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RESP & GIT Pharmacology > GORD > Flashcards

GORD Flashcards

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1
Q

Management of GORD

A
  1. Reduce/suppress gastric acid secretion
  2. Mucosal protection (barrier)
  3. Neutralizing gastric acid
  4. Eradicate H. Pylori
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2
Q

Proton pump inhibitors mechanism

A

-prazole’s

  • irreversible inhibition of H+/K+ ATPase enzyme (proton pump)
  • suppress H+ ions into lumen

Omeprazole: only one that has significant drug interactions (inhibits CYP450) - toxic side effects from other drugs

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3
Q

PPI side effects

A
  • hypomagnesemia (in prolonged use
  • risk of fractures and osteoporosis (incomplete absorption of calcium carbonate)
  • clostridium difficile associated diarrhea NB
  • prevent B12 absorbtion (acid required for absorbtion) -> anemia
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4
Q

H2 receptor antagonists

A

Reversibly binds H2 receptors in parietal cells of stomach

-gastric acid secretion response to other secretagogues also reduced
(Food, caffeine, Ach, gastrin)

  • nocturnal acid hypersecretion: useful
  • or in people allergic to PPI’s
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5
Q

H2 receptor antagonists SE

A
  • not in pregnancy

- anti-androgenic effects

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6
Q

Cimetidine

A

H2RA
-inhibits CYP450 - more interactions

-also can be used to Rx molluscum contagiosum

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7
Q

Ranitidine

A

H2RA

  • as effective as cimetidine, less SE and interactions
  • little/no androgenic effects
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8
Q

Prostaglandins

A

Inhibit HCl secretion, wtimulates mucus and bicarbonate secretion and vasodilation of submucosa

  • Misoprostol
  • USE only in NSAID induced ulcers
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9
Q

Prostaglandin SE

A
  • not in pregnancy (contraction of uterus)

- nausea & diarrhea

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10
Q

Sucralfate

A

Mucosal protective agent

  • sucrose hydrogen sulphat-aluminum complex
  • forms paste like gel when in contact with HCl - barrier

-Don’t use with any other med (at least 2h) - forms unabsorbable complex

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11
Q

Bismuth Subcitrate

A

High affinity for damaged tissue - coats

SE: blackening of tongue, stools
-renal faiure in prolonged Rx

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12
Q

Alginates

A

-used in pregnancy

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13
Q

Antacids

A

-doesn’t block acid production, but neutralizes

  • aluminum hydroxide
  • calcium carbonate
  • magnesium
  • sodium bicarbonate
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14
Q

H. Pylori eradication

A

Triple therapy
-7-14d regimen

1. PPI (for 1mo)
Any two of following:
-clarithromycin 500mg bd
-amoxicillin 1g bd
Metronidazole 400mg bd
Levofloxacin if resistant to clarithromycin

PPI CI - then use ranitidine + bismuth

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15
Q

Vomiting centre

A

5HT2 receptors
Achm receptors
H receptors

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16
Q

Stomach & intestines

A

Stretch receptors
Chemoreceptors
5HT3 receptors

-projections to chemoreceptor trigger zone and vomiting centre

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17
Q

Chemoreceptor trigger zone

A

D2 (central) receptors
5HT3 receptors
NK1 receptors (NB)

-projections to vomiting centre

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18
Q

Vestibular system

A

Achm
H1 receptors

-projections to chemoreceptor trigger zone and vestibular center

19
Q

Antihistamines

A

-H1 blockers

20
Q

Antihistamines SE

A

Anticholinergic SE

21
Q

Promethazine

A

F

22
Q

Cyclizine

A

F

23
Q

Betahistine

A

D

24
Q

Cinnarizine

A

F

25
Q

Phenothiazines

A

Dopamine antagonists

  • most common general purpose anti-emetic
  • helpful in hiccups NBNB - numbs phrenic nerve which supplies diaphragm

-extra pyramidal SE

26
Q

Benzamides

A

D

27
Q

Butyrophenones

A

F

28
Q

Domperidone

A

D

29
Q

Haloperidol

A

D

30
Q

Metoclopramide

A

Dopamine antagonist

  • 5HT4 stimulation (prokinetic)
  • 5HT3 antagonist at higher doses
  • promotes gastric emptying
  • all nausea except labyrinth disorders
  • anti dopamine effects:
  • extrapyramidal Sx
31
Q

5HT3 receptor antagonists

A
  • chemotherapy induced emesis

- SE: headache, QT interval prolonged (monitor in heart disease)

32
Q

Ondansetron

A

F

33
Q

Granisetron

A

Ss

34
Q

Palonsetron

A

D

35
Q

Dolasetron

A

D

36
Q

Tropisetron

A

S

37
Q

Benzodiazepine

A

D

38
Q

Neurokinin Antagonists

A

Aprepitant

-

39
Q

Corticosteroids

A

Unknown mechanism of action

  • used with cytotoxic drugs - large doses
  • combo with NK1 Antagonists and 5HT3 antagonists
40
Q

Cannabinoids

A

Dronabinol and Nabilone

  • useful in cytotoxic therapy
  • blocks descending pathways in cortical centres
41
Q

Anti muscarinic agents

A
  • decreased GI motlity and secretory activity
  • muscarinic receptor blocking in vomiting centre and vestibular centre

-Don’t use in prostatic enlargement, or closed angle glaucoma, or intestinal obstruction

42
Q

Hyoscine

A

Anti-muscarinic

  • used in preventing motion sickness in short journeys
  • not for long term use!

-can be used to relieve smooth muscle spasms (intestinal, biliary, or genitourinary)

43
Q

Antimuscarinic SE

A

Think - fight or flight

  • cardiac arrhytmias
  • dry mouth
  • constipation
  • urinary retention
  • respiratory collapse/apnoea

RESP & GIT Pharmacology (4 decks)

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