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GI Anatomy > 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
Q

Mechanism of drugs which decrease motility

A

Activate opiate receptors in GI tract, causing them to decrease ACh release  decreased smooth muscle contraction of GI tract  increased anal sphincter tone

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26
Q

4 types of laxatives

A

bulk, osmotic, stimulant, softeners

laxatives work by increasing bulk or drawing fluid into gut

27
Q

Complications of laxatives (3)

A

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
Q

What laxative shouldn’t be used for IBS as it may cause bloating

A

Lactulose

29
Q

First-line choice of anti-motility drug for relief of diarrhoea in IBS

A

Loperamide

30
Q

Name 2 aminosalicylates used for IBD

A

Mesalazine

Olsalazine

31
Q

Aminosalicylates route of administration (2)

A

Oral or rectal

32
Q

Aminosalicylates are anti what

A

Anti-inflammatory

33
Q

Contraindication of aminosalicylates

A

Renal impairment - need to be cautious with use

34
Q

Adverse effects of aminosalicylates (5)

A 
GI upset
Blood dyscrasias (disease of blood cells)
Renal impairment
Headache 
Pancreatitis
35
Q

Adverse effects of corticosteroids used in IBD (5)

A 
Osteoporosis
Facial puffiness
weight gain
Increased susceptibility to infection
ADDISONIAN (ADRENAL) CRISIS if corticosteroid is abruptly withdrawn
36
Q

When do you get addisonian (adrenal crisis)

A

If corticosteroid is abruptly withdrawn

37
Q

Name corticosteroids used in IBD (2)

A

Prednisolone

Hydrocortisone

38
Q

3 routes of administration of corticosteroids in IBD

A

Oral/IV/rectal

39
Q

Name 2 immunosuppressants used in IBD

A

Azathioprine

Methotrexate

40
Q

Mechanism of action of immunosuppressants

A

prevents purine formation needed for DNA synthesis so reduces immune cell replication

41
Q

Adverse effects of immunosuppressants

A

Bone marrow suppression

Hypersensitivity of azathioprine –> ORGAN DAMAGE (lung, liver, pancreas)

42
Q

Mechanism of action of biologics (anti-TNFa antibodies)

A

prevents action of TNFa (important cytokine in inflammatory response)

43
Q

Name a biologic used in IBD

A

Infliximab

44
Q

3 Contraindications of infliximab (a biologic used in IBD)

A

TB
MS
Pregnancy/breast feeding

45
Q

Adverse effects of infliximab (5)

A 
Infection risk, especially TB
Fever + itch
Anaemia
Thrombocytopenia (low platelets)
Neutropenia (low neutrophils)
Malignancy
46
Q

Mechanism of action of cholestyramine (a drug affecting biliary secretions)

A

reduces bile salts by binding with them and excreting them as insoluble complex

47
Q

What is ursodeoxycholic acid (UDCA) used for (2)

A

Gallstones

Primary biliary cholangitis

48
Q

Mechanism of action of ursodeoxycholic acid (UDCA)

A

inhibits an enzyme involved in formation of cholesterol, altering cholesterol content in bile
Reduces cholesterol absorption

49
Q

How is absorption of drugs affected

A

pH
Gut length
Transit time of food

50
Q

GI disease can affect ADME of drugs - what are these

A

ABSORPTION, DISTRIBUTION, METABOLISM AND EXCRETION

51
Q

How can distribution of drugs be affected in some GI/liver diseases

A

Low albumin in some GI/liver diseases –> decreased albumin to bind to drug in blood –> therefore increased free drug concentration

52
Q

How can metabolism of drugs be affected in some GI/liver diseases (4)

A

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
Q

How can excretion of drugs be affected in some GI diseases

A

Biliary excretion can be more toxic than usual

54
Q

Diarrhoea is an adverse effect of what drugs (2)

A

Cholinergics

Antimicrobials

55
Q

Constipation is an adverse effect of what drugs (2)

A

opioids,

anticholinergics

56
Q

GI bleeds/ulcers are caused by what drugs (2)

A

Aspirin

NSAIDs

57
Q

Type A adverse drug reactions are… (2)

A

Predictable

Dose dependent

58
Q

What type of ADR can cause intrinsic hepatotoxicity (liver injury)

A

Type A

59
Q

Risk factors of adverse hepatic reactions (6)

A 
Young or elderly
Female
Alcohol
Genetics
Malnourishment
60
Q

Severity of liver disease measured with what classification

A

CHILD-PUGH CLASSIFICATION

61
Q

Describe the child-pugh classification (a measure of liver disease severity, assesses prognosis of CLD such as cirrhosis) (3)

A

Classification A = <7
Classification B = 7-9
Classification C = >9

62
Q

Avoid what drugs in those with liver disease (3)

A

Methotrexate - hepatotoxic
Benzodiazepines - worsen non-liver aspects of liver disease (precipitate encephalopathy)
Those are toxic due to changes in pharmacokinetics

63
Q

where to find information about risks with specific drugs in liver disease

A

BNF guidance

GI Anatomy (21 decks)

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