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GI AM > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What are the types of GI drug?

A 
Acid suppressants
Drugs affecting motility
Laxatives
IBD drugs
Drugs affecting intestinal secretions
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2
Q

What are the types of acid suppressants?

A

Antacids
H2 receptor antagonists
Proton pump inhibitors

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3
Q

What drugs affect GI motility?

A

Anti-emetics
Antimuscarinics/other antispasmodics
Antimotility

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4
Q

What are the types of IBD drug?

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

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5
Q

What are the types of drug affecting intestinal secretions?

A

Bile acid sequestrates

Urodeocycolic acid

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6
Q

How do antacids work?

A

Neutralise gastric acid

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7
Q

What are alginates?

A

A type of antacid that works by forming a viscous gel that floats on stomach contents and reduces reflux

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8
Q

How do H2 receptor antagonists work?

A

Block histamine receptor, and thereby reducing acid secretion

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9
Q

When are H2indicated for use?

A

GORD

Peptic ulcer disease

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10
Q

How are H2 receptor antagonists given?

A

Oral or IV

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11
Q

How do proton pump inhibitors work?

A

Block proton pump and thereby reduce acid secretion

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12
Q

When are proton pump inhibitors indicated for use?

A

GORD
Peptic ulcer disease
Triple therapy for treatment of PU/DU associated H pylori

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13
Q

What are the problems associated with proton pump inhibitor use?

A

GI upset

Predisposition to c. diff, hypomagnesaemia, B12 deficiency

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14
Q

What do pro kinetic agents do?

A

Increase gut motility and gastric emptying

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15
Q

What are pro kinetic agents used for?

A

Gastroparesis
GORD
as antiemetics

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16
Q

How do prokinetics work?

A

Unclear

Involves parasympathetic nervous system control of smooth muscle and sphincter tone

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17
Q

What can drugs which decrease motility be used for?

A

Clinical benefit i.e. antidiarrhoea

Cause unwanted effects i.e. constipation

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18
Q

How do drugs decreasing motility work?

A

Via opiate receptors in GI tract to decrease Ach release, decreasing smooth muscle contraction and increasing anal sphincter tone

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19
Q

What are antispasmodics used for?

A

IBS

Renal colic

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20
Q

What are the 3 mechanisms of antispasmodics action?

A

Anti cholinergic muscarinic antagonists
Direct smooth muscle relaxants
CCBs reducing Ca required for smooth muscle contraction

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21
Q

What are the 4 types of laxatives?

A

Bulk
Osmotic
Stimulant
Softeners

22
Q

What are the issues associated with laxatives?

A

Obstruction
Route of adminisation
Need for other measures
Misuse

23
Q

Wat is the mechanism of action of aminosalicylates?

A

Unclear but anti inflammatory

24
Q

What are the adverse effects of aminosalicylates?

A

GI upset
Blood dycrasias
Renal impairment

25
Q

How do corticosteroids work?

A

Antiinflmmatory

26
Q

What are the complications of corticosteroids?

A

Increases susceptibility to infection

Addisonian crisis with abrupt withdrawal

27
Q

How do immunosuppressants work?

A

Prevents formation of purines required for DNA system thesis so reduces immune cell proliferation

28
Q

What are the adverse effects of immunosuppressants?

A

Mainly relate to bone marrow suppression
Asatioprine hypersensitivity
Organ damage

29
Q

How do biologics work?

A

Addresses inflammatory response but not underlying disease process

30
Q

What are the contraindications for biologics use

A

Current TB or other serious infection
MS
Pregnancy/breastfeeding

31
Q

What are the adverse effects of biologics?

A 
Risk of infection, esp TB
Infusion reaction
Anaemia, thrombocytopenia, neutropenia
Demyelination
Malignancy
32
Q

How does cholestryamine work?

A

Reduces bile salts by binding with them in the gut and then excreting them as an insoluble complex

33
Q

What is ursodeoxycholic acid used to treat>

A

Gallstones and primary biliary cirrhosis

34
Q

How does ursodeoxycholic acid work?

A

Inhibits an enzyme involved in the formation of cholesterol, altering the amount of bile and slowly dissolving non calcified stones

35
Q

What can affect the ADME processes of a drug?

A

Gi or liver disease

36
Q

What can affect the absorption of a drug?

A

pH
Gut length
Transit time

37
Q

What can affect the distribution of a drug and how?

A

Low albumin- decreased binding and increased free drug concentration

38
Q

What can affect the metabolism of a drug?

A

Liver enzymes
Gut bacteria
Gut wall metabolism
Liver blood flow

39
Q

What are the most common GI adverse effects?

A 
GI upset
COnstipation/diarrhoea
GI bleeding/ulceration
Changes to gut bacteria
Liver injury
40
Q

What causes changes to gut bacteria?

A

Mainly antibiotics

41
Q

What can changes in gut bacteria cause?

A

Loss of OCP activity
Reduced vit K absorption
Overgrowth of pathogenic bacteria

42
Q

What are the 2 types of drug induced liver injury?

A

Intrinsic hepatotoxicity

Idiosyncratic hepatotoxicity

43
Q

What is intrinsic hepatotoxicity?

A

Predictable, dose dependent, acute reaction

44
Q

What is idiosyncratic hepatotoxicity?

A

Unpredictable, not dose dependent, may occur at amy time and be part of hypersensitivity reaction

45
Q

What are the risk factors for drug induced liver injury?

A 
Age
Female
Alcohol consumption
Genetic factors
Malnourishment
46
Q

How is the severity of liver disease classified?

A

Child-Pugh classification

47
Q

What does the Child-Pugh classification look at?

A 
Bilirubin
Albumin
PT
Encephalopathy
Ascites
48
Q

What are the 2 year survival rates in the Child-Pugh classification system?

A 
<7= 85%
7-9= 57%
>9= 35%
49
Q

When should care be taken when prescribing in patients with liver disease?

A

Drugs which can be toxic due to changes in pharmacokinetics
Drugs with hepatotoxicity or may worsen non liver aspects of liver disease
Warfarin/anticoagulents
Aspirin/NSAIDs
Opiates/benzodiazepines

50
Q

Why must care be taken in liver disease with warfarin/anticoagulents?

A

Clotting factors already low

51
Q

Why must care be taken in liver disease with aspirin/NSAIDs?

A

Increase bleeding time

Worsen ascites

52
Q

Why must care be taken in liver disease with opiates/benzodiazepines?

A

May precipitate encephalopathy by increasing sedation

GI AM (34 decks)

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