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Year 2 - Alimentary > GI pharmacology > Flashcards

GI pharmacology Flashcards

1
Q

Main drug classes used in GI disease (5)

A 
Acid suppressants
Drugs affecting GI motility
Laxatives
Drugs for IBD
Drugs affecting intestinal secretions
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2
Q

Name 3 acid suppressant drugs

A

Antacids
H2 receptor antagonists
Proton pump inhibitors

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3
Q

Name 3 drugs affecting GI motility

A

Anti-emetics
Anti-muscarinics/ other anti-spasmodics
Anti-motility agents

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4
Q

Name 4 drugs used for IBD

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

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5
Q

Name 2 drugs affecting intestinal secretions

A

Bile acid sequestrants

Ursodeoxycholic acid

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6
Q

Mechanism of antacids

A

Contain magnesium or aluminium to neutralise gastric acid

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7
Q

Indications of antacids

A

When symptoms occur, e.g. heartburn

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8
Q

What are alginates + mechanism of action

A

Acid suppressant, e.g. gaviscon

-forms a viscous gel that floats on stomach contents and reduces reflux

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9
Q

Name 2 histamine receptor antagonists

A

Ranitidine

Cimetidine

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10
Q

Mechanism of action of histamine receptor blockers

A

Block histamine receptor therefore reducing gastric acid secretion

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11
Q

Indications of histamine receptor antagonists (2)

A

GORD

peptic ulcer

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12
Q

Name a proton pump inhibitor

A

Omeprazole

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13
Q

Mechanism of action of proton pump inhibitors

A

Blocking the H+/K+ ATPase (gastric proton pump) so reducing gastric acid secretion

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14
Q

Decreasing gastric acid in stomach can aid the healing of what

A

aid the healing of duodenal ulcers and reduce the pain from indigestion and heartburn

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15
Q

Indications of PPIs (3)

A

GORD
Peptic ulcer
H. pylori infection

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16
Q

Complications/prolonged use of PPIs (3)

A

Predispotion to C. diff infection
Hypomagnesaemia- fatigue, muscle tremor
B12 deficiency - fatigue, muscle tremors

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17
Q

What do prokinetic agents do + name 2

A

increase gut motility and gastric emptying

metoclopramide, domperidone

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18
Q

What is gastroparesis

A

nerves controlling stomach muscles/ the muscles themselves don’t work properly –> inadequate grinding –> poor gastric emptying

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19
Q

Mechanism of action of prokinetic agents

A

Involves parasympathetic nervous system controlling smooth muscle and sphincter tone via ACh

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20
Q

Domperidone is an antagonist of what neurotransmitter + domperidone mechanism

A

Dopamine

blocking dopamine receptors inhibits post-synaptic cholinergic neurones

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21
Q

Stimulants of the vomiting centre in the medulla

  • chemoreceptor trigger zone triggered by what (1)
  • vestibular nuclei triggered by what (1)
  • cerebral cortex triggered by what (2)
  • pharynx & GIT triggered by what (2)
A

Chemoreceptor trigger zone (in the brain) – triggered by some drugs/toxins

Vestibular nuclei – triggered by excess motion (motion sickness)

Cerebral cortex – triggered by smell or sight of things

Pharynx & GIT – triggered by gastroenteritis, radiotherapy, some drugs

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22
Q

Antimuscarinics act on what centre

A

Vomiting centre

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23
Q

Anti-spasmodics 3 mechanisms of action

A

They are anti-cholinergic (muscarinic receptor antagonists)
–> so inhibit smooth muscle contraction in gut wall + ureter –> relaxation and less spasm

Are direct smooth muscle relaxants

Block calcium channels
–> reduce calcium needed for smooth muscle contraction

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24
Q

Name 2 drugs which decrease GI motility + what they are used for

A

Loperamide
Opioids

Can be beneficial as an anti-diarrhoea agent

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25
Mechanism of drugs which decrease motility
Activate opiate receptors in GI tract, causing them to decrease ACh release  decreased smooth muscle contraction of GI tract  increased anal sphincter tone
26
4 types of laxatives
bulk, osmotic, stimulant, softeners laxatives work by increasing bulk or drawing fluid into gut
27
Complications of laxatives (3)
Gut obstruction Need for other measures to allow laxative to work -Osmotic laxatives won’t work without adequate fluid intake Misuse – can get addicted
28
What laxative shouldn't be used for IBS as it may cause bloating
Lactulose
29
First-line choice of anti-motility drug for relief of diarrhoea in IBS
Loperamide
30
Name 2 aminosalicylates used for IBD
Mesalazine | Olsalazine
31
Aminosalicylates route of administration (2)
Oral or rectal
32
Aminosalicylates are anti what
Anti-inflammatory
33
Contraindication of aminosalicylates
Renal impairment - need to be cautious with use
34
Adverse effects of aminosalicylates (5)
``` GI upset Blood dyscrasias (disease of blood cells) Renal impairment Headache Pancreatitis ```
35
Adverse effects of corticosteroids used in IBD (5)
``` Osteoporosis Facial puffiness weight gain Increased susceptibility to infection ADDISONIAN (ADRENAL) CRISIS if corticosteroid is abruptly withdrawn ```
36
When do you get addisonian (adrenal crisis)
If corticosteroid is abruptly withdrawn
37
Name corticosteroids used in IBD (2)
Prednisolone | Hydrocortisone
38
3 routes of administration of corticosteroids in IBD
Oral/IV/rectal
39
Name 2 immunosuppressants used in IBD
Azathioprine | Methotrexate
40
Mechanism of action of immunosuppressants
prevents purine formation needed for DNA synthesis so reduces immune cell replication
41
Adverse effects of immunosuppressants
Bone marrow suppression | Hypersensitivity of azathioprine --> ORGAN DAMAGE (lung, liver, pancreas)
42
Mechanism of action of biologics (anti-TNFa antibodies)
prevents action of TNFa (important cytokine in inflammatory response)
43
Name a biologic used in IBD
Infliximab
44
3 Contraindications of infliximab (a biologic used in IBD)
TB MS Pregnancy/breast feeding
45
Adverse effects of infliximab (5)
``` Infection risk, especially TB Fever + itch Anaemia Thrombocytopenia (low platelets) Neutropenia (low neutrophils) Malignancy ```
46
Mechanism of action of cholestyramine (a drug affecting biliary secretions)
reduces bile salts by binding with them and excreting them as insoluble complex
47
What is ursodeoxycholic acid (UDCA) used for (2)
Gallstones | Primary biliary cholangitis
48
Mechanism of action of ursodeoxycholic acid (UDCA)
inhibits an enzyme involved in formation of cholesterol, altering cholesterol content in bile Reduces cholesterol absorption
49
How is absorption of drugs affected
pH Gut length Transit time of food
50
GI disease can affect ADME of drugs - what are these
ABSORPTION, DISTRIBUTION, METABOLISM AND EXCRETION
51
How can distribution of drugs be affected in some GI/liver diseases
Low albumin in some GI/liver diseases --> decreased albumin to bind to drug in blood --> therefore increased free drug concentration
52
How can metabolism of drugs be affected in some GI/liver diseases (4)
Increased liver enzyme levels --> toxic effects Increased gut bacteria in some diseases --> metabolise drugs faster? --> so higher dose needed Disease may reduce gut wall metabolism Disease can also affect liver blood flow
53
How can excretion of drugs be affected in some GI diseases
Biliary excretion can be more toxic than usual
54
Diarrhoea is an adverse effect of what drugs (2)
Cholinergics | Antimicrobials
55
Constipation is an adverse effect of what drugs (2)
opioids, | anticholinergics
56
GI bleeds/ulcers are caused by what drugs (2)
Aspirin | NSAIDs
57
Type A adverse drug reactions are... (2)
Predictable | Dose dependent
58
What type of ADR can cause intrinsic hepatotoxicity (liver injury)
Type A
59
Risk factors of adverse hepatic reactions (6)
``` Young or elderly Female Alcohol Genetics Malnourishment ```
60
Severity of liver disease measured with what classification
CHILD-PUGH CLASSIFICATION
61
Describe the child-pugh classification (a measure of liver disease severity, assesses prognosis of CLD such as cirrhosis) (3)
Classification A = <7 Classification B = 7-9 Classification C = >9
62
Avoid what drugs in those with liver disease (3)
Methotrexate - hepatotoxic Benzodiazepines - worsen non-liver aspects of liver disease (precipitate encephalopathy) Those are toxic due to changes in pharmacokinetics
63
where to find information about risks with specific drugs in liver disease
BNF guidance

Year 2 - Alimentary (21 decks)

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