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GIT & HEPATOBILIARY PMCLGY > Lecture 7 > Flashcards

Lecture 7 Flashcards

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1
Q

State clinical usefulness of drug that stimulate GI motility

A
  • In Gastroesophageal reflux disease, if it can increase lower esophageal sphincter pressure.
  • In gastroparesis & postsurgical gastric emptying delay, if it can improve gastric emptying.
  • For postoperative ileus or chronic intestinal pseudo-obstruction.
  • For treatment of constipation, if it enhance colonic transit.
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2
Q

What are the common causes of GI disorder (constipation) ?

A
  • dietary factor
  • lack of exercise
  • elderly person
  • pathologic condition
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3
Q

What is the prokinetic agent

A

Drug that increases GI tract motility without evacuation

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4
Q

what are the example of prokinetic agent

A
  • metoclopramide
  • domperidone
  • cisapride
  • parasympathomimetics
  • motility like agents
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5
Q

WHICH PROKINETIC AGENT IS DOPAMINE RECEPTOR ANTAGONIST?

A
  • metoclopramide

- domperidone

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6
Q

what are the actions of metoclopramide and domperidone?

A 
*blocking central dopamine receptors in
the chemoreceptor trigger zone, they
produce an antiemetic action
*increase contractions in the stomach and
enhance the tone of the lower esophageal
sphincter, actions that combine to speed
the transit of contents from the stomach
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7
Q

What is the difference between metoclopramide and domperidone in term of crossing BBB

A

Metoclopramide ca ross BBB meanwhile domperidone had limited passages to pass through BBB

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8
Q

What are the therapeutic uses of metoclopramide

A

● All vomiting EXCEPT motion sickness.
● Gastric hypomotility e.g. Diabetic gastroparesis.
● Emergency evacuation of stomach before surgery or
X-ray.
● Gastroesophageal-Reflux-Disease (GERD. Reflux
Esophagitis),
● Hiccup.

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9
Q

what is the doses for metoclopramide

A

10 mg 3-4 times/day Orally, Rectally. IM & IV.

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10
Q

what are the side effects of metoclopramide

A

●Gastrointestinal upset
● Dizziness & nervousness.
● Extrapyramidal manifestations e.g. Parkinsonism &
ataxia.
● Hyperprolactinemia ~> Galactorrhea in females

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11
Q

what are the therapeutic uses of domperidone

A
  • To increase motility

- hyperprolactinemia

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12
Q

what are the side effects of domperidone?

A
  • Rarely extrapyramidal
  • hyperprolactinaemia
  • cardiac arrhythmias
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13
Q

what are the pharmacodynamics of cisapride?

A

1) Increase 5-HT4 receptors in enteric ganglia
2) Causes release of Ach
3) Gastric and colonic motility increases

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14
Q

State the four intestinal evacuants

A
  • purgatives
  • cleansing enema
  • glycerin suppository
  • smooth muscle stimulants
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15
Q

what is purgatives?

A

Drugs taken Orally to evacuate the bowel.

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16
Q

purgative can be divided to what?

A
  • MILD(LAXATIVE) PURGATIVE

- POTENT(CATHORTIC) PURGATIVE

17
Q

WHATS THE DIFFERENCES BETWEEN MILD AND POTENT PURGATIVES?

A

MILD-production of a soft formed stool over a period of 1 or more days
POTENT-prompt, fluid evacuation of the bowel, more intense

18
Q

WHAT ARE THE THERAPEUTIC USES OF PURGATIVES

A
  • Constipation
  • Constipation
  • Before operation & X-ray abdomen
  • To avoid straining in some patients
19
Q

WHAT ARE THE CLASSIFICATIONS OF PURGATIVES

A
  • PHYSICAL PURGATIVES

- CHEMICAL(IRRITANT) PURGATIVES

20
Q

PHYSICAL PURGATIVES CAN BE DIVIDED TO?

A
  1. BULK FORMING (LUMINALLY ACTIVE AGENTS)
  2. LUBRICANT (EMOLLIENT)
  3. SURFACTANT ( SURFACE ACTIVE AGENTS)
21
Q

CHEMICAL PURGATIVES CAN BE DIVIDED INTO?

A
  1. MILD IRRITANT
  2. MODERATE IRRITANT
  3. SEVERE IRRITANT
22
Q

WHAT ARE THE ACTIONS OF BULK FORMING PURGATIVES?

A

-They ↑ bulk of gastric & intestinal contents → Stretch
of wall → Reflex peristalsis.
-They act on BOTH small & large intestine.

23
Q

WHAT ARE THE ONSET OF ACTIONS OD BULK FORMING PURGATIVE?

A

-1-3 hours
● Taken in the
morning

24
Q

WHAT ARE THE EXAMPLE OF BULK FORMING PURGATIVES?

A
  • FOOD
  • METHYL CELLULOSE
  • SALINE PURGATIVES
  • PLANTAGO SEEDS AND AGAR
  • LACTULOSE (DUPHALAC SYRUP)
25
Q

WHAT ARE THE ACTIONS OF LUBRICANT PURGATIVE?

A 
1. Synthetic mineral Not
absorbed orally.
”emollient”
2. Softens & lubricates hard
fecal masses & mucosa of
large intestine.
3. Useful in Chronic
Constipation.
26
Q

WHAT IS THE ONSET OF ACTION OF LUBRICANT PURGATIVE?

A

● 8-10 hours

27
Q

WHAT ARE THE DISADVANTAGES OF LUBRICANT PURGATIVES?

A 
1. ↓↓Absorption of fat-soluble
vitamins (A, D, E & K)
2. ↓↓Absorption of other drugs
e.g. Oral Contraceptives.
3. Uncontrolled leakage from
anal sphincter.
4. If absorbed orally → Foreign
body reaction in liver.
5. If it reaches the lung → Lipid
pneumonia.
28
Q

WHAT ARE THE ACTIONS OF SURFACTANT PURGATIVES?

A 
1. Lowers surface tension of hard
fecal masses
2. →facilitate penetration of water
to stool
3. → Wetting & softening.
29
Q

WHAT ARE THE DISADVANTAGES AND CONTRANDICATIONS OF CHEMICAL PURGATIVES?

A
  1. Colic, diarrhea & dehydration → Add small doses of Atropine or Hyoscine.
  2. ↓↓ Absorption of nutrients & drugs.
  3. Pelvic congestion:
    a- Menstruation → Dysmenorrhea.
    b- Pregnancy → Abortion.
  4. May be excreted in milk → Affect suckling baby.
30
Q

WHAT ARE THE TYPES OF ENEMATA?

A
  • RETENTION ENEMATA

- EVACUANT ENEMATA

31
Q

WHAT ARE THE DIFFERENCES BETWEEN RETENTION AND EVACUANT ENEMATA

A 
Retention Enemata
● Small volume
● Low head pressure
● non-irritant
Evacuant Enemata
● Large volume
● High head pressure
● Mild irritant
32
Q

WHAT ARE THE PHARMACODYNAMICS OF LAXATIVE

A

● Stimulate peristalsis by irritate the smooth muscle of large intestine
● Alter water and electrolyte secretion

33
Q

WHAT ARE THE CAUTIONS OF LAXATIVE?

A

● Children
● Pregnancy
● lactation

GIT & HEPATOBILIARY PMCLGY (3 decks)

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