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Liver failure GIM week 3 > Lower GI pharmacology > Flashcards

Lower GI pharmacology Flashcards

1
Q

What is the proper name for vomiting

A

emesis

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2
Q

HOW do toxins cause vomitin

A

Can affect visceral afferents or directly affect chemoreceptors

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3
Q

Different anti-emetics

A
  • H1- receptor antagonists
  • Anti-muscarinic agents
  • Dopamine antagonists
  • 5-hydroxytryptamine antagonists
  • Nabilone
  • Steroids
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4
Q

What are H1 receptor antagonists used for

A
  • Motion sickness

- Have anti-muscarinic actions

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5
Q

What are side effects of anti muscarinic agents

A

Are anti-muscarinic drugs so:

-Blurred vision, dry mouth, constipation, urinal tension

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6
Q

What are the uses of anti-muscarinic agents

A

Motion sickness and irritation of stomach

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7
Q

What do H1 receptors act on

A

Vestibular nuclei

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8
Q

What are the actions of dopamine antagonists and what are they effective against

A

Acts in chemoreceptor trigger zone but has unwanted CNS effects (drug induced Parkinson’s)

-effective against anticancer drug-induced emesis

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9
Q

What is the action of 5-hydroxytryptamine antagonists and what is it effective against

A

Blocks 5-HT at 5-HT3 receptors in gut and CNS

-Effective against anti-cancer drugs

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10
Q

WHen are steroids commonly used

A

IN patients with cancer

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11
Q

How do adhesive enterotoxigenic bacteria cause diarrhoea

A

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

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12
Q

How does cholera cause diarrhoea

A

CFTR is a Cl- specific channel

  • Cholera infects
  • CHolera toxin chemically modifies G protein
  • Activates adenylyl cyclase
  • Rise in cAMP which activates cl- channel and efflux of cl- from cell and that leads to removal of water from body
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13
Q

What drugs may diarrhoea be secondary to

A

Antibiotics
ORlistat (anti obesity drug) (is a pancreatic lipase inhibitor and so will cause fatty diarrhoea as fat is not being digested) (steatorrhea)
Misoprostol
PPIs

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14
Q

Which antibiotic may lead to pseudomembranous colitis

A

Clindamycin (c.difficil causes)

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15
Q

What is the first step of action for those with diarrhoea

A

Oral rehydration therapy (solution of electrolytes to replace electrolytes lost in diarrhoea)

  • ->Must be isotonic
  • ->glucose allows transport of Na via a symporter
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16
Q

How does oral rehydration therapy work

A

Amount of glucose is the right osmolarity. Glucose and sodium piggy back same transporter, sodium flows into cell with glucose and that is then followed by water

17
Q

When are antibiotics used for diarrhoea?

A

Are of little value. If a microbiologist identifies a causative bacteria then appropriate antibiotics may be used.

18
Q

Are probiotics appropriate for diarrhoea>

A

Can be recommended for elderly and children because it may reduce the duration of infection

19
Q

how else can diarrhoea be treated

A

Antimotility agents: opioids such as codeine and loperamide (Imodium)

20
Q

How do anti motility agents help with diarrhoea

A

Reduce tone and peristaltic movements of GI muscle by inhibiting the release of acetylcholine

21
Q

Mode of action of anti motility agents

A
  • Normally, depolarisation activates Ca2+ channel and calcium moves into cell. Act causes muscle to contract and that causes GI muscles to contract
  • loperamide activates opioid receptor. This switches off AC enzyme and reduces levels of cAMP and so activates K+ channels and K+ moves out. Causes hyper polarisation and so stops Ca2+ entry and stops release of ACh
22
Q

Benefits and drawbacks of anti motility agents

A

Provides symptomatic relied but does not shorten the course of the infection and could potentially increase the time of infection

23
Q

Side effect of codeine

A

COnstipation

24
Q

What side effects do some tricyclic antidepressants have

A

COnstipation

25
Q

What is the best approach for constipation

A

Balanced diet with roughage and plenty of fluid

26
Q

What are the go-to laxatives

A

Osmotic laxatives. They enter the colon unchanged and converted by bacteria to lactic and acetic acid which raises fluid volume osmotically

-MAcrogols also widely used

27
Q

Other laxatives

A
  • Magnesium (Mg2+ release cholecysystokinin which increases GI motility)
  • BUlking agents
  • Stimulant laxatives
  • Prucalopride (last option)
28
Q

What does IBS present as

A

At least 3 days per month in the last 3 months
A- abdominal pain/discomfort
B-Bloating relieved by defecation
C- Change in bowel habit

29
Q

IBS treatment

A

Lactulose or loperamide for symptoms

Antispasmodic agents which relieve constipation

Amitripyiline in low doses which provides some pain relief etc

30
Q

How to manage inflammatory bowel diseases such as Chronhs and ulcerative colitis

A

Anti-inflammatories and immunosuppressants

31
Q

Causes of constipation

A

Opiods
TCAs
Antimuscarinic drugs
Diuretics

Liver failure GIM week 3 (10 decks)

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