Pharmacology

Question 1

2 types of mucosal strengthener

Answer 1

Sucraflate

Bismuth Chealate

Question 2

Sulfacrate

Answer 2

Negative charge allows drug to bind to postivley charged proteins
Forms complex gel, strengthens mucous
Reduces secretion

Question 3

Bismuth Chealate

Answer 3

Mucosal strengthening

Toxic towards H. Pylori

Question 4

PPI example

Answer 4

Omeprazole, Iansoprazole, Pantoprazole

Question 5

PPI mechanism of action

Answer 5

Block enzyme in wall of stomach that produced acid
(Irreversible inhibition, blocks ATPase PP in of gastric gland parietal cell)
Reduce acid secretion

Question 6

PPI major indications

Answer 6

1. Peptic ulcer disease
2. Symptomatic relief of GORD
3. Eradication of H. Pylori (in conjunction with antibiotics)

Question 7

PPI uncommon indications

Answer 7

Zollinger-Ellison syndrome

Question 8

PPI adverse affects

Answer 8

Generally safe
Diarrhoea, headache, abdominal pain
Increased risk of C dif
Prolonged PPI = rebound acid hypersecretion

Question 9

PPI Warnings

Answer 9

May disguise symptoms of gastric cancer

Question 10

Histamine Type H2 Receptor Antagonists examples

Answer 10

Ranitadine

Question 11

H2 receptors antagonists Mechanism of Action

Answer 11

Comp antagonism of H2 receptor located on basolateral membrane of acid secreting parietal cells of gastric glands
Reduces gastric acid production (less effective than PPI)

Question 12

H2 receptor antagonist indications

Answer 12

1. Prevention and treatment of peptic ulcer disease

2. Symptomatic relief of dyspepsia and GORD

Question 13

Alginates and Antacids examples

Answer 13

Gaviscon, Peptac, Mucogel

Question 14

Antacids

Answer 14

Alone can be used for short term relief of dyspepsia
Act as buffers that increase pH of gastric juice and inactivate pepsin
Suppress mucosal damage

Question 15

Alginates

Answer 15

Increase viscosity of gastric juice and upon reaction with acid produce a foam, separating gastric contents from oesophagus
Suppress mucosal damage

Question 16

Indications for A&A

Answer 16

GORD

Dyspepsia

Question 17

A&A adverse effects

Answer 17

Antacids alone can cause diarrhoea
Alginates alone can cause constipation
Together in equal amounts = safe

Question 18

Antimuscarinic drug examples

Answer 18

Hyoscine Butylbromide

Question 19

Antimuscarinic mechanism of action

Answer 19

Competitive antagonist of muscarinic acetylcholine receptors
Oppose parasympathetic division of ANS
Reduces spasm of smooth muscle, peristalsis and glandular secretions blocked by M3

Question 20

Antimuscarinic indications

Answer 20

Relieve smooth muscle spasms in IBS

Question 21

Adverse effects of antimuscarinics

Answer 21

Dry mouth, tachycardia, constipation, urinary retention, blurred vision

Question 22

Anti-motility drug examples

Answer 22

Loperamide, codeine phosphate

Question 23

Loperamide mechanism of action

Answer 23

Synthetic opioid with agonist activity
Increases tone and rhythmic contractions of intestine, constricts smooth muscle sphincters but inhibits peristalsis
Constipation

Question 24

Anti-motility drugs indications

Answer 24

1. Acute diarrhoea (NOT HOSPITAL)
2. Symptomatic relief of IBS
3. Analgesia for acute moderate pain (codeine)

Question 25

Anti-motility drug contraindications

Answer 25

UC = risk of toxic megacolon and perforation Acute bloody diarrhoea C dif colitis

Question 26

Aminosalycates examples

Answer 26

Mesalazine, balsalazide, sulfasalzine

Question 27

Aminosalycate mechanism of action

Answer 27

5-ASA acts locally to exert an anti-inflammatory response and immunosuppressant affect upon the colon

Question 28

Mesalazine and balsazide 1st line treatment fot

Answer 28

UC

Question 29

Sulfalazine indications

Answer 29

Arthritis

Question 30

Sulfsalazine side effects

Answer 30

Hypersensitivity reaction

Question 31

Bulk forming Laxatives examples

Answer 31

Ispagula husk

Question 32

Bulk laxative indication

Answer 32

1. Constipation and faecal impaction | 2. Mild chronic diarrhoea with diverticular disease or IBS

Question 33

Bulk laxative warnings

Answer 33

Don't use in those with intestinal obstruction

Question 34

Osmotic laxatives examples

Answer 34

Lactulose, macrogol and phosphate enema

Question 35

Osmotic laxative mechanism of action

Answer 35

Osmotically active agents that are neither digested or absorbed Water attracted to stool, increases bulk and stimulates peristalsis

Question 36

Osmotic laxative indications

Answer 36

1. Constipation and faecal impaction 2. Bowel preparation before endoscopy or surgery 3. Hepatic encephalopathy

Question 37

Side effects of osmotic laxatives

Answer 37

Abdominal cramps, flatulence etc

Question 38

Stimulant laxatives examples

Answer 38

Senna bisocodyl, gylcercol suppository

Question 39

Stimulant laxatives mechanism of action

Answer 39

Increased electrolyte and thus water secretion from the colonic mucosa Colonic content is increased stimulating peristalsis, which for some agents may also occur by a direct action on the enteric nervous system

Question 40

Stimulant laxative indications

Answer 40

1. Constipation | 2. Faecal impaction

Question 41

Antiemetics (Dopamine D2 receptor antagonists) examples

Answer 41

Domperdione, metoclopramide

Question 42

D2 receptor antagonists mechanism of action

Answer 42

Antagonists of D2 receptors Dopamine relaxes stomach and lower oesophageal sphincter and disrupts gastroduodenal coordination Pro-motility agents

Question 43

D2 receptors antagonist indications

Answer 43

1. Treatment of nausea and vomiting | 2. Treatment of GORD

Question 44

Histamine H1 Receptor antagonist examples

Answer 44

Cyclizine, cinnarazine

Question 45

H1 receptors antagonist mechanism of action

Answer 45

Comp antagonism of H1 receptors in vomiting centre and elsewhere in CNS to cause sedation Also block M3

Question 46

H1 receptor antagonist major indications

Answer 46

Treatment of nausea and vomiting: - Sickness and vertigo - Post op

Question 47

Phenothiazine examples

Answer 47

Procloperazine

Question 48

Phenothiazine mechanism of action

Answer 48

Comp antgaonism of D2, H1 and M1 receptors in vomiting centre, vestibular system and peripherally in gut

Question 49

Phenothiazine indications

Answer 49

1. Nausea and vomiting | 2. Psychiatric disorders

Question 50

5-HT3 receptor antagonists examples

Answer 50

ondansetron

Question 51

5-HT3 receptor antagonists mechanism of action

Answer 51

Competitive antagonism of 5-HT3 receptors | Located in chemoreceptor trigger zone

Question 52

5-HT3 receptor antagonists indications

Answer 52

1. Treat nausea and vomiting induced by chemo and radiotherapy and post op