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Y3 DRUGS PROFILES > GI DRUGS > Flashcards

GI DRUGS Flashcards

1
Q

what is the mechanism of action for antacids?

A

alkaline ions to neutralise stomach acid

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2
Q

what ions are normally present in antacids?

A

bicarbonate or hydroxide ( magnesium or aluminum salts)

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3
Q

name 2 conditions antacids are used in

A

GORD for symptomatic relief of heart burn

Dyspepsia–> short term relief

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4
Q

name a contraindication of magnesium-containing antacids

A

renal disease

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5
Q

when shouldn’t aluminium-containing antacids be administered?

A

gastric obstruction (inhibit gastric emptying)

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6
Q

which electrolytes does gaviscon contain?

A

aluminium

magnesium

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7
Q

what are the side effects of aluminium-containing antacids?

A

constipation

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8
Q

what are the side effects of magnesium-containing antacids?

A

diarrhoea

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9
Q

why shouldn’t antacids be taken within 1-2 hours of other drugs?

A

alter GI transit time so can affect absorption of other drugs

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10
Q

Antacids increase the alkalinity of urine and therefore increase the excretion of two drugs via urine.
What are these two drugs?

A

Aspirin and lithium

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11
Q

give an example of a H2 antagonist

A

ranitidine (trade name zantac)

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12
Q

how do H2 antagonists work?

A

competitive antagonists of histamine for H2 receptor on the gastric parietal stomach cells which reduces acid production

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13
Q

name 2 instances when H2 antagonists are used

A

dyspepsia
peptic ulcer disease
GORD

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14
Q

name 3 ways H2 antagonists can be administered

A

tablets
IM
IV

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15
Q

when is the only instance H2 antagonists are contraindicated?

A

hypersensitivity

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16
Q

What are the common side effects of H2 antagonists

A

Diarrhea
dizziness
headaches

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17
Q

name 2 circulatory side effects of H2 antagonists

A

bradycardia

arrhythmia

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18
Q

name 2 other side effects of H2 antagonists

A

agitation
fatigue
erythema multiforme

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19
Q

how can H2 antagonists interact generally with other drugs?

A

decrease GI absorption

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20
Q

what drug interaction with H2 antagonists can cause hyoprothrombinaemia?

A

warfarin (bleeding)

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21
Q

H2 antagonists increase plasma levels of which substance?

A

alcohol

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22
Q

give an example of a proton pump inhibitor

A

omeprazole

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23
Q

how do proton pump inhibitors work?

A

Permanent block of the parietal cell proton pumps (H+/K+-ATPase)
Stops H+ ions being produced and therefore gastric acid production

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24
Q

name 5 instances where PPIs are used

A 
dyspepsia
peptic ulcer disease
H pylori
GORD
barrett's oesophagus
gastritis
gastrinoma
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25
Q

when in the day are proton pump inhibitors not meant to be taken?

A

with food

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26
Q

what is contraindications for PPIs?

A

hypersensitivity

Osteoporosis

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27
Q

name 2 GI side effects of PPIs

A

nausea
abdo pain
constipation
flatulence

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28
Q

which electrolyte imbalance can arise with PPIs?

A

hypomagnesaemia which can cause tetany or ventricle arrhythmia

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29
Q

name 2 other side effects of PPIs

A 
headache
dizziness
fatigue
anxiety
rash
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30
Q

how do PPIs interact with cytochrome p450?

A

It is metabolised by it and inhibits the enzyme

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31
Q

how do PPIs affect the bioavailability of digoxin?

A

increase

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32
Q

give an example of a laxative

A

senna

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33
Q

how do bulk-forming/roughage laxatives work?

A

add bulk + water to stools which increases mass so can pass more easily= stimualates peristalsis

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34
Q

how do emollient laxatives work?

A

stool softeners with extra water & fat in stool

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35
Q

how do lubricant laxatives work?

A

coat stool in slippery lipid to aid passing

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36
Q

how do hyperosmotic laxatives work? give an example

A

draw water into stools maintaining its
volume and stimulating peristalsis
e.g. lactulose

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37
Q

how do stimulant laxatives work?

A

act on mucosa &; nerves to stimulate water secretion and peristalsis

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38
Q

Give examples of when

a) bulking laxative are used
b) osmotic laxatives are used

A

a) Constipation or faecal impaction (cannot increase fibre intake)
Mild chronic diarrhoea associated with IBS or divertiulitar diseae

b) Constipation and feacal impaction
Bowel prep prior to surgery and endoscopy
hepatic encalopathy

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39
Q

what are the 2 ways that laxatives can be administered, and what it the difference between them?

A

oral (works in 12hrs)

rectal (works w/i mins)

40
Q

give 3 examples of when laxatives are contraindicated

A

intestinal obstruction= increae risk of perforation
Crohn’s
ulcerative colitis
ileus

41
Q

What is a long term risk of laxative use?

A

dependance

42
Q

what is melanosis coli? and what is it a complication of?

A

brown pigmentation of colonic wall

complication of laxatives

43
Q

how do laxatives increase digoxin toxicity?

A

reduce serum potassium

44
Q

give an example of an aminosalicylate

A

Mesalazine

Sulfasalazine

45
Q

how do aminosalicylates work?

A

They release 5 aminosalicylic acid (5-asa)

Have anti inflammatory and immunosuppressive effects specifically on the gut (topically)

46
Q

name 2 conditions aminosalicylates are used in?

A

Mesalazine used for mild to moderate ulcerative colitis

Sulfasalazine is a DMARD and used for RA

47
Q

name 2 organ insufficiencies which would contra-indicate use of aminosalicylates

A

renal

hepatic

48
Q

name 2 conditions that would contra-indicate use of aminosalicylates

A 
active peptic ulcer
haemorrhagic diathesis (tendency to bleed)
49
Q

which drugs may reduce the effect of aminosalicylates?

A

antacids, H2 antagonists, PPIs= increase gastric PH

lactulose= lowers stool ph in colon

50
Q

what drugs may cause toxicity of aminosalicylates

A

other 5-ASA derivatives

51
Q

give an example of an antiemetic

A

metoclopramide and domperidone = stop nausea and vomiting

52
Q

how do 5-HT3 receptor antagonist antiemetics work?

A

block serotonin receptors

53
Q

when are dopamine antagonist antiemetics used?

A

neoplastic disease
radiation sickness
surgery

54
Q

what kind of antiemetic is metoclopramide?

A

5-HT3 and dopamine antagonist (prokinetic effect)

55
Q

name 2 other types of antiemetics

A

steroids
cannabinoids
antihistamines

56
Q

which neurological disease could be worsened by use of dopamine antagonists?

A

Parkinson’s

57
Q

give 3 mental health conditions that are contraindicated for antiemetics

A

depression
ADHD
restless leg syndrome

58
Q

give a GI side effect of antiemetics

A

diarrhoea

59
Q

which of these is not a neurological side effect of metaclopramide ?

1) tardive dyskinesia (involuntary movement)
2) migraines
3) extrapyramidal disorders

A

2) migraines

60
Q

give 2 other side effects of antiemetics

A

tiredness
depression
restlessness

61
Q

name 2 substances with which antiemetics produce a sedative effect?

A

alcohol
hypnotics
narcotics
tranquilliser

62
Q

where do antiemetics reduce absorption?

which drug could this effect?

A

In the stomach

digoxin

63
Q

where do antiemetics increase absorption?

name 2 drugs this could effect

A

small bowel

L dopa, tetracycline, cyclosporin, ethanol

64
Q

name an antidiarrhoeal agent

A

loperamide

immodium

65
Q

on which receptors do antidiarrhoeals act?

A

opioid receptor agonists - act on opioid receptors in mesenteric plexus

66
Q

how does acting on opioid receptors act in an antidiarrhoeal fashion?

A

decrease activity & tone of smooth muscles in intestinal wall
increases time things stay in intestine so more water absorbed out of fecal matter
decreases mass movement

67
Q

what reflex do antidiarrhoeals suppress?

A

gastro-colic (stretching of stomach stimulates colon movement)

68
Q

what prevents antidiarrhoeal opioid receptor agonists crossing the blood brain barrier?

A

p-glycoprotein

69
Q

give 3 examples when antidiarrhoeal agents used?

A

gastroenteritis
IBD
short bowel syndrome
travellers diarrhoea

70
Q

which 3 conditions contra-indicate the use of antidiarrhoeals?

A 
dysentery= especially if caused by e.coli can cause HUS
acute UC exacerbating= can lead to toxic megacolon and perforation
bacterial enterocolitis ( C.diff colitis)
71
Q

name 3 organisms that cause bacterial enterocolitis

A

e coli
salmonella
c. diff

72
Q

name 2 GI side effects of antidiarrhoeal agents

A

constipation
vomiting
increased risk of toxic megacolon

73
Q

which drug should not be taken in conjunction with antidiarrhoeal agents?

A

quinidine - p-glycoprotein inhibitor

increases risk of drug crossing blood brain barrier

74
Q

What can prolong use of PPI cause in a elderly patient?

A

Can increase the risk of bone fracture

75
Q

What affect does omeprazole have on clopidogrel?

A

Due to its effect of p450 it reduces the anticoagulant effects and therefore alterantive PPI should be used

76
Q

What affect on plasma levels does PPI have on nelfavir?

A

Reduces the plasma levels

77
Q

Why is H2 antagonist not as effective of stopping acid production compared to PPI’s?

A

Histamine is one of many mediators of the proton pump so therefore it cannot completely suppress the pump while PPI’s can.
PPI’s can almostly completely stop acid production

78
Q

Hypersensitivity to what other drug would be a contradiction to the use of aminosalicylates?

A

Aspirin hypersensitivity

79
Q

What type of laxative is movicol?

A

Bulk forming laxative

80
Q

What type of laxative is Senna?

A

Stimulant laxative

81
Q

What is the effect of dopamine on the stomach and what receptor does it act on?

A

It acts on D2 receptor and is an important neurotransmitter in the gut, where it promotes
relaxation of the stomach and lower oesophageal sphincter and inhibits gastroduodenal coordination.

82
Q

What is a GI contradiction of anti emetics?

A

Bowel obstruction

83
Q

What effect does me metoclopramide and domperidone have on the D2 receptors?

A

They have a prokinetic effects which promotes gastric emptying

84
Q

How does histamine cause acid production?

A

Histamine produce by paracrine cells promote proton pump on the gastric parietal cell to release H+ into the stomach for exchange for K+ into the cells

85
Q

What drugs serum concentration is reduced if taken at the same time as antacids?

A 
PPI's
ACE inhibitors
Levothyroxine
Some Abx( tetracycline, ciprofloxacin and cephalosporin)
Digoxin
PPI's
86
Q

Give two trade name examples of antacids?

A

Gaviscon

Pepto bismol

87
Q

Which aminosalicylate has fewer side effects?

A

Mesalazine has fewer side effects than sulfasalazine

88
Q

What are the common side effects of aminosalicylates?

A

GI upset (nausea and dyspesia) and headache

89
Q

What are the rare but serious blood and renal side effects of aminosalicylate?

A

Leucopenia and thrombocytopenia

Renal impairement

90
Q

What affect can sulfasalazine have on mens production of sperm?

A

oligospermia

91
Q

Why should you ask specific alarm questions regarding a gastric cancer when prescribing ppi?

A

It can mask the symptoms of gastric cancer

92
Q

When should phosphate enemas used cautiously?

A

Patients with heart failure, ascites and when electrolyte disturbances are present.
Due to significant fluid shift

93
Q

When should domperidone be used cautiously?

A

when the patient has cardiac defect as it increase the risk of cardiac incidences

94
Q

What type of drug is cyclizine?

A

Anti emetic Histamin H1 receptor antagonist

95
Q

What is the use of cylcizine?

A

Treatment of nausea and vomiting caused by motion sickness and vertigo

96
Q

In who’m should metacolopramide and domperidone be invoved in?

A

Eldrely, Young adults and children

Any cardiac events

Y3 DRUGS PROFILES (9 decks)

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