ↑ faecal mass → ↑ peristalsis
Stimulant laxatives:
Docusate, Glycerin (PR), Senna, Picosulfate - increased intestinal motility
Osmotic laxatives: Lactulose, Macrogol, Phosphates (PR), Mg Salts - ↑ stool water content
Stool softener: Liquid paraffin

bowel obstruction

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6
Q

Co-danthrusate use?

A

mild stimulant laxative used in Rx of opioid-induced constipation.

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7
Q

Hepatic encephalopathy Tx?

A

Lactulose

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8
Q

Liquid paraffin use? SE?

A

Stool softener

↓ absorption of ADEK vitamins
Granulomatous reactions

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9
Q

Hyoscine butylbromide MOA? SE? CIs?

A

Antimuscarinic - Antispasmodic

SEs: anti-cholinergic effects

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10
Q

Mebeverine peppermint oil MOA?

A

Antispasmodic

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11
Q

Loperamide MOA? SEs? CIs?

A

Opioid receptor agonist - Doesn’t cross BBB so no central effects.
Anti-diarrhoea (used in IBS)

Abdo cramps

CIs: Infective diarrhoea, Colitis, Caution in hepatic
impairment

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12
Q

Name two anti-diarhoea tablets?

A

loperamide

diphenoxylate

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13
Q

Name two 5-aminosalicylates? SEs? CI? Monitoring?

A

Sulfasalazine
Mesalazine

SEs: oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, blood dyscrasias: Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

CI: Caution in
G6PD deficiency and
allergy to aspirin or sulphonamides (cross-sensitivity)

Monitor FBC

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14
Q

Budesonide MOA? Use?

A

steroid - more potent than prednisolone

High 1st pass metabolism so ↓
systemic effects.

Used to induce remission in
ileal Crohn’s

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15
Q

Name three anti-TNF drugs? SEs? Caution?

A

Infliximab
Etanercept
Adalimumab

Severe infections
TB
Allergic reactions
CCF
CNS demyelination

CI by TB - Screen for TB before use
give with hydrocortison to reduce allergic SEs

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16
Q

Conservative, medical and surgical Mx of GORD?

A 
Conservative: Lose wt.
 Raise head of bed
 Small regular meals ≥ 3h before bed
 Stop smoking and ↓ EtOH
 Avoid hot drinks and spicy food
 Avoid tight clothes
 Stop drugs: NSAIDs, steroids, CCBs, nitrates
Medical: 
OTC antacids: Gaviscon, Mg trisilicate
1st: full-dose PPI for 1-2mo
2nd: double dose PPI
3rd: add H2RA
Surgical: Nissen Fundoplication - 
Indications: all 3 of:
 Severe symptoms
 Refractory to medical therapy
 Confirmed reflux (pH monitoring)
17
Q

Indications of Nissen Fundoplication?

A

Indications: all 3 of:
 Severe symptoms
 Refractory to medical therapy
 Confirmed reflux (pH monitoring)

18
Q

Investigation for GORD?

A 
Indications for upper GI endoscopy:
age > 55 years
symptoms > 4 weeks or persistent symptoms despite treatment
dysphagia
relapsing symptoms
weight loss

If endoscopy is negative consider 24-hr oesophageal pH monitoring (the gold standard test for diagnosis)

19
Q

Causes of GORD? Complications? Symptoms?

A

Causes:
Lower oesophageal sphincter hypotension
hiatus hernia, oesophageal dysmotility (eg systemic sclerosis), obesity,
gastric acid hypersecretion, delayed gastric emptying, smoking, alcohol, pregnancy,
drugs (tricyclics, anti cholinergics, nitrates), Helicobacter pylori?

Complications: Oesophagitis, ulcers, benign stricture, iron-deficiency. Barretts oesophagus

Symptoms
Oesophageal: Heartburn (burning, retrosternal discomfort after meals,
lying, stooping, or straining, relieved by antacids)
belching
acid brash (acid or bile
regurgitation)
waterbrash (increased salivation: ‘My mouth fi lls with saliva’);
odynophagia
(painful swallowing, eg from oesophagitis or ulceration). Extra-oesophageal:Nocturnal asthma, chronic cough, laryngitis (hoarseness, throat clearing), sinusitis.

20
Q

Mx of Peptic ulcer disease?

A

Conservative: Lose wt.
 Stop smoking and ↓ EtOH
 Avoid hot drinks and spicy food
 Stop drugs: NSAIDs, steroids

Medical:
 OTC antacids: Gaviscon, Mg trisilicate
 H. pylori eradication: PAC500 or PMC250
 Full-dose acid suppression for 1-2mo
 PPIs: lansoprazole 30mg mane
 H2RAs: ranitidine 300mg nocte
 Low-dose acid suppression PRN

Surgical: Rarely performed
 Selective vagotomy
 Antrectomy + vagotomy
 Subtotal gastrectomy + Roux-en-Y

21
Q

H-Pylori Ix? Tx?

A

NB. PPIs and cimetidine → false –ve C13 breath tests
and antigen tests  stop >2wks before.

PAC 500:
 PPI: lansoprazole 30mg BD
 Amoxicillin 1g BD
 Clarithromycin 500mg BD

PMC 250:
 PPI: lansoprazole 30mg BD
 Metronidazole 400mg BD
 Clarithromycin 250mg BD

Failure
 95% success -Mostly due to poor compliance
 Add bismuth - Stools become tarry black

22
Q

Risk factors for peptic ulcer disease? differentiation?

A

Helicobacter pylori is associated with the majority of peptic ulcers:
95% of duodenal ulcers
75% of gastric ulcers

drugs: NSAIDs, SSRIs, corticosteroids, bisphosphonates

Zollinger-Ellison syndrome: rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour

Duodenal ulcer - more common than gastric ulcers - epigastric pain when hungry, relieved by eating
gastric ulcers: epigastric pain worsened by eating

23
Q

How to treat acute severe UC?

A

Resus: Admit, IV hydration, NBM
 Hydrocortisone: IV 100mg QDS + PR
 Transfuse if required
 Thromboprophylaxis: LMWH

Monitoring: Bloods: FBC, ESR, CRP, U+E
 Vitals + stool chart
 Twice daily examination
 ± AXR

Improvement → oral therapy: Switch to oral pred + 5-ASA
 Taper pred after full remission

No Improvement → rescue therapy - Medical: ciclosporin, infliximab or visilizumab or Surgical
Discussion between pt, physician and surgeon

24
Q

How to induce remission of UC in mild to moderate disease?

A

OPD treatment

Oral Tx:
1st line: 5-ASAs
2nd line: prednisolone
3rd line: ciclosporin or infliximab

Topical treatment: for left sided disease mainly
Proctitis: suppositories - More proximal disease: enemas or foams - 5-ASAs ± steroids (prednisolone or budesonide)

Additional Therapy: steroid sparing: Azathioprine or Infliximab: steroid-dependent pts

25
Q

How to maintain remission in UC?

A

1st line: 5-ASAs PO – sulfasalazine or mesalazine - Topical Rx may be used in proctitis

2nd line: azathioprine or 6-mercaptopurine Relapsed on ASA or are steroid-dependent
Use 6-mercaptopurine if azathioprine intolerant

 3rd line: infliximab / adalimumab

26
Q

Elective surgery for UC indications? procedures?

A

Indications
 Chronic symptoms despite medical therapy
 Carcinoma or high-grade dysplasia

Procedures
 Proctocolectomy c¯ end ileostomy or IPAA
 Total colectomy c¯ (IRA)

27
Q

Mx of Acute severe crohns?

A

Assessment
 ↑temp, ↑HR, ↑ESR, ↑CRP, ↑WCC, ↓albumin

Management
 Resus: Admit, NBM, IV hydration
 Hydrocortisone: IV + PR if rectal disease
 Abx: metronidazole PO or IV
 Thromboprophylaxis: LMWH
 Dietician Review: Elemental diet; Consider parenteral nutrition
 Monitoring: Vitals + stool chart, Daily examination

Improvement → oral therapy - Switch to oral pred (40mg/d)

No Improvement → rescue therapy
 Discussion between pt, physician and surgeon
 Medical: methotrexate ± infliximab
 Surgical

28
Q

How to induce remission in mild or moderate crohns disease?

A

OPD treatment
Supportive
 High fibre diet
 Vitamin supplements

Oral Therapy
 1st line:
Ileocaecal: budesonide; Colitis: sulfasalazine

 2nd line: prednisolone (tapering)

 3rd line: methotrexate

 4th line: infliximab or adalimumab

Perianal Disease
 Occurs in ~50%
 Ix: MRI + EUA
Rx: Oral Abx: metronidazole; 
 Immunosuppression ± infliximab
 Local surgery ± seton insertion
29
Q

How to maintain remission in Crohns?

A

1st line: azathioprine or mercaptopurine
 2nd line: methotrexate
 3rd line: Infliximab / adalimumab

30
Q

Elective surgery in crohns indications? Procedures?

A 
Indications
 Abscess or fistula
 Perianal disease
 Chronic ill health
 Carcinoma

Procedures
 Limited resection: e.g. ileocaecal
 Stricturoplasty
 Defunction distal disease ¯c temporary loop ileostomy

31
Q

High-risk ABx for C.diff? general and specific Mx of C.diff diarrhoea?

A

High Risk Abx: Cephalosporins, Clindamycin

General: Stop causative Abx; Avoid antidiarrhoeals and opiates; Enteric precautions

1st line: Metronidazole

Metronidazole Failure: Vancomycin

Severe: Vancomycin (may add metro IV)

Urgent colectomy may be needed if: Toxic megacolon, ↑ LDH, Deteriorating condition

Recurrence (15-30%): Reinfection or residual spores - Repeat course of metro x 10-14d - Vanc if further relapse (25%)

Treatment Failure: Defined as no clinical response after 1wk - C. diff toxin assay will remain positive for ≥2wks
following original infection.

Drugs (from scott's notes) (5 decks)

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