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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Pirenzipine is obsolete for PUD but is a ___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
nabilone(CB1 r. ant) is used for ____ emesis decreases emesis that is due to ___ stimulation side effects =
cytotoxic chemo when others dont work CTZ drowsy, dizzy, xerostomia, mood changes
26
Anti-emetics used for motion sickness
Muscarinic r. ant.s - hyoscine/scopolamine | H1 r. ant.s - cyclizine/cinnarizine
27
Anti-emetics for chemo. emesis
5-HT3 r. ant (ondansetron) with NK1 r. ant (aprepitant) and dexamethasone nabilone (CB1 r. ant.) if others don't work
28
Slow acting laxatives =
bulk laxatives | methylcellulose, Ispaghula husk = indigestible polysaccharides
29
Fast acting laxatives =
osmotic laxatives Mg sulfate/hydroxide, lactulose PO Na citrate PR
30
Stimulant purgatives eg.s
biasacodyl PO/suppository, senna, Na picosulfate
31
Faecal softener purgatives eg.s
docusate Na PO | arachis oil enema
32
To reverse warfarin give __ then ___
vitamin K | Prothrombin Complex Concentrate (contains 2, 7, 9 and 10)
33
In liver disease coagulopathy(prone to bleeding) give ___ | however if is significant biliary obstruction the give ___ because it has ___
vitamin K first line | fresh frozen plasma - contains all clotting factors
34
Don't give ___ to bleeding ascitic patient as makes it worse
saline
35
Gentamicin can't be given___ (route)
PO
36
antibiotic for pseudomonas =
quinolones eg. ciprofloxacin PO
37
omeprazole and lansoprazole are __ | indicated for
``` PPIs PUD GORD/dyspepsia H. pylori eradication Zollinger-Ellison ```
38
Reduces pepsinogen to pepsin | irreversibly blocks H+K+ATPase on canalicular membrane =
PPI | omeprazole
39
PPIs interact with ___ and ___ action of clopidogrel and ___ action of phenytoin and warfarin
cytochrome P450 isoenzymes decrease clopidogrel increase phenytoin and warfarin
40
Administration of PPIs =
PO od morning 30-60mins before food | IV for reccurent ulcer bleeds in high risk pt.s
41
PPIs may increase risk of ___ infection and disguise symptoms of
risk of C. diff | disguise gastric ca
42
Ranitidine is a
H2 receptor antagonist
43
H2 receptor antagonists are bettter than PPIs in this case
reducing acid pre-op as have a faster onset of action
44
loperamide and codeine phosphate are ___
anti-motility drugs
45
loperamide is indicated in
acute diarrhoea and IBS diarrhoea (symptom control only)
46
Mechanism of action of loperamide and codeine phosphate
agonise μ opiod receptors on enteric neurones > increase tone and rhythmic contraction of intestine, contrict SM sphincters and decrease peristalsis also antisecretory
47
Contraindications for anti-motility drugs -
acute UC (megacolon and perf risk) dysentry C.diff colitis (therefore not for any hosp acquired diarr) not if under 4yo
48
loperamide is administered ___
PO as capsule/tablet
49
Ispaghula husk is a
bulk laxative
50
Contraindications to bulk laxatives =
at risk/have intestinal obstruction/ileus | post-op constipation (may have ileus)
51
Administer bulk laxatives __ at __ with ___
PO mealtimes lots of water
52
lactulose and phosphate enemas are ___
osmotic laxatives
53
used in hepatic encephalopathy because reduces ammonia reabsorption in gut by decreasing transit time acidifies stool inhibits proliferation of NH3 producing bacteria
lactulose
54
If faecal impaction try ___ before ___enema
stimulant eg. glycerol suppository | phosphate enema
55
Senna, bisocodyl, docusate Na and glycerol suppository are
stimulant laxatives
56
increase H2O and electrolyte secretion from colonic mucosa and stimulate peristalsis =
stimulant laxatives eg. senna
57
doperamide and metoclopramide are
D2 (dopamine) receptor anatagonist anti-emetics
58
cyclizine and cinnarizine are
H1 receptor antagonist anti-emetics
59
Mechanism of action of H1 receptor antagonist eg. cyyclizine
block H1 rec in VC and elsewhere in CNS (sedation) | block M1 rec in vestibular apparatus
60
side effects of H1 rec ants eg. cyclizine
xerostomia sedation transient tachy (if IV)
61
H1 rec ant.s treat nausea and vom in
vertigo, motion sickness and post-op
62
D2 rec ants treat nausea and vomiting in
esp if reduced gut motility as are pro-motility in drug and chemo induced vomiting in emergency hormonal contraception.
63
procloperazine =
phenothiazine anti-emetic
64
mechanism of action of procloperazine =
comp ant of D2, H1 and M1 receptors in VC, vestibular system and ENS
65
indications for procloperazine
nausea and vom (others preferred though) vertigo and chemo related psychiatric disorders eg. schizophrenia
66
Contraindications for H1 rec ant anti emetics
at risk of hepatic encephalopathy | prostatic hyperplasia
67
contraindications for procloperazine
severe liver disease prostatic hyperplasia reduce dose in elderly as may lead to confusion
68
ondansetron is a
5-HT3 receptor antagonist anti-emetic
69
alosetron indication =
diarrhoea predominant IBS in females
70
indications for 5-HT3 rec ants =
nausea and vom chemo/radio induced/post op after general anaesthesia
71
high dose ondansetron can cause what side effect?
long QT syndrome
72
Contraindications for ondansetron
``` severe/prolonged constipation intestinal obstruction/stricture toxic megacolon ischaemic colitis Crohn's UC diverticulitis ```
73
Mechanism of action of ondansetron
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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