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JazGI > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Pirenzipine is obsolete for PUD but is a ___

A

M1+3 muscarinic receptor antagonist

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2
Q

PPIs block ___ on ___ NOT in ____

eg.s =

A

H+K+ATPase on apical membrane NOT in tuberovesicles

omeprazole

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3
Q

PGE1 analogue co-admined with NSAIDS to prevent PUD

Its effects =

A

misoprostol
decreases basal and stimulated secretion of acid
maintains/increases mucus and HCO3- secretion

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4
Q

Effect of COX-1 inhibitors on stomach

A

decrease PGE2 which increases acid secretion and causes PUD

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5
Q

eg. of H2 receptor antagonist

A

ranitidine

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6
Q

Drugs that inhibit gastric acid secretion are used to treat __(3)

A

GORD/dyspepsia
PUD
acid hypersecretion - by Zollinger-Ellison(gastrinoma)/Cushings (causes increased vagal tone)

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7
Q

mucosal strengtheners eg.s

Mechanism:

A

sucralfate
bismuth chealate
= bind to ulcer base and form gel with mucus, increase mucosal blood flow (^H+ removal), mucus, HCO3- and PG production

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8
Q

5-HT3 receptor antagonist eg.s

A

ondansetron, palonosetron

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9
Q

5-HT3 receptor antagonists are for ___
not ___
side effects:

A

For: chemo and radio acutely (long term add corticosteroid and (neurokinin) NK receptor ant.), Post op N+V
NOT motion sickness/dopaminergic v
constipation + headaches

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10
Q

5-HT3 receptor antagonists block receptors in __+_

A

peripheral (gut) and central (AP) receptors

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11
Q

muscarinic ACh receptor antagonist anti emetic eg.s

A

hyoscine, scopolamine

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12
Q

hyoscine and scopolamine (M antagonists) are used for

A

prophlaxis/treatment of motion sickness

can be given as a trans-dermal patch

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13
Q

side effects of M antagonist anti-emetics

A

para ANS = blurred vision, urinary retention, xerostomia

sedation

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14
Q

H1 receptor antagonist anti-emetic egs

A

cyclizine, cinnarizine

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15
Q

H1 rec. ant. antiemetics are used for ___

A

prophylaxis/treatment of motion sickness
acute labyrinthitis
stomach irritants

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16
Q

H1 rec ant.s block receptors in + and so may cause sedation. Not for emesis causes that directly affect ___

A

vestibular nuclei and NTS

not CTZ

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17
Q

anti-emetics: dopamine receptor antagonist eg.s

A

domperidone

metoclopramide

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18
Q

dopamine rec ant anti-emetics are for __

and not ___

A

drug induced and GI disorder causes of N+V

NOT motion sickness

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19
Q

mechanism of action of dopamine rec ant anti-emetics

A

block D2+3 in CTZ and have prokinetic effects on oeso, stomach and intestines

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20
Q

dopamine rec. ant.s are restricted in ___

metoclopramide/domperidone crosses the BBB and causes ___ side effects

A

children
metoclopramide
extra-pyramidal effects - eg. disorders of movement

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21
Q

Anti emetic used for severe vomiting with partial D2 blockade

A

Phenothiazines

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22
Q

NK1 receptor antagonist anti emetic eg. =

assumed to antagonise ____

A

aprepitant

substance P

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23
Q

aprepitant (NK1 r. ant) is used in combination with + in acute phase of chemo for anti-emesis
and with ___ in delayed phase

A

dexamethasone and 5-HT3 r. ant - eg. ondansetron

dexamethasone

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24
Q

CB1 (cannabinoid) r. ant anti-emetic eg.

A

nabilone

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25
Q

nabilone(CB1 r. ant) is used for ____ emesis
decreases emesis that is due to ___ stimulation
side effects =

A

cytotoxic chemo when others dont work
CTZ
drowsy, dizzy, xerostomia, mood changes

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26
Q

Anti-emetics used for motion sickness

A

Muscarinic r. ant.s - hyoscine/scopolamine

H1 r. ant.s - cyclizine/cinnarizine

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27
Q

Anti-emetics for chemo. emesis

A

5-HT3 r. ant (ondansetron) with NK1 r. ant (aprepitant) and dexamethasone
nabilone (CB1 r. ant.) if others don’t work

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28
Q

Slow acting laxatives =

A

bulk laxatives

methylcellulose, Ispaghula husk = indigestible polysaccharides

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29
Q

Fast acting laxatives =

A

osmotic laxatives
Mg sulfate/hydroxide, lactulose PO
Na citrate PR

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30
Q

Stimulant purgatives eg.s

A

biasacodyl PO/suppository, senna, Na picosulfate

31
Q

Faecal softener purgatives eg.s

A

docusate Na PO

arachis oil enema

32
Q

To reverse warfarin give __ then ___

A

vitamin K

Prothrombin Complex Concentrate (contains 2, 7, 9 and 10)

33
Q

In liver disease coagulopathy(prone to bleeding) give ___

however if is significant biliary obstruction the give ___ because it has ___

A

vitamin K first line

fresh frozen plasma - contains all clotting factors

34
Q

Don’t give ___ to bleeding ascitic patient as makes it worse

A

saline

35
Q

Gentamicin can’t be given___ (route)

A

PO

36
Q

antibiotic for pseudomonas =

A

quinolones eg. ciprofloxacin PO

37
Q

omeprazole and lansoprazole are __

indicated for

A 
PPIs
PUD
GORD/dyspepsia
H. pylori eradication
Zollinger-Ellison
38
Q

Reduces pepsinogen to pepsin

irreversibly blocks H+K+ATPase on canalicular membrane =

A

PPI

omeprazole

39
Q

PPIs interact with ___ and ___ action of clopidogrel and ___ action of phenytoin and warfarin

A

cytochrome P450 isoenzymes
decrease clopidogrel
increase phenytoin and warfarin

40
Q

Administration of PPIs =

A

PO od morning 30-60mins before food

IV for reccurent ulcer bleeds in high risk pt.s

41
Q

PPIs may increase risk of ___ infection and disguise symptoms of

A

risk of C. diff

disguise gastric ca

42
Q

Ranitidine is a

A

H2 receptor antagonist

43
Q

H2 receptor antagonists are bettter than PPIs in this case

A

reducing acid pre-op as have a faster onset of action

44
Q

loperamide and codeine phosphate are ___

A

anti-motility drugs

45
Q

loperamide is indicated in

A

acute diarrhoea and IBS diarrhoea (symptom control only)

46
Q

Mechanism of action of loperamide and codeine phosphate

A

agonise μ opiod receptors on enteric neurones > increase tone and rhythmic contraction of intestine, contrict SM sphincters and decrease peristalsis
also antisecretory

47
Q

Contraindications for anti-motility drugs -

A

acute UC (megacolon and perf risk)
dysentry
C.diff colitis (therefore not for any hosp acquired diarr)
not if under 4yo

48
Q

loperamide is administered ___

A

PO as capsule/tablet

49
Q

Ispaghula husk is a

A

bulk laxative

50
Q

Contraindications to bulk laxatives =

A

at risk/have intestinal obstruction/ileus

post-op constipation (may have ileus)

51
Q

Administer bulk laxatives __ at __ with ___

A

PO
mealtimes
lots of water

52
Q

lactulose and phosphate enemas are ___

A

osmotic laxatives

53
Q

used in hepatic encephalopathy
because reduces ammonia reabsorption in gut by decreasing transit time
acidifies stool
inhibits proliferation of NH3 producing bacteria

A

lactulose

54
Q

If faecal impaction try ___ before ___enema

A

stimulant eg. glycerol suppository

phosphate enema

55
Q

Senna, bisocodyl, docusate Na and glycerol suppository are

A

stimulant laxatives

56
Q

increase H2O and electrolyte secretion from colonic mucosa and stimulate peristalsis =

A

stimulant laxatives eg. senna

57
Q

doperamide and metoclopramide are

A

D2 (dopamine) receptor anatagonist anti-emetics

58
Q

cyclizine and cinnarizine are

A

H1 receptor antagonist anti-emetics

59
Q

Mechanism of action of H1 receptor antagonist eg. cyyclizine

A

block H1 rec in VC and elsewhere in CNS (sedation)

block M1 rec in vestibular apparatus

60
Q

side effects of H1 rec ants eg. cyclizine

A

xerostomia
sedation
transient tachy (if IV)

61
Q

H1 rec ant.s treat nausea and vom in

A

vertigo, motion sickness and post-op

62
Q

D2 rec ants treat nausea and vomiting in

A

esp if reduced gut motility as are pro-motility
in drug and chemo induced
vomiting in emergency hormonal contraception.

63
Q

procloperazine =

A

phenothiazine anti-emetic

64
Q

mechanism of action of procloperazine =

A

comp ant of D2, H1 and M1 receptors in VC, vestibular system and ENS

65
Q

indications for procloperazine

A

nausea and vom (others preferred though) vertigo and chemo related
psychiatric disorders eg. schizophrenia

66
Q

Contraindications for H1 rec ant anti emetics

A

at risk of hepatic encephalopathy

prostatic hyperplasia

67
Q

contraindications for procloperazine

A

severe liver disease
prostatic hyperplasia
reduce dose in elderly as may lead to confusion

68
Q

ondansetron is a

A

5-HT3 receptor antagonist anti-emetic

69
Q

alosetron indication =

A

diarrhoea predominant IBS in females

70
Q

indications for 5-HT3 rec ants =

A

nausea and vom chemo/radio induced/post op after general anaesthesia

71
Q

high dose ondansetron can cause what side effect?

A

long QT syndrome

72
Q

Contraindications for ondansetron

A 
severe/prolonged constipation
intestinal obstruction/stricture
toxic megacolon
ischaemic colitis
Crohn's
UC
diverticulitis
73
Q

Mechanism of action of ondansetron

A

comp ant 5-HT3 rec in CTZ, NTS and vagal afferent terminals in GI tract
Stop CTZ sensing emetogenics, stop visceral afferents from GI tract stimulating NTS in infection/chemo

JazGI (26 decks)

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