GI V: motility and inflammatory bowel disease Flashcards

1
Q

Drugs used to relieve constipation

A

1st line–> Bulk laxatives (methylcellulose)
2nd line –> osmostic laxatives (Mg hydroxide, Sodium citrate)
3rd line –> Stimulant laxatives (Senna)

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2
Q

Osmotic laxatives Examples

A

Mg Sulfate
Mg hydroxide
Sodium citrate
Sodium Phosphate
Lactulose
Macrogols

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3
Q

MoA of Osmotic laxatives

A

Provides osmotic load to draw water into GI lumen –> traps increased volumes of fluid in the lumen of the bowel –> accelerate the transfer of the gut contents through the small intestine.
* Distension in colon and purgation within 1h

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4
Q

Clinical uses of Magensium sulfate/ Mg hydroxide

A

2nd line tx of constipation
they are Saline purgatives→ poorly absorbed
solutes. Mg absorbed is too small to have adverse effects

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5
Q

AE of Osmotic laxatives

A

1) Heart block,
2) neuromuscular block or CNS depression.
3) Abdominal cramps.

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6
Q

Contraindication of Osmotic laxatives

A

In Small kids and
poor renal function

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7
Q

Bulk laxatives Examples

A

Methylcellulose
Sterculia
Agar
Bran
Ispaghula husk
Psyllium

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8
Q

Clinical uses of Methylcellulose and Psyllium

A

1st line anti-constipation drugs
* May take a few days to work
* slow-acting

* Bulk laxatives

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9
Q

AE of Bulk laxatives

A

Bloating

* no serious AE

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10
Q

MoA of Bulk laxatives

A

soluble fibers that draw water into gut lumen, forming viscous liquid (bulky hydrated mass) that promotes peristalsis

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11
Q

Clinical uses of Lactulose

A

1) Relives constipation
2) tx of hepatic encephalopathy

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12
Q

AE of Lactulose

A

1) Flatulence (“passing wind”),
2) cramps,
3) diarrhoea,
4) electrolyte disturbance.

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13
Q

Stimulant laxatives examples

A

Bisacodyl
Glycerol
Senna
Dantron

*Great Bella Sees Delusions

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14
Q

MoA of Senna/ Bisacodyl

A

Enteric nerve stimulation –> colonic contraction (increases peristalsis)

* Stimulant laxatives

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15
Q

Clinical uses of Senna/ Bisacodyl

A

3rd line anti-constipation tx

* Stimulant laxatives

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16
Q

AE of Stimulant laxatives

A

1) Abdominal cramps and
2) melanosis coli - caused by lon-term tx esp. Senna (deposition of brown/black pigment in the colorectal mucosa)

17
Q

Stool softener examples

A

Docusate sodium
Arachis oil
Liquid paraffin

18
Q

why are laxatives preferred over stool softeners in the tx of Constipation?

A

laxatives increase motility in the GI tract unlike stool softners, which only soften stool

19
Q

D2 receptor antagonists (Prokinetic) used in the tx of constipation

A

Metoclopramide
Domperidone

20
Q

Clinical uses of Metoclopramide and
Domperidone

A

1) GOERD
2) Gastroparesis (paralysis of the stomach -> slows digestion)
3) Anti-emesis

* D2 receptor antagonists

21
Q

MoA of Metoclopramide
Domperidone

A

D2 receptor antagonists –> increases motility in the lower oesophageal sphincter and duodenum

22
Q

4th line tx of constipation?

A

Prucalopride - selective HT-4 receptor agonist (prokinetic)

23
Q

AE of Prucalopride

A

Ab cramps,less appetite, diarrhoea, dizziness, dyspepsia, fatigue, flatulence, headache, nausea, polyuria, rectal bleeding, vomiting

24
Q

Anti-diarrheal agents?

A

1) Opiates (Codeine, Loperamide)
2) Anti-cholinergics (Atropine, Hyoscine)

25
Q

Which Opiate is more preferred in the tx of diarrhea, Codein or Loperamide . Explain

A

Loperamide –> not Addictive

Codeine acts on the CNS unlike Loperamide which acts on the PNS, meaning that it does not cross the BBB and therefor is not addictive like Codeine

  • Codeine is addictive if used for > 7 days
26
Q

AE of Opiates

*Codeine, Loperamide

A

1) Sedation
2) Dizziness
3) dry mouth
4) nausea
5) Constipation
6) Vomiting
7) ab cramps
8) mioses ( pupil constriction- “pin-point pupil)

27
Q

AE of anti-cholinergics (muscarinics)

*Hyoscine , Atropine

A

1) Mydriasis (pupil dilation )
2) Dry mouth
3) blurred vission
4) urinary retetion
5) constipation
6) Tachycardia

28
Q

Drugs used in the tx of inflamatory bowel disease (IBD)

A

1) Glucocorticoids (Prednison) –> Chron’s
2) Aminocalycilate (Sulfasalazine)–> Ulcerative colitis

29
Q

clinical uses of Methotrexate and Azathioprine

A

Long-term managment of IBD (reduce the long-term need for steroids)

30
Q

MoA of Azathioprine and 6-mercapto-purine

A

Inhibits Purine synthesis –> reduces inflammation

31
Q

1st line tx of Chron’s disease

A

Glucocortcoids
Prednisone/ Budesonide

* reduce inflammation

32
Q

1st line tx of Ulcerative colitis

A

Aminosalicylates (5-ASAS)
1) Sulfasalazine
2) Olsalazine
3) Balsalazide

-salazin/d

33
Q

CU of Sulfasalazine

* 5-ASA

A

Ulcerative colitis

34
Q

AE of Sulfasalazine

A

1) Diarrhoea,
2) salicylate sensitivity,
3) interstitial nephritis (monitor kidney
function - GFR)
,
4) decreases number and motility of sperm (reversible)

35
Q

Alternative drugs used in the tx of IBD when pateints are unresponsive to other treatments (steroids/ 5-ASAs)

A

Infliximab/Adalimumab
(TNF-a inhibitors)