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Therapeutics > Lower GI > Flashcards

Lower GI Flashcards

1
Q

What do adhesive enterotoxigenic bacteria do?

A

Adhere to brush border, increase cAMP leading to CL- and Na+ secretion followed by water

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2
Q

Which drugs can cause diarrhoea?

A

Antibiotics- superinfection, alter lower GI flora
Clindamycin associated with pseudomembranous colitis
Orlistat- pancreatic lipase inhibitor
Causes fatty diarrhoea (steatorrhea)
Misoprostol- via cAMP
PPIs- Infection
Digoxin toxicity, acarbose, metformin and iron salts

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3
Q

What is oral rehydration therapy?

A

Solution of electrolytes to replace the electrolytes lost in diarrhoea e.g dioralyte
Must be isotonic
Glucose allows transport of Na via a symporter

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4
Q

Which antibiotic is often used for traveller’s diarrhoea?

A

Cirprofloxacin

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5
Q

What are anti-motility agents (opioids)?

A

Codeine and loperamide
Used for symptomatic relief
In infection can reduce clearance of infective organisms from the GI tract
Reduce tone and peristaltic movements of GI muscle by inhibiting presynaptically (via u-opioid receptors) the release of acetylcholine

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6
Q

What is presynaptic inhibition?

A

Reduces the release of Ach
Reduces motility and increases transit time
Promotes reabsorption of water

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7
Q

Where is loperamide largely retained?

A

In the gut

Does not penetrate BBB and has an efficient enterohepatic cycling

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8
Q

What does clonidine do?

A

Alpha2-adrenoceptor agonist

Cause presynaptic inhibition via a2 receptor leading to constipation

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9
Q

What is dicycloverine?

A

An antimuscarinic

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10
Q

What do tricyclic antidepressants do?

A

Constipating

Side effect through antagonism of muscarinic receptors

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11
Q

What drugs induce constipation?

A

Opioids
Tricyclic antidepressants
Antimuscarinic drugs
Diuretics- due to dehydration

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12
Q

What are osmotic laxatives?

A

Lactulose

Enters the colon unchanged and converted by bacteria to lactic and acetic acid- raise fluid volume osmotically

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13
Q

What are magnesium laxatives?

A

Osmotic effect

Mg2+ also release cholecystokinin which increases GI motility

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14
Q

What are bulking agents laxatives?

A

Ispaghula

Methylcellulose

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15
Q

What are stimulant laxatives?

A

Senna extracts, enter colon metabolised to anthracene derivatives which stimulates GI activity
Dantron- irritant

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16
Q

How is IBS treated?

A

Lactulose or loperamide
Antispasmodic agents
Amitriptyline

17
Q

What are antispasmodic agents?

A

Antimuscarinics: inhibit parasympathetic activity
Mebeverine: direct relaxant of GI smooth muscle- probably acting as a phosphodiesterase inhibitor

18
Q

What does amitriptyline (TCA) do?

A

Low doses widely used + effective
Provide some pain relief
Antimuscarinic effects
Alters the sensitivity of sensory nerves in low GIT

19
Q

What is inflammatory bowel disease?

A

Encompasses both ulcerative colitis and Crohn’s disease

Causes are unclear and include genetics, microbial, environmental aetiologies

20
Q

What are clinical features of inflammatory bowel disease?

A 
Diarrhoea
Faecal incontinence
Rectal bleeding, bloody diarrhoea 
Passing of mucus 
Cramping pains
Weight loss
In Crohn's disease there may be mouth ulcers and anal skin tags
21
Q

What complication can occur in Chrohn’s disease?

A

Malabsorption leading to deficiencies in folate and iron associated with iron-deficiency anaemia respectively

22
Q

What complication can occur in ulcerative colitis?

A

Blood loss can lead to iron deficiency anaemia

23
Q

What can inflammatory bowel disease be associated with?

A

Arthritis
Iritis
Uveitis
Increased risk of thromboembolism

24
Q

What’s Crohn’s disease?

A

Can affect any part of the GI tract, but mostly the ileum and/or colon are involved
T-lymphocytes are activated and lead to transmural inflammation and the extensive involvement may lead to the formation of fistulae

25
Q

What’s the treatment for Crohn’s disease?

A

5-aminosalicylates- mainstay for UC, less clear for Crohn;s
Sulphasalazine- metabolised in colon by gut flora to 5-ASA and sulphapyridine
Masalazine- pH changes yield 5-ASA
5-ASA- inhibits leukotriene and prostanoid formation, scavenge free radicals, decrease neutrophil chemotaxis

26
Q

What else is used to treat Crohn’s disease?

A

Corticosteroids
Prednisolone (anti-inflammatory, immunosuppressive actions)
Budesonide (poorly absorbed few side effects)
Probiotics
Fish oils
Immunosuppressants

27
Q

Which immunosuppressants are used to treat Crohn’s disease?

A

Azathiopine
Cyclosporine
Methotrexate
Infliximab (monoclonal antibody tumour necrosis factor (TNF-a) in severe disease)

28
Q

What counselling do patients need who are taking mesalazine (5-ASA)?

A 
Risk of blood dyscrasia
Report: 
Sore throats
Fevers
Easy bruising or bleeding
29
Q

What side effects are aminosalicylates associated with?

A

Rashes
Headaches
Diarrhoea

30
Q

What lifestyle advice should you give to people with Crohn’s disease?

A

Stop smoking
Exacerbated by NSAIDs
Exacerbated by alcohol

31
Q

If there is a narrowing which foods should be avoided that can form a bolus?

A

Nuts
Sweetcorn
Raw fruit
popcorn

32
Q

What’s an elemental diet?

A

Basic food substances
Amino acids as opposed to proteins
Low fat
Allows correction of micronutrients

33
Q

What are the side effects of aziothioprine?

A

Risk of pancreatitis
Requires FBC monitoring (6-8 weeks)
Risk of myelosuppression: bruising and bleeding, infections

34
Q

What is methotrexate effective in?

A

Crohn’s disease not in ulcerative colitis

Role in refractory disease and for steroid sparing

35
Q

What does methotrexate interact with?

A

Serious interaction with NSAIDs leading to toxicity

Once weekly dose (25 mg i.m or 12.5mg orally)

36
Q

What needs to be monitored when taking methotrexate?

A

FBC, renal function, LFT
Report fever/cough (indicate infection due to neutropenia)
Report cough/dyspnoea (indicate pulmonary toxicity)

37
Q

What happens if you give ciclosporin with steroids?

A

Increased risk of pneumocystis carinii and prophylactic co-trimoxazole must be used

38
Q

What is infliximab?

A

Monoclonal antibody which neutralises the pro inflammatory cytokine TNF-a, which is implicated in Crohn;s disease, possibly via leucocyte recruitment
Risk factor for developing tuberculosis
Infusion reactions are common so carried out in hospital

Therapeutics (17 decks)

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