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RBM2202 Pathophysiology and Pharmacology 2 > GI Pharmacology > Flashcards

GI Pharmacology Flashcards

1
Q

What are the 5 main types of anti-ulcer drugs

A
  • Antacids
  • Histamine 2 antagonist
  • Proton Pump Inhibitors
  • Prostaglandin analogues
  • Systemic Antibiotics
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2
Q

What are 2 indications for anti-ulcer drugs?

A

PUD and GORD

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3
Q

What are the 4 compounds that make up antacids?

A
  • Aluminium hydroxide
  • Calcium carbonate
  • Magnesium salt
  • Sodium bicarbonate
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4
Q

Which of the 4 antacid compounds cause a laxative effect?

A
  • Magnesium salt

- Sodium bicarbonate

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5
Q

Which of the 4 antacid compounds cause constipation

A
  • Aluminium hydroxide

- Calcium Carbonate

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6
Q

How do antacids work?

A

Neutralise gastric acids

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7
Q

Do not take antacids within ___ of other medications

A

2 hours

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8
Q

How much water needs to be taken throughout the day when taking antacids?

A

3L

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9
Q

How to avoid laxative or constipation effects when taking antacids?

A

Combine agents with opposite effects.

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10
Q

Antacids can produce _____ colour ____.

A

white, stool

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11
Q

What are 2 examples of H2 receptor antagonists?

A
  • Cimetidine

- famotidine

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12
Q

How do H2 receptor antagonists work?

A

Block the H2 receptor of gastric parietal cells. This reduces HCL secretion.

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13
Q

H2 receptor antagonists cause ____ depression symptoms. Such as ____, ____, _____.

A

CNS, dizziness, headache, sleepiness

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14
Q

If a drug has CNS depression effect what needs to be considered?

A

Falls risk, driving, etc.

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15
Q

H2 receptor antagonists has a drug interaction. What is this?

A

It blocks hepatic enzymes which increase plasma levels of certain drugs. Such as Metformin, betablockers, phenytoin, CCB, opioid analgesics, and oral anticoagulants.

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16
Q

When on H2 receptor antagonists, HR and BP needs to be monitored if administered via ____

A

IM or IV

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17
Q

What is a very strong anti-ulcer medication?

A

PPI

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18
Q

How do PPIs work?

A

Block gastric ATPase enzyme on parietal cells which inhibit the last step of acid formation.

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19
Q

What are 2 examples of PPIs?

A

Esomeprazole

Omeprazole

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20
Q

What are the indications for PPI use?

A

H. Pylori induced PUD, chronic gastritis, GORD or erosive esophagitis (cons. Biphosphonates)

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21
Q

PPI treatment should last a maximum of ____

A

8 weeks

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22
Q

PPIs have a short/long half life.

A

short - 2-3hrs

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23
Q

What does PPI increase the risks of?

A

URTI

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24
Q

PPIs block the hepatic enzymes that metabolise what drugs?

A
  • Warfarin
  • Diazepam
  • Phenytoin
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25
Q

PPI reduce absorption of _____ and ______. Both drugs require gastic pH to be absorbed.

A

digoxin and ampicillin

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26
Q

What is an example of a prostaglandin analogue?

A

Misoprostol

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27
Q

What are the indications for Misoprostol?

A
  • prevent NSAID induced gastric ulcers
  • treat PUD
  • IOL or abortion
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28
Q

What is the action of prostaglandin analogues?

A

It binds to prostaglandin receptors on parietal cells which decreases gastric acid secretion, increase mucous production and mucosal blood flow.

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29
Q

When in Misoprostol contraindicated?

A

pregnancy.

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30
Q

What are the ADRs of prostaglandin analogues?

A
  • GI upset
  • premature labour
  • menstrual disorders
  • bleeding/cramps
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31
Q

What drug has a bactericidal effect on H. Pylori and provides a protective layer on mucosa?

A

Colloidal Bismuth Subsitrate

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32
Q

What anti-ulcer drug can cause black tongue and faeces?

A

CBS

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33
Q

What is used to treat H. Pylori?

A

Triple or quadruple therapy of ABs. This is due to the bacteria being very resistant.

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34
Q

What are some examples of ABs that treat H. Pylori?

A
  • Clarithromycin
  • Amoxicillin
  • Metronidazole
  • Tetracycline
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35
Q

What are tests that diagnose H. Pylori?

A
  • Urea breath test
  • GI endoscopy
  • Stool sample for antigen
36
Q

What is the treatment for diarrhoea?

A
  • Rehydration and electrolyte replacement
  • ABs for severe infectious diarrhoea
  • peristalsis slowing drugs for systematic relief
37
Q

Loperamide and can/cannot cross the BBB. This means it does/doesn’t have a CNS effect

A

cannot, doesn’t

38
Q

What are the 5 types of laxatives?

A
  • bulk-forming
  • stimulants
  • emollients
  • osmotic
  • lubricants
39
Q

What is an example of a bulk-forming laxative?

A

Psyllium - metamucil

40
Q

What is the 1st line therapy for acute/chronic constipation?

A

Bulk-forming laxative

41
Q

What laxative is used for opioid-induced constipation and has a fast onset <30mins?

A

methylnaltrexone

42
Q

How do bulk-forming laxatives work?

A

The substance swells in water which enlarges the stool and promotes peristalsis.

43
Q

________ laxatives interfere with Ca absorbtion.

A

bulk-forming

44
Q

Bulk forming laxative are contraindicated with pt with ______.

A

GI obstruction.

45
Q

How long do bulk forming laxatives take to take effect?

A

2-3 days

46
Q

Monitor ________ balance while pt is taking laxatives.

A

electrolyte.

47
Q

What is an example of a stimulant laxative?

A

Bisacodyl

Sennosides

48
Q

What is the indication for stimulant laxatives?

A

For those who are unresponsive to bulk or osmotic laxatives.
Mod-severe constipation
Post surgery

49
Q

What is the MOA of stimulant laxatives?

A

Stimulates nerve endings in intestinal smooth muscle which increases peristaltic movements.

50
Q

Stimulant laxatives work within ______

A

6-12 hours.

51
Q

Overuse of stimulant laxatives may lead to ____ _______. Long term use can lead to _______.

A

rebound constipation.

dependence.

52
Q

What laxatives do you need to avoid laying down after taking?

A

Bulk-forming and lubricant.

53
Q

What laxatives should be avoided during pregnancy?

A

stimulant.

54
Q

What is Docusate?

A

Emollient/stool softener

55
Q

How do emollient laxatives work?

A

Prevent water reabsorption and promote water and electrolyte secretion.

56
Q

How long do emollient laxatives take to work?

A

1-3 days

57
Q

_____ laxatives are indicated for increased ICP and hernias, as they prevent _________.

A

emollient, straining.

58
Q

Magnesium sulphate, Sodium sulphate, lactulose, glycerol and sorbitol are all examples of _____.

A

Osmotic laxatives.

59
Q

Pt with HTN should avoid what osmotic laxative?

A

Na osmotic laxative

60
Q

Pt with DM should avoid what osmotic laxative?

A

Lactulose

61
Q

How do Osmotic Laxatives work?

A

The substance is not absorbable and makes the bowel contents HYPERTONIC. This draws H20 into the intestinal lumen which increases faecal mass.

62
Q

What laxative is the 1st line for chronic constipation and 2nd line for acute constipation?

A

Osmotic laxatives.

63
Q

How long do osmotic laxatives take to work?

A

1 - 3 hrs

64
Q

Liquid paraffin is a ____ laxative.

A

lubricant.

65
Q

Polyp-like growths and colon cancer are associated with _____.

A

lubricant laxatives.

66
Q

What laxative impairs the absorption of vit A, D, E and K?

A

lubricant laxatives.

67
Q

Antagonists of Histamine 1, Dopamine 2, Serotonin 5HT3, Neurokinin-1, Acetylcholine/muscarinic are commonly used as _______.

A

antiemetics.

68
Q

Anti-emetic agents bind to relevant receptors on ___, _______, ______ centre and ____.

A

GI, vestibular-apparatus, vomiting centre and CTZ.

69
Q

Promethazine is a representative of what class?

A

H1 Antihistamines.

70
Q

How does promethazine work?

A

Blocks H1 receptor in the CNS and possibly anti-Ach on the vestibular apparatus.

71
Q

H1 antihistamines can cause _____ or _______ due to CNS inhibition.

A

drowsiness, sedation

72
Q

Hyoscine is an example of a ______

A

Antimuscarinic/anticholinergic

73
Q

Anticholinergic action is in the………

A

Vestibular apparatus and vomit centre. It blocks acetylcholine.

74
Q

Dopaminergic D2 antagonists are__________ as well as antiemetics.

A

antipsychotics.

75
Q

What are examples of dopaminergic D2 antagonists?

A
  • Metoclopramide (crosses BBB)

- Domperidone (does not cross BBB)

76
Q

What is the MOA metoclopramide?

A

Block dopamine receptors in CTZ and gut. This increases the rate of gastric emptying and oesophageal tone.

77
Q

What drug causes extrapyramidal symptoms?

A

Metoclopramide.

78
Q

What are extrapyramidal symptoms?

A

akathisia, psuedoparkinsonism, tardive dyskinesia, dystonia.

79
Q

Dopaminergic D2 antagonists can cause_____ _____, so they require ____ monitoring.

A

orthostatic hypotension, BP

80
Q

Which anti-emetic has a less sedative effect than H1 antihistamines but does cause dry mouth, constipation and blurred vision?

A

Antimuscarinic/anticholinergics such as Hyoscine

81
Q

5-HT3 receptor antagonists block ______ receptors in the CTZ and ____.

A

serotonin, GIT

82
Q

What is an example of a 5-HT3 receptor antagonist?

A

Ondansetron.

83
Q

Ondansetron has more/less ADR compared to metoclopramide.

A

Less

84
Q

Ondansetron can cause _______ and _____ ____ so is not for pt with CVD. It can also cause ____.

A

bradycardia, heart block. Headaches.

85
Q

What is an example of Neurokinin-1 antagonist?

A

Aprepitant.

86
Q

Aprepitant site of action is in the ___, _____ _____ and maybe the ___.

A

CTZ, vomiting centre and GIT

87
Q

What are the ADRs of Aprepitant?

A

Hiccups, diarrhoea

RBM2202 Pathophysiology and Pharmacology 2 (11 decks)

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