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year 3 drug list > GI PPT > Flashcards

GI PPT Flashcards

1
Q

name some antacids

A

magnesium tricilicate, aluminium/magnesium hyrdoxide

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2
Q

indications for antacids

A

GORD, dyspepsia

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3
Q

MOA of antacids

A

neutralise gastric acid. prolonged effect if taken after food

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4
Q

side effects of antacids

A

diarrhoea (with magnesium salts), constipation (with aluminium salts), systemic alkalosis

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5
Q

indications of alginates

A

dyspepsia, GORD

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6
Q

name an alginate

A

alginic acid

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7
Q

MOA of alginates

A

reacts with gastric acid to form a foam that sits on top of the gastric contents and prevents it from reaching oesophageal mucosa in reflux

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8
Q

side effects of alginates

A

nausea, bloating, diarrhoea

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9
Q

name some H2 receptor antagonists

A

ranitidine, cimetidine

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10
Q

MOA of H2 receptor antagonists

A

Competitive inhibitors of histamine receptors on gastric parietal cells. This helps to reduce acid secretion and pepsin production

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11
Q

indications of H2 receptor antgonists

A

GORD, dyspepsia, peptic ulcers, prophylaxis for NSAID associated peptic ulcers

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12
Q

side effects of H2 receptor antagonists

A

GI disturbance, rash, gynaecomastia

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13
Q

name some PPIs

A

omeprazole, lansoprazole

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14
Q

indications for PPIs

A

GORD, dyspepsia, peptic ulcers, prophylaxis for NSAID associated peptic ulcers, eradication of H.pylori

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15
Q

MOA of PPIs

A

Administered as a pro drug, but is activated to irreversibly inhibit H+/K+ ATPase which prevents gastric acid secretion

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16
Q

side effects of PPIs

A

N&V, abdo pain, diarrhoea & constipation, headaches

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17
Q

contraindications of PPIs

A

Inhibit enzymes in liver important for metabolism of other drugs. Can lead to increased clinical effect of warfarin, clopidogrel, phenytoin

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18
Q

name some opioids used in treatment of diarrhoea

A

Codeine phosphate, diphenoxylate, loperamide

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19
Q

Important effects of PPIs and H2 receptor antgonists that must be known before start of treatment

A

they mask the signs of gastric cancer

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20
Q

MOA of opioids used in diarrhoea

A

bind to mu receptors in the intestinal wall. This prolongs transit time through inhibition of propulsive movements, allowing time for more water reabsorption

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21
Q

side effects of opioids

A

respiratory depression, N&V, drowsiness, constipation

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22
Q

indications of bulk forming laxatives

A

constipation

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23
Q

name some bulk forming laxatives

A

ispaghula husk, methylcellulose, sterculia, bran

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24
Q

MOA of bulk forming laxatives

A

contain a hydrophillic compound which retains water already in the bowel well and builds stool mass. Increased bulk encourages peristalsis and relieves constipation

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25
Q

side effects of bulk forming laxatives

A

abdominal distention, flatulence, GI obstruction

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26
Q

name some osmotic laxatives

A

macrogol, lactulose, magnesium salts, sodium acid phosphate

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27
Q

indication of osmotic laxatives

A

constipation

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28
Q

MOA of osmotic laxatives

A

based on osmotically active substances which draw water in from other areas and hold it in the stool. This helps to stimulate peristalsis

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29
Q

side effects of osmotic laxatives

A

abdominal cramps, flatulence, nausea

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30
Q

name some irritant/stimulant laxatives

A

senna, dantron, bisacodyl, docusate sodium, sodium picosulfate

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31
Q

indications for irritant/stimulant laxatives

A

constipation

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32
Q

MOA of irritant/stimulant laxatives

A

Increase electrolyte and water secretion into colonic lumen. This increases colonic content and stimulates peristalsis

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33
Q

side effects of irritant/stimulant laxatives

A

abdo pain, diarrhoea, melanosis coli (pigmentation of intestinal wall)

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34
Q

name some faecal softeners

A

arachis oil, docusate sodium, co-danthrusate

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35
Q

MOA of faecal softeners

A

increase penetration of intestinal fluid into faecal mass, softening the stool and allowing peristalsis more easily

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36
Q

side effects of foecal softeners

A

abdo pain, nausea, rash

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37
Q

indication of faecal softeners

A

constipation

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38
Q

Name some aminosalicylates

A

mesalazine, sulfasalazine

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39
Q

indications for aminosalicylates

A

UC - first line, Crohns - used if intolerant to corticosteroids and others (drug works topically but crohns is full thickness)

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40
Q

MOA of aminosalicylates

A

Deliver 5- aminosalicylic acid (5-ASA) to lumen of colon, which has antiinflammatory action. Reduce cytokine formation, infammatory mediators and free radical formation

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41
Q

side effects of aminosalicylates

A

sulfasalazine has a higher side effect profile and can also cause oligospermia. GI disturbance e.g. N&V, Diarrhoea, rash, AGRANULOCYTOSIS

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42
Q

Name some corticosteroids used for IBD

A

prednisolone, hydrocortisone, budenoside

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43
Q

indications for corticosteroids

A

UC - usually used in addition to aminosalicylates. Crohn’s - first line

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44
Q

MOA of corticosteroids

A

Bind to glucocorticoid receptors, enter the nucleus of the cell and alter gene expression. Upregulates anti-inflammatory genes and downregulates pro-inflammatory genes. Also have a mineralocorticoid effect, stimulating Na+ & H2O retention and K+ secretion

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45
Q

side effects of corticosteroids

A

Immunosuppression
Metabolic - diabetes, osteoporosis, skin thinning and bruising
Mood and behavioural changes
Mineralocorticoid actions - oedema, hypokalaemia, hypertension
sudden withdrawal leads to addisonian crisis

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46
Q

name some anti-TNF alpha antibodies

A

infliximab, adalimumab

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47
Q

indications of anti-TNF alpha antibodies

A

UC and Crohn’s

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48
Q

MOA of anti-TNF alpha antibodies

A

Inhibit the binding of TNF-alpha to it’s receptors, reducing production of pro-inflammatory cytokines, leucocyte migration, activation of neutrophils and eosinophils

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49
Q

side effects of anti-TNF alpha antibodies

A

GI upset
Hypersensitivity reactions,
Blood disorders - anaemia, thrombocytopenia, leucopenia
Worsening heart failure

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50
Q

name some antimuscarinic drugs

A

hyoscine, dicycloverene, propantheline

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51
Q

indications for antimuscarinic drugs

A

IBS

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52
Q

MOA of antimuscarinics

A

competetive inhibition of Ach which inhibits parasympathetic innervation of myenteric and submucosal plexuses. This reduces colonic motility and inhibits gastric emptying

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53
Q

side effects of antimuscarinics

A

constipation
transient bradycardia and tachycardia
urinary retention

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54
Q

name some antispasmodic agents used in IBS

A

mebeverine, peppermint oil, dicycloverine

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55
Q

MOA of antispasmodics in IBS

A

smooth muscle relaxants. Relieves gut spasm and abdo pain

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56
Q

side effects of antispasmodics

A

heartburn, perianal irritation, headaches

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57
Q

name some antifungals

A

nystatin, fluconazole, amphotericin

58
Q

indications for nystatin

A

any candida infection

59
Q

MOA of nystatin

A

It’s a polyene. Binds to a component of the fungal cell wall and form pores which allows ions to leak out. Can be fungistatic or fungicidal

60
Q

side effects of nystatin

A

very little when used topically, only local irritation. Oral use can cause GI upset

61
Q

indications for fluconazole

A

candiasis and cryptococcal infections

62
Q

MOA of fluconazole

A

triazole antifungal. Inhibit a from of cytochrome P450 which is important in production of components of cell wall. This alters cell membrane fluidity and increases cell wall permeability

63
Q

side effects of fluconazole

A

GI disturbance, headaches, hepatitis, hypersensitivity

64
Q

indications for metronidazole

A

C.difficile, oral and gynae gram -ve bacteria, H.pylori & diverticulitis, protozoal infections

65
Q

MOA of metronidazole

A

only effective in anaerobic bacteria. Diffuses into the cell, is reduced which produces nitroso free radicals to bind to DNA cause degradation and cell death.

66
Q

side effects of metronidazole

A

GI upset
Hypersensitivity reactions
Long term - seizures, optic neuropathy

67
Q

contraindications of metronidazole

A

drinking alcohol, people with severe liver disease

68
Q

indications of vancomycin

A

gram +ve infection

C.difficile infection - used in antibiotic associated colitis if metronidazole is ineffective

69
Q

MOA of vancomycin

A

inhibits cross-linking of peptidoglycan chains, inhibiting cell wall synthesis of gram +ve bacteria

70
Q

side effects of vancomycin

A

thrombophlebitis at injection site
red man syndrome - generalised erythema, hypotension and bronchospasm
hypersensitivity
blood disorders

71
Q

name some antihelminthic drugs

A

ivermectin, albendazole

72
Q

indications of ivermectin

A

filariasis(elephantiasis), hookworm, S. stercoralis infection

73
Q

MOA of ivermectin

A

acts on glutamate gated ion channels, causing an influx of Cl-, generating muscle hyperpolarisation and paralysis of filariae (worms)

74
Q

side effects of ivermectin

A

itching, rash

75
Q

indications of albendazole

A

cysts, S stercoralis, hookworm

76
Q

MOA of albendazole

A

bind to parasitic tubulin, preventing its polymerisation into cytoskeletal microtubules

77
Q

side effects of albendazole

A

GI disturbance, headaches

78
Q

name some opioids

A

morphine, diamorphine, tramadol, fentanyl, codeine phosphate

79
Q

indications of opioids

A

acute/chronic moderate to severe pain management

80
Q

MOA of opioids

A

Activate mu receptors in CNS which then causes reduced neuronal excitability and pain transmission.
In medulla they reduce respiratory drive and breathlessness. They reduce sympathetic nervous activity

81
Q

side effects of opioids

A 
respiratory depression
N&V
constipation
dependance
withdrawal reaction
82
Q

warnings of opioid use

A

reduce doses in hepatic and renal impairment

avoid in biliary colic as it worsens the pain

83
Q

name some combination analgesics

A

co-codamol (paracetamol, codeine), co-dydramol (paracetamol, dihydrocodeine)

84
Q

indications of combination analgesics

A

mild to moderate pain

85
Q

MOA of combination analgesics

A

paracetamol is a weak inhibitor of COX enzyme, this action appears to increase the pain threshold.
codeine and dihydrocodeine are weak opioids, so have weak activation of mu receptors.

86
Q

side effects of combination analgesics

A

same side effect profile of opioids

paracetamol OD causes hepatotoxicity

87
Q

name some NSAIDs

A

ibuprofen, naproxen, aspirin

88
Q

indications of NSAIDs

A

chronic/neuropathic pain that’s mild to moderate

89
Q

MOA of NSAIDs

A

COX 1 and 2 inhibition. COX-2 is responsible for prostaglandin production which causes inflammation and pain

90
Q

Side effects of NSAIDs

A

GI toxicity
Renal impairment
Increased risk of CV event

91
Q

name some non-opioid, non-NSAID analgesics

A

amitriptyline, carbamazepine, capsaicin, pregabalin

92
Q

indications for non-opioid, non-NSAID analgesics

A

chronic or neuropathic pain

93
Q

MOA of amitriptyline

A

inhibit neuronal reuptake of serotonin and norepinipherine

94
Q

side effects of amitryptiline

A

arrhythmias, convulsions, hallucinations, extrapyramidal symptoms

95
Q

indications of carbamazepine for analgesia

A

first choice for trigeminal neuralgia (sudden severe face pain)

96
Q

MOA of carbamazepine

A

inhibit neuronal sodium channels, stabilising resting potentials and reducing neuronal excitability

97
Q

side effects of carbemazepine

A

GI upset
hypersensitivity
hyponatraemia

98
Q

indications of capsaicin

A

localised neuropathic pain, symptomatic relief of osteoarthrtitis

99
Q

MOA of capsaicin

A

reduces substance P during inflammation. Causes defunctionalisation of nociceptors by causing a hypersensitivity reaction on the skin

100
Q

side effects of capsaicin

A

temporary pain at application site
redness
N&V

101
Q

Indications of pregabalin for analgesia

A

second line (to duloxetine) for diabetic neuropathy, first line in other neuropathies

102
Q

MOA of pregabalin

A

binds to calcium channels and inhibits calcium inflow into neuron. This inhibits neurotransmitter release and reduces neuronal excitability

103
Q

side effects of pregabalin

A

drowsiness, dizziness, ataxia

104
Q

name a H1 receptor antagonist anti-emetic

A

cyclizine

105
Q

indications of H1 receptor antagonists

A

motion sickness and vertigo

can also treat post op and drug induced sickness

106
Q

MOA of H1 receptor antagonists

A

Block H1 and Ach receptors in vomiting centre of medulla and prevent them communicating with the vestibular system

107
Q

side effects of H1 receptor antagonists

A

drowsiness
dry mouth
palpitations

108
Q

warnings of H1 receptor antagonsists

A

avoid in patients with hepatic encephalopathy and prostatic hypertrophy

109
Q

name an antimuscarinic anti-emetic

A

hyoscine

110
Q

indications of antimuscarinic anti-emetic

A

motion sickness

post-op vomiting

111
Q

MOA of antimuscarinic anti-emetic

A

block the Ach (muscarinic) receptors in vomiting centre of medulla and prevent communication with the vestibular system

112
Q

side effects of antimuscarinic anti-emetics

A

dry mouth
urinary retention
blurred vision
sedation

113
Q

name some dopamine (D2)receptor antagonists

A

metoclopramide, domperidone

114
Q

indications of D2 receptor antagonists

A

vomiting due to reduced gut motility
drug induced vomiting
vomiting in pregnancy
can be used for other causes of vomiting

115
Q

MOA of D2 receptor antagonists

A

D2 receptors are the main receptors in CTZ, so antagonists of these help to prevent CTZ stimulation. D2 receptors are also present in the gut, and if blocked, this promotes gastric emptying and gut motility

116
Q

side effects of D2 receptor antagonists

A

diarrhoea

metoclopramide - extrapyramidal symptoms like an acute dystonic reaction e.g. oculogyric crisis

117
Q

name a phenothiazine

A

prochlorperazine

118
Q

indications for phenothiazines

A

vomiting from vertigo
vomiting from radio and chemotherapy
other causes of vomiting

119
Q

MOA of phenothiazines

A

blockade of D2 receptors in CTZ and gut, and to a lesser extent blockade of H1 and Ach receptors in vomiting centre

120
Q

side effects of phenothiazines

A

rarely used because of side effect profile
drowsiness
postural hypotension
extrapyramidal symptoms

121
Q

name a 5-HT3 receptor antagonist

A

ondansetron

122
Q

indications for 5-HT3 receptor antagonists

A

anaesthetic and chemo induced vomiting

123
Q

MOA of 5-HT3 receptor antagonists

A

There are lots of 5-HT3 receptors in CTZ, so blockage of these prevents stimulation of vagus nerve at CTZ and prevents it activating the vomiting centre. Serotonin is a key neurotransmitter released by the gut in response to emetogenic stimuli, so 5-HT3 antagonists prevent this.

124
Q

side effects of 5-HT3 receptor antagonists

A

side effects are rare
constipation
diarrhoea
headaches

125
Q

warnings for use of 5-HT3 receptor antagonists

A

don’t use in people with a prolonged QT interval. Avoid in patients using antipsychotics and SSRIs

126
Q

name a neurokinin-1 receptor antagonist

A

aprepitant

127
Q

indications for neurokinin-1 receptor antagonist

A

cytotoxic drug induced vomiting

128
Q

MOA of neurokinin-1 receptor antagonists

A

Block NK1 receptors in CTZ, inhibiting the action of substance P

129
Q

side effects of NK-1 receptor antagonists

A

fatigue
dizziness
diarrhoea or constipation

130
Q

name a cannabinoid

A

nabilone

131
Q

indications of cannibinoids

A

cytotoxic drug induced vomiting

132
Q

MOA of cannibinoids

A

inhibit CB1 receptors in several areas of the CNS, reducing their ability to release serotonin

133
Q

side effects of cannabinoids

A

sedation
hallucination & disorientation
dry mouth

134
Q

name a corticosteroid anti-emetic

A

dexamethasone

135
Q

indications of corticosteroid anti-emetics

A

cytotoxic drug induced vomiting

usually used as an additive

136
Q

side effects of corticosteroid anti-emetics

A

insomnia
indigestion
agitation

137
Q

name some crystalloid solutions

A

0.9% NaCl
5% glucose
hartmann’s solution (comound sodium lactate)

138
Q

indications of crystalloid solutions

A

fluid resuscitation and maintenance

139
Q

MOA of hartmanns solution

A

contains NaCl, CaCl2, KCl, sodium lactate and water and is used to replace elcrolytes

140
Q

side effects of hartmann’s solution

A

hypervolaemia
hyperkalaemia
hypercalcaemia
hypersensitivity

141
Q

side effects of 09% NaCl

A

oedema
hypertension
hypernatraemia

142
Q

side effects of 5% IV glucose

A

electrolyte imbalance
polyuria
oedema

year 3 drug list (4 decks)

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