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Final Year MBBS > Pharmacology - Gastroenterology > Flashcards

Pharmacology - Gastroenterology Flashcards

1
Q

Magnesium Trisilicate

A

Indications: Dyspepsia

MOA: Antacid –> Increases pH, neutralises gastric acid

S/E’s: Diarrhoea, belching due to liberated CO2

CI’s: - Hypophosphataemia

Interactions: Can affect absorption of other drugs therefore take it separately

Other info: Take when sypmtomatic or when expect symptoms

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2
Q

Aluminium Hydroxide

A

Indications: Dyspepsia, Hyperphosphataemia

MOA: Antacid –> Increases pH, neutralises gastric acid

S/E’s: Constipation

CI’s: Hypophosphataemia (PO4), Neonates and Infants

Interactions: Can affect absorption of other drugs therefore take separately

Other info: Take when symptomatic or when symptoms expected

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3
Q

Gaviscon

10-20mL after meals and bedtime

Oral solution

A
  • *Indications**: Dyspepsia, GORD
  • *MOA:** Na Alginate –> decreases reflux (increases viscosity of stomach contents and forms a raft on top of the stomach contents)
  • *S/E’s:** -
  • *CI’s:** -
  • *Interactions:** -
  • *Other info:** - Multiple flavours e.g. Aniseed, peppermint, sugar-free
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4
Q

Omeprazole

Lansoprazole

Pantoprazole

Esomeprazole

20 - 40mg OD Oral

A
  • *Indications:** GORD, Dyspepsia, PUD, Helicobacter pylori, Prevention and treatment of NSAID associated ulcers, Zollinger Ellison disease
  • *MOA:** Proton pump inhibitors –> Activated in acidic pH, irreversibly inhibit H/K/ATPase pump in parietal cells
  • *S/E’s:** GI disturbance - N,V+D, headache
  • *CI’s:** Lower dose in hepatic impairment
  • *Interactions:** P450 inhibitor (Omeprazole)
  • *Other info:** More effective than H2R antagonists. CAUTION - can mask symptoms of gastric ca. Increases likelihood of aspiration pneumonia. Can give by IV injection or infusion if need to.
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5
Q

Helicobacter Pylori Eradication Regime

A

PAC-500 = PPI: Lansoprazole 30mg BD, Amoxicillin 1g BD, Clarithromycin 500mg BD

PMC-250 = PPI: Lansoprazole 30mg BD, Metronidazole 400mg BD, Clarithromycin 250mg BD

7 days of Rx

Rem: PPI’s/H2RA’s = false negative C13 breath tests/antigen tests therefore stop 2 weeks before test

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6
Q

Cimetidine

Ranitidine

C - 400mg BD/800mg nocte

R - 150mg BD/300mg nocte

A
  • *Indications:** GORD, PUD, functional dyspepsia
  • *MOA:** H2R antagonist therefore descreases gastric parietal cell H+ secretion
  • *S/E’s:** Mainly cimetedine –> GI disturbance, headache, dizziness
  • *CI’s:** Decrease dose in hepatic and renal impairment
  • *Interactions:** Cimetidine is a P450 inhibitor therefore avoid in pts on warfarin, phenytoin and theophylline
  • *Other info:** Can mask symptoms of gastric ca. Take at night time.
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7
Q

Misoprostol

200 micrograms QDS with meals and nocte

A
  • *Indications:** NSAID associated PUD, abortion, delayed miscarriage and to induce labour (uterine stimulant)
  • *MOA:** Prostaglandin analogue –> acts on parietal cells to decrease H+ secretion, also has protective properties and promotes ulcer healing
  • *S/E’s:** Diarrhea = very common, abdo pain, flatulence, N+V, abnormal PV bleeding
  • *CI’s:** PREGNANCY/ Women of child bearing age (teratogenic in 1st trimester), caution in IBD/CVD/IHD
  • *Interactions:** -
  • *Other info:** Often given in combination with NSAID (Diclofenac + Misoprostol = Arthrotec)
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8
Q

Ispaghula husk (Fybogel)

Bran

Methylcellulose

Sterculia

A
  • *Indications:** CONSTIPATION - can be used in those with stomas, haemorrhoids, anal fissures, IBS, IBD and diverticular disease.
  • *MOA:** Bulk forming laxatives –> increase faecal mass which stimulates peristalsis. Can take several days to work.
  • *S/E’s:** Flatulence, abdo distension/ bloating
  • *CI’s:** Bowel obstruction, faecal impaction, difficulty swallowing
  • *Interactions: -**
  • *Other info:** Very useful in those with small hard stools.Counsel pt re adequate fluid and fibre intake to avoid constipation. Try bran first, then ispaghula.
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9
Q

Sodium Docusate

Sodium Picosulfate

Senna (an anthraquinone) Tablets 7.5mg 2-4 tablets nocte

Glycerol PR suppositories x 1 PRN

Stimulant laxatives

A

Indications: CONSTIPATION
MOA: Stimulant laxatives –> increase intestinal motility
S/E’s: Abdo cramp/colic, excess use causes diarrhoea and hypokalaemia
CI’s: -
Interactions: -
Other info: Senna acts in 8-12 hours

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10
Q

Lactulose solution 15mL BD

Macrogol - Movicol oral powder

Phosphate enemas bowel clearance prep pre op/radiology etc

Mg Salts used in rapid bowel evactuation

Osmotic laxatives

A
  • *Indications:** CONSTIPATION (lactulose used in hepatic encephalopathy)
  • *MOA:** Osmotic laxatives –> Stay in the gut lumen and increase osmolarity therefore increases stool water content
  • *S/E’s:** Colic/flatulence, nausea
  • *CI’s:** Bowel obstruction, galactosaemia (lactulose), severe IBD
  • *Interactions: -**
  • *Other info:** Lactulose produces an osmotic diarrhoea of low faecal pH and discourages the proliferation of ammonia producing bacteria therefore it is used in the treatment of hepatic encephalopathy 50mL TDS causing 3 soft stools per day.
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11
Q

Liquid paraffin oral emulsion 20mL nocte

Arachis Oil enema 130mL warm

A
  • *Indications:** Constipation esp with haemorrhoids/anal fissures
  • *MOA:** Stool softener
  • *S/E’s:** Faecal leakage, anal irritation and decreases absorption of ADEK fat soluble vitamins. Granulomatous reactions.
  • *CI’s:** Under 3 year olds. Avoid prolonged use. Bowel obstruction.
  • *Interactions:** -
  • *Other info:**
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12
Q

Hyoscine butylbromide aka Buscopan

20mg QDS

A
  • *Indications:** Symptomatic relief of GI or GU disorders characterised by smooth muscle spasm e.g in IBS, bowel colic and excessive respiratory secretions
  • *MOA:** Anti muscarinic + Anti cholinergic = antispasmodic
  • *S/E’s:** Anti cholinergic side effects –> Constipation, palpitations, urinary retention, pupil dilation/loss of accomodation, dry mouth, flushing
  • *CI’s:** Myasthenia gravis, paralytic ileus, pyloric stenosis, toxic megacolon, BPH
  • *Interactions:** TCA’s, ETOH, MAOI’s
  • *Other info:**
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13
Q

Mebeverine 135mg TDS before meals

Peppermint Oil capsules 2 TDS swallow whole

A
  • *Indications:** IBS, diverticular disease
  • *MOA:** Antispasmodic –> direct relaxant of intestinal smooth muscle, relief of colic pain in IBS
  • *S/E’s:** Allergies to mebeverine reported, heartburn
  • *CI’s:** Bowel obstruction/ileus
  • *Interactions:** -
  • *Other info:** -
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14
Q

Loperamide (Imodium)

4mg initially then 2mg after each loose stool for max 5 days

A
  • *Indications:** Symptomatic relief of acute uncomplicated diarrhoea or chronic diarrhoea in adults
  • *MOA:** Opiod receptor agonists –> bind to opiod receptors in GIT, slows intestinal transit. Does not cross BBB therefore no central effects.
  • *S/E’s:** Nausea, flatulence, headache, dizziness
  • *CI’s:** Infective diarrhoea, abdo distension, abx assoc colitis, caution in hepatic impairment
  • *Interactions:** -
  • *Other info:** -
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15
Q

Sulfasalazine

Mesalazine

(5-ASA)

1g QDS in acute attacks

A

Indications: Mild - Mod -Severe UC + remission maintenance, active Crohn’s, RA
MOA: Unknown, aminosalicylates
S/E’s: N+V+D, abdo pain. Sulfasalazine = blood dyscrasias(agranulocytosis, aplastic anaemia, leucopaenia etc), hepatitis, rashes, oligospermia, pulm fibrosis
CI’s: Salicylate hypersensitivity, caution in renal/hepatic impairment
Interactions: -
Other info:Check renal function/LFT’s/FBC before Rx, at 3 months and then annually.Advise pt to report any bleeding, bruising, fever, sore throats etc (–>blood dyscrasias, check FBC). Can use topically by suppositories in distal disease.

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16
Q

Infliximab (aka Remicade)

IV infusion 5mg/kg every 8weeks

A
  • *Indications:** IBD - severe active Crohn’s, severe UC (not respnsive to steroids or conventional drugs), Ank spond, RA, Psoriasis.
  • *MOA:** Chimeric monoclonal antibody against TNFalpha (prevents it binding)
  • *S/E’s:** Serious infections (TB), mod/severe heart failure (CCF), CNS demyelination, allergic reactions, hepatosplenic T cell lymphoma
  • *CI’s:** TB, demyelinating disorders, hx or development of malignancy, PUVA Rx in psoriasis, heart failure
  • *Interactions:** Live vaccines, Abatacept
  • *Other info:** Screen for TB before use. Parenteral administration.Give with hydrocortisone for decreases allergic side effects.
17
Q

Adalimumab (aka Humira)

40 S/C 2 weekly

A
  • *Indications:** IBD - severe active Crohn’s, severe UC, Ank spond, RA/JIA, Psoriasis
  • *MOA:** Human monoclonal antibody against TNFalpha (blocks its action)
  • *S/E’s:** Severe infections (TB), injection site reactions, GI disturbances
  • *CI’s:** TB, pregnancy, demyelinating disorders
  • *Interactions:** Live vaccines, abatacept
  • *Other info:** By sub cut injection. Check for TB/hepatitis before use.
18
Q

Azathioprine

2.5mg/kg daily PO

Steriod sparing agent/ Immunosuppressant

A
  • *Indications:** IBD - severe Crohn’s, maintenance Crohns’s/UC, transplant rejection prophylaxis, RA, severe refractory eczema, autoimmune conditions
  • *MOA:** Immunosuppressant. Prodrug - metabolised to 6-mercaptopurine which inhibits the synthesis of purines–> inhibiting cell proliferation
  • *S/E’s:** Hypersensitivity reactions, bone marrow suppression, liver impairment, cholestatic jaundice, hair loss, increased infection risk.
  • *CI’s:** Decreased thiopurine methyltransferase activity (TPMT). TPMT metabolises the drug. Increases the risk of bone marrow suppression.
  • *Interactions:** Allpurinol. ACEi, Trimethoprim
  • *Other info:** If absent TPMT activity do not give the drug!! Check before! Decrease the dose if renal/liver impairment. Monitor FBC weekly initially. Counsel pt to report signs of bone marrow suppression.
19
Q

GORD Rx

A

Conservative –> Lose weight, raise head of bed, small regular meals no later than 3 hours before bed, stop smoking, decrease ETOH, avoid hot drinks and spicy foods, avoid tight clothes, stop NSAIDs/steriods/CCB’s/nitrates

Medical –>

  1. OTC antacids: Gaviscon/Mg trisilicate
  2. Full dose PPI for 4-8weeks e.g. lansoprazole 30mg OD
  3. No response –> double dose of PPI
  4. No response –> add an H2RA e.g. ranitidine 300mg nocte

Surgical –> Nissen’s fundoplication

20
Q

PUD Rx

A

Conservative –> lose weight, stop smoking and decrease ETOH, avoid hot drinks and spicy foods, stop NSAID’s and steroids

Medical –>

  1. OTC Antacids - Gaviscon/Mg Trisilicate
  2. H.Pylori eradication - PAC500 or PMC250
  3. Full dose acid suppression PPI/H2RA for 4-8weeks

Surgical –> Selective vagotomy, Subtotal gastrectomy + Roux-en-Y

21
Q

Ulcerative Colitis Rx

A

Acute Severe UC

Resus, ABC, Admit, IV fluids, NBM, Hydrocortisone IV 100mg QDS + PR, transfusion if needed, LMWH, monitoring/bloods/stool chart/AXR. If no improvement within 3 days MDT discussion, add ciclosporin. If improve swtich to oral prednisolone tapering regime + 5-ASA

Inducing Remission

Out pt Rx, Oral therapy = 5-ASA, Prednisolone, Ciclosporin/Infliximab. Topical therapy = mainly left sided disease, suppositories/enemas/foams (5-ASA + Pred). +/- steroid sparing azathioprine/infliximab

Maintaining Remission

1st line = 5-ASA PO and topical, 2nd line = azathioprine, 3rd line = Infliximab/Adalimumab

Surgery - Elective/Emergency - Proctocolectomy with end ileostomy or total colectomy. Curative treatment!!

22
Q

Crohn’s Rx

A

Acute severe Crohn’s

Resus, ABC, Admit, IV fluids, NBM, Hydrocortisone IV 100mg QDS + PR if rectal disease, Abx Metronidazole, LMWH, Dietician review, Monitor closely. If improve switch to oral prednisolone reducing regime. If no improvement add methotrexate/infliximab + MDT review

Inducing remission

Out pt Rx, high fibre diet and vitamin supplements, 1st line = Budesonide (ileocaceal disease), Sulfasalazine (colitis). 2nd line = Prednisolone. 3rd line = Methotrexate, 4th line = Infliximab/Adalimumab

Maintaining remission

Azathioprine/Methotrexate/Infliximab

Surgery - limited resections/stricturoplasty/defunctioning temporary loop ileostomy. Up to 80% have surgery at some point. Not curative ever!

23
Q

Clostridium difficile Rx

A

HIGH RISK Abx = Cephalosporins, Clindamycin

Conservative - stop causative Abx, avoid anti-diarrhoeal’s, enteric precautions, isolate/side room etc. Send stool samples to confirm by c. diff toxin assay

Medical - 1st line = Metronidazole 400mg PO TDS 10-14days 2nd line = Vancomycin 125mg PO QDS 10-14days Severe = Vancomycin 125mg PO + Metro IV

Surgical - May need urgent colectomy if toxic megacolon/deteriorating

Re-infection - can use repeat course of metronidazole 10-14days

Final Year MBBS (39 decks)

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