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Pharmacology > GI Management > Flashcards

GI Management Flashcards

1
Q

What is the first line treatment to GORD?

A

Proton pump inhibitor

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2
Q

What medication is added secondary to a lack of response to PPI?

A

H2 receptor antagonists

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3
Q

Name a PPI

A 
Omeprazole 
Esomeprazole 
Rabeprazole 
Pantoprazole 
Lansoprazole
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4
Q

What is the common therapy administered for eradication of H.pylori and its duration?

A

10-14 days

PPI +amoxicillin+clarithromycin/metronidazole

Or

PPI+bismuth+2xantibiotics (if previously taken macrolide/metronidazole)

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5
Q

What is given to patients with autoimmune chronic gastritis (pernicious anaemia)?

A

Cyanocobalamin treatment (B12)

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6
Q

Which prostaglandins are considered gastric prostaglandins?

A

PGE2 and PGI2

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7
Q

What is the role of prostaglandins in the GI system?

A
  • potent vasodilator
  • decrease acid secretion
  • stimulate mucus and bicarbonate secretion
  • reduce permeability of acid back flow
  • reduce inflammatory mediator release
  • promote ulcer healing
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8
Q

What is the mechanism of action of antacids?

A

Relieve dyspepsia as they neutralise HCl, reacting with the acid to form water and salt.

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9
Q

what are some of the common preparations of antacids?

A

Aluminium hydroxide
Magnesium hydroxide
Sodium bicarbonate
Calcium bicarbonate

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10
Q

What patient groups must avoid sodium bicarbonate ?

A

Hypertension

Fluid overload

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11
Q

What patients should avoid magnesium hydroxide?

A

Renal failure- causes increased magnesium

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12
Q

what adverse side effect can be caused by magnesium hydroxide?

A

Diarrhoea

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13
Q

What side effects may be experienced with aluminium hydroxide?

A

Constipation
Binding of phosphate resulting in lower levels- weakness and malaise
Neurotoxicity in presence of renal failure

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14
Q

What patient group should avoid taking aluminium hydroxide?

A

Renal failure- neurotoxicity.

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15
Q

Name a prostaglandin analogue and its mechanism of action?

A

Misoprostol

Acts on PGE2 and affects similar pathway to H2 RAs

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16
Q

What are the side effects and contraindications of prostaglandin analogues?

A

Side effects: diarrhoea and abdominal pain

Contraindications: pregnancy - induce uterine contractions (can be used in pp haemorrhage).

17
Q

What is the mechanism of action of H2 RAs?

A

Competitively and reversible inhibition of histamine to H2 receptors. Reduces PK and therefore not changing shape, not allowing proton pumps to be expressed.
Indirectly block effects of gastrin and Ach on parietal cells.

18
Q

What is the common side effects of H2 RAs?

A 
Diarrhoea 
Constipation 
Muscle ache 
Fatigue 
Reduced ketoconazole absorption (needs acidic environment)
19
Q

Name a H2 RA?

A

Cimetidine

20
Q

Why is cimetidine used less frequently?

A

Inhibits CYP450 enzymes, decreasing metabolism of lidocaine, phenytoin, theophylline and warfarin.
Potentially results in toxic levels.

21
Q

Describe the non-secreting state of the parietal cells

A

Proton pumps are located in the membrane bound compartment (tubulovesicles). These lack K permeability, blocking H/K ATPase activity.

22
Q

Describe the transition of non-secreting to a secreting state in a parietal cell

A

Apical membrane of the parietal cell has involutions (canaliculi), they have microvilli.

In the secreting state, tubulovesicles fuse with canalicular membrane. Moves proton pump to apical surface.
This involves a huge movement of membrane to canaliculi and elongation of microvilli.

23
Q

What is the mechanism of action of PPI

A

Pro drugs - they are weak bases and accumulate in the acidic space of the secretory canaliculus.
Bind covalently to H/K ATPase irreversibly and block function. Prolonged and nearly complete suppression of acid secretion.

24
Q

What are the potential side effects of PPI?

A

Headache
Nausea
GIT issues
Abdominal pain

25
Q

what are the potential issues with PPIs?

A

Increased level of gastrin - parietal cell and ECL hyperplasia, some concern could increase gastric carcinoid tumours.

May decrease effectiveness of clopidogrel - both use CYP2C19.

Increase risk of hip fractures (increased stomach pH may reduce gastric absorption of soluble calcium).

Increase risk of various infections within hospitals.

26
Q

What patient groups should avoid sodium bicarbonate as an antacid?

A

Hypertension and oedematous

27
Q

What is the mechanism of H2 RA excretion?

A

Liver and kidney

28
Q

PPI s need a coating because?

A

Enteric coating prevents premature activation (prodrug)

29
Q

What are the potential issues with PPIs?

A

Metabolised by CYP P450 - decrease clopidogrel effectiveness
Liver failure
Excreted by kidney
Increased risk of hip fracture - decreased calcium absorption
Increased risk of infection in hospital- loss of barrier

30
Q

Misoprostol is used when NSAIDs are needed, hoe does it work?

A

Inhibit adenylate cyclase and therefore decrease proton pump activity

Pharmacology (22 decks)

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