GI Pharmacology

Question 1

What is 5-aminosalicyclic acid (5-ASA)

Answer 1

acts locally as an anti-inflammatory.

released in the colon and is not absorbed.

may inhibit prostaglandin synthesis

Question 2

Sulphasalazine

a combination of ? and 5-ASA

Answer 2

sulphapyridine (a sulphonamide)

Question 3

Sulphasalazine has few side effects due to the sulphapyridine moiety

Answer 3

FALSE

many side-effects are due to the sulphapyridine moiety

Question 4

Sulphasalazine may cause which types of anaemia?

Answer 4

Heinz body anaemia, megaloblastic anaemia

Question 5

Sulphasalazine sepcific side effects?

Answer 5

: rashes, oligospermia, headache

lung fibrosis

Question 6

delayed release form of 5-ASA

Answer 6

Mesalazine

Question 7

Aminosalicylates are associated with a variety of haematological adverse effects, including

Answer 7

agranulocytosis - FBC is a key investigation in an unwell patient taking them.

Question 8

Mesalazine - sulphapyridine side-effects seen in patients taking sulphasalazine are avoided
mesalazine is still however associated with side-effects such as

Answer 8

GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

Question 9

Olsalazine

two molecules of 5-ASA linked by a diazo bond, which is broken by colonic bacteria

Answer 9

true

Question 10

pancreatitis is 7 times more common in patients taking ? than sulfasalazine

Answer 10

mesalazine

Question 11

Antidiarrhoeal agents - Opioid agonists include

Answer 11

loperamide

diphenoxylate

Question 12

Cholestyramine is

Answer 12

bile acid sequestrant used in the management of hyperlipidaemia.

Question 13

Cholestyramine works by?

Answer 13

decreases bile acid reabsorption in the small intestine, therefore upregulating the amount of cholesterol that is converted to bile acid

Question 14

Cholestyramine effect on lipid profile

Answer 14

reduce LDL cholesterol

Question 15

Cholestyramine Adverse effects

Answer 15

abdominal cramps and constipation
decreases absorption of fat-soluble vitamins
cholesterol gallstones
may raise level of triglycerides

Question 16

Metoclopramide is

Answer 16

D2 receptor antagonist* mainly used in the management of nausea.

Question 17

Metoclopramide causes hyper/hypoprolactinaemia?

Answer 17

hyperprolactinaemia

Question 18

Metoclopramide neuro s/e

Answer 18

extrapyramidal effects
tardive dyskinesia
parkinsonism

Question 19

Metoclopramide should be avoided in

Answer 19

bowel obstruction, but may be helpful in paralytic ileus.

Question 20

Metoclopramide it is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist

Answer 20

true

Question 21

Proton pump inhibitors (PPI) work by?

Answer 21

rreversible blockade of H+/K+ ATPase of the gastric parietal cell.

Question 22

Proton pump inhibitors (PPI) electrolyte disturbances?

Answer 22

hyponatraemia, hypomagnasaemia

Question 23

Proton pump inhibitors (PPI) adverse effects?

Answer 23

osteoporosis → increased risk of fractures
microscopic colitis
increased risk of Clostridium difficile infections

Question 24

Refeeding syndrome describes

Answer 24

metabolic abnormalities which occur on feeding a person following a period of starvation. It occurs when an extended period of catabolism ends abruptly with switching to carbohydrate metabolism

Question 25

Refeeding syndrome metabolic consequences

Answer 25

hypophosphataemia
hypokalaemia
hypomagnesaemia
abnormal fluid balance

Question 26

hypomagnesaemia may predispose to?

Answer 26

may predispose to torsades de pointes

Question 27

Refeeding syndrome may avoided by identifying patients at a high-risk of developing refeeding syndrome:

Patients are considered high-risk if one or more of the following:

Answer 27

BMI < 16 kg/m2
unintentional weight loss >15% over 3-6 months
little nutritional intake > 10 days
hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)

Question 28

Refeeding syndrome may avoided by identifying patients at a high-risk of developing refeeding syndrome:

Patients are considered high-risk if TWO or more of the following:

Answer 28

BMI < 18.5 kg/m2
unintentional weight loss > 10% over 3-6 months
little nutritional intake > 5 days
history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

Question 29

NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than ?% of requirements for the first 2 days.

Answer 29

NICE recommend that if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.