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GSS > Ulcer and Inflammation + Laxatives > Flashcards

Ulcer and Inflammation + Laxatives Flashcards

Know more about the pharmacology of antacids, cytoprotective agents and all that jazz

1
Q

what is a peptic ulcer

A

erosion of small patch of the lining of stomach (gastric ulcer) or duodenum (duodenal ulcer)

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2
Q

how do NSAIDS cause ulcers

A

less prostaglandins so less cytoprotection of gastric antrum

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3
Q

State Factors that attack the gastric and duodenal mucosae

A
  1. Acid and pepsin
  2. H.pylori
  3. Bile reflux and delayed gastric emptying – autonomic system dysfunction
  4. Absence of protective prostaglandins (NSAID side effect – inhibit production of PGI2)
  5. Microvascular vasoconstriction
  6. Failure of epithelial regeneration – anticancer drugs, cytotoxic drug
  7. Presence of stress and other risk factors - e.g. alcohol, smoking, aspirin
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4
Q

Worldwide diarrhoeal diseases

A

cholera or rotaviral infections

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5
Q

why take glucose with electrolytes and rice water

A

to optimise absorption of electrolytes into the blood from GIT

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6
Q

What is Dexamethszone? When used?

A

an Anti-emetic corticosteroid. Used in Post-Operative or Cancer associated vomiting.

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7
Q

name protective mechanisms of the stomach

A

Mucus layer - good mucosal blood flow - HC03 buffer - cytoprotective prostaglandins that inhibit acid release - epithelial regeneration

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8
Q

Histamine is often known as:

A

the ‘final common mediator’, although Ach and gastrin can both activate the paritetal cell directly.

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9
Q

State the three acid stimulators that cause release from acid from the parietal cell

A

Histamine, Gastrin and Acetylcholine

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10
Q

Stimulant laxative indication and action

A

Bisacodyl (synthetic drug, based on active principle of senna); acts in about 8hr, take the night before; stimulates enteric nerves to cause peristalsis. Suppository acts quicker. ‘Abuse’ –> cramps: not suitable for repeated use.

Glycerol suppositories; act as a rectal stimulant (mild irritant)

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11
Q

Crohns Disease and Ulcerative Colitis are both..

A

manifestations of IBD

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12
Q

what is a natural alternative to ORS?

A

Rice water with electrolytes - boil rice water and use the starchy water produced. add salt.

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13
Q

How does Misoprostol work?

A

it’s a PG analogue that mimics PGE2 which works by increasing Mucus and HCO3 secretion + Vasodilation

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14
Q

name the two classes of drugs for IBD

A

Anti-inflammatories (Corticosteroids, Aminosalicylates) Anti-cytokine agents (infliximab)

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15
Q

how does PGE2 work?

A

It inhibits the ATP-dependent proton pump within parietal cells

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16
Q

what’s the most common type of ulcer

A

Duodenal Ulcer

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17
Q

benefits of dietary fibre?

A
  • gives bulk, enhances mechanical efficiency of intestine
  • speeds up transit (reduces exposure to toxins ),
  • Adsorbs water (keeps stools soft but bulky),
  • Promotes regular bowel habit
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18
Q

Describe the Biosynthesis of Prostaglandins

A
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19
Q

H2 Antagonists (block histamine’s effect E.g Cimetidine) - PPI’s (irreversible inhibition E.g Omeprazole, Lansoprazole) Prostaglandin Analogues (Misoprostol)

A

Acid-Modifying drug examples

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20
Q

what does IBD stand for

A

Inflammatory Bowel Disease

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21
Q

What should we NOT do in patients with diarrhoea

A

Do not employ bulk-forming agents with anti-spasmodics as this could lead to intestinal obstruction

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22
Q

Domperidone is a

A

D2 receptor antagonist at the CTZ

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23
Q

what does bismuth sulfate do

A

improve mucosal defence

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24
Q

List the Key Treatments of IBS

A

reassurance

anxiolytics

anti-spasmodics

dietary improvement

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25
Q

General causes of diarrhoea

A

(a) too rapid transit through colon - hypermotility, or (b) failure of colonic water reabsorption; or both

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26
Q

For radiation and cancer sickness/emesis, give..

A

Ondansetron, dolasetron (5HT3 antags) very effective against severe nausea/vomiting esp. post anticancer chemotherapy (i.v. plus oral dexamethazone)

  • Aprepitant (first of the NK1 antagonists)
  • Nabilone (synthetic cannabinoid, given if patient is refractory to above drugs, or significant side effects)
  • Dexamethasone – anti-emetic corticosteroid
  • Domperidone – short term only (D2 antag, less sedating)
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27
Q

what drugs can inhibit the vomiting centre?

A

Hyoscine and Promethazine

28
Q

What is PGF2-Alpha?

A

bronchiconstrictor

29
Q

Define IBS

A

Abnormal bowel activity, alternating episodes of diarrhoea & constipation assoc. with colic and pain. Patients are often anxious.

30
Q

Side effects of H2 Antagonists

A

Highly sedative

31
Q

What is the best treatment for Diarrhoea in healthy people? What do we check for in at-risk groups?

A

The best treatment of mild diarrhoea in healthy people is to abstain from food and drink plenty of clear fluids • In infants, children and the elderly check that fluid intake is adequate • Check patient’s diet : increasing the amount of fibre may help in the longer term

32
Q

Osmotic laxative indication and action

A

Osmotic laxatives attract water. E.g lactulose (non-absorbed disaccharide) acts in 24-48 hours. Suitable for chronic constipation.

Macrogols (intert polymers of ethylene gylcol)

Side effects; abdominal distension, pain, nausea

33
Q

What is the presenting symptoms of peptic ulcer

A

inflammation and pain. Gastric irritation. Vomiting, loss of appetite and poor sleep

34
Q

Bulk forming laxatives: Indication and action etc

A

E.g Ispagula husk, sterculia- theyre Indigestible materials, attracts water & swells in colon, increasing peristalsis and promoting soft stool.

Takes several days to work.

e,g of BFL: Methylcellulose, Bran, High Fibre diets - similar principle. Take plenty of water with all these. Can cause abdominal swelling

35
Q

General treatment strategies to peptic ulcer

A
  1. Relieve pain e.g Antacids
  2. Allow healing, e.g antisecretory agents and mucosal strengtheners.
  3. Prevent relapse, e.g maintenance therapy
  4. Avoidance of risk factors Stop smoking
36
Q

Anti-spasmodics used in IBS and how they work

A

peppermint oil capsules, mebeverine (both relax the smooth muscle & reduce pain)

37
Q

How do the acid stimulators work?

A

Act on the parietal cell to activate ATP-dependent ‘proton pump’ which exchanges H+ for K+

38
Q
A
39
Q

Lubiprostone. Whats it for?

A

stimulates colonic fluid secretion, used to treat chronic idiopathic constipation in adults. Can be used in IBS

40
Q

Generally speaking, whats given for motion, pegnancy, vertigo and post-op nausea, give..

A
  1. Motion sickness: hyoscine
  2. Pregnancy-associated sickness (only in severe cases): promethazine (sedating H1 antagonist, use with caution)
  3. Vertigo & other vestibular disorders: cinnarizine or cyclizine (H1 antags, less sedating than promethazine)
  4. Post-operative nausea and vomiting: effective drugs are 5HT3 & H1 antags, and dexamethazone, some phenothiazines
41
Q

State the four types of Laxatives

A
  1. Bulk Forming Laxatives
  2. Osmotic Laxatives
  3. Stimulant Laxatives
  4. Lubrican Laxatives
42
Q

Acid-Modifying drug examples

A

H2 Antagonists (block histamine’s effect E.g Cimetidine) - PPI’s (irreversible inhibition E.g Omeprazole, Lansoprazole)

Prostaglandin Analogues (Misoprostol)

43
Q

What does a Thrombotic do?

A

Promotes platelet aggregation

44
Q

Indication for PG Analogue

A

Prophylaxis in the frail elderly whose use of NSAIDS cannot be withdrawn

45
Q

lubricant laxative indication and action

A

Useful in management of haemorroids and anal fissure. • Arachis (peanut/ground nut) oil - warmed enema of 130 ml used to soften impacted faeces, promote bowel movement.

Glycerol - as a suppository in infants

46
Q

name an example of an Anti-cytokine agent for IBD. What else can it be used to treat?

A

infliximab, used elsewhere in Rheumatoid Arthritis

47
Q

What is Colic?

A

Episodes of crying for more than three hours

48
Q

Treatment of IBD

A

A - Corticosteroid (inhibit PLA2 activity and AA-PG cascade) e.g Prednisolone, Hydrocortisone, Budesonide (as adjunct to aminosalicylates)

B - Immunosuppressants (ciclosporin)

C - Monoclonal TNFα Antibodies (infliximab inhibits TNFα actions

D - Aminosalicylates - Maintain remission in ulcerative colitis

49
Q

Main stimulant laxatives available otc and side effects

A

Bisacodyl or senna are the main OTC therapies currently with limiting side effects, e.g. abdominal cramping, diarrhoea, dehydration.

50
Q

Traditional remedies for Diarrhoea

A

charcoal, kaolin (china clay) are helpful for mild infective diarrhoea (BUT - will also help absorb toxins if not a mild infection).

51
Q

Vomiting can be triggered by activation of the CTZ - what does that stand for?

A

Chemoreceptor Triggering Zone

52
Q

What is peppermint oil

A

a direct acting antispasmodic which relaxes the smooth muscle and reduces pain

53
Q

What is loperamide

A

an antumotility drug

54
Q

Key Differences between IBS and IBD

A

Irritable bowel syndrome (IBS) is a non-inflammatory condition, while inflammatory bowel disease (IBD) causes chronic swelling (or inflammation).

Both conditions can lead to abdominal pain, constipation, or urgent bowel movements, but IBD can also cause extreme fatigue or rectal bleeding.

55
Q

The cAMP induced pathway in acid secretion is switched on by

A

Histamine.

56
Q

what is acid rebound? why is it bad?

A

when bicarbonates neutralise the acid, more acid is produced to counteract. hence pain returns!

57
Q

name 2 highly selective antagonists

A

Ranitidine and Cimetidine

58
Q
A
59
Q

How does cancer and other cytotoxic drugs cause ulcers

A

they interfere with regeneration of epithelial cells that line the gastric Antrum

60
Q

Main treatment to peptic ulcers

A

1.Avoid risk factors, stress, smoking, alcohol, aspirin 2.Neutralise acid (antacids) or reduce its secretion Mg carbonate, Al(OH)3; NaHCO3 in indigestion remedies 3.Encourage healing with H2 antagonists, or 4.Eliminate H.pylori (after positive urease test) antibiotics 5 Improve mucosal defence

61
Q

state the triple therapy to eradicate H.Pylori

A

Omeprazole Clarithromycin Metronidazole

62
Q

Bicarbonate pros and cons in gastric ulcer treatment

A

Rapid relief as acid is neutralised chemically. Cons of Acid rebound, and cannot be used for weeks

63
Q

H Pylori Eradicaiton Regime. How long is this therapy? what side effects?

A

Omeprazole 20mg BD (S/E - Nausea)

Amoxicillin 1g BD (S/E - Rash)

Clarithromycin 500mg BD (insomnia)

Metronidazole 400mmg TDS (darkening urine)

Last seven days

64
Q

if we cant give a penicillin, what do we give?

A

Tetracycline 500mg QDS

65
Q

risk factors of PUD?

A

Age (>65) - Previous peptic ulcer or GI bleed - Combining anti-inflammatories - Concurrent warfarin - Smoking - Alcohol

66
Q
  • Anti-cholinergic drug (M antagonist), e.g. hyoscine
  • Sedating anti-histamines (H1 antagonists) e.g. promethazine, cinnarizine – useful against motion sickness etc.
  • Phenothiazines (D2 antagonists), e.g. prochlorperazine
  • More D2 antagonists, e.g. droperidol, domperidone ]
  • 5HT3 antagonists, e.g. granisetron, ondansetron
  • Neurokinin (NK)1 antagonists, e.g. aprepitant, fosaprepitant
  • Dexamethazone, has anti-emetic effects useful against vomiting assoc. with chemotherapy (mechanism not clear)
A

GSS (10 decks)

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