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Alimentary System > Pharmocology > Flashcards

Pharmocology Flashcards

1
Q

what drugs are used for acid suppression?

A

> antacids
h2-receptor antagonists
proton pump inhibitors

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2
Q

what drugs affect GI motility?

A

> anti-emetics
anti-muscarinics
anti-motility

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3
Q

what drugs are used in inflammatory bowel disease?

A

> aminosalicylates
corticosteroids
immunosuppressants
biologics

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4
Q

what drugs affect intestinal secretions?

A

> bile acid sequestrants

> ursodeoxycholic acid

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5
Q

what metals do antacids contain?

A

magnesium or aluminium

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6
Q

what is the action of antacids?

A

they neutralise gastric acid

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7
Q

what is the action of alginates?

A

they form a viscous gel that floats on the stomach contents reducing reflux

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8
Q

describe the action of H2-receptor antagonists

A

they block histamine (H2) receptor thereby reducing acid secretion

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9
Q

when are h2-receptors indicated?

A

in GORD or peptic ulcer disease

unless patient cannot use proton pump inhibitor do not use a lot of them

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10
Q

how are h2-receptor antagonists administered?

A

orally or intravenously

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11
Q

when are proton pump inhibitors indicated?

A

in GORD or peptic ulcer disease

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12
Q

how are proton pump inhibitors administered?

A

orally or intravenously

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13
Q

what is triple therapy for treatment of PU/DU associated with?

A

H. Pylori

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14
Q

what problems are associated with proton pump inhibitors?

A

> GI upset
predisposition to c. difficile infection
hypomagnesaemia
b12 deficiency

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15
Q

what agents increase gut motility and gastric emptying?

A

prokinetic agents

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16
Q

what is the mechanism of prokinetic agents?

A

it is not clear but involves parasympathetic control of smooth muscle and sphincter tone

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17
Q

what is the action of domperidone?

A

it acts by blocking dopamine receptors which inhibit post synaptic cholinergic neurones

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18
Q

what drugs work on the chemoreceptor trigger zone to stop vomiting?

A

> dopamine antagonists
5HT3 antagonists
cannabinoids

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19
Q

what drugs act on the pharynx and GIT to stop vomiting?

A

> 5HT3 antagonists

> dopamine antagonists

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20
Q

what drug acts on the vestibular nuclei to stop vomiting?

A

anti-histamines

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21
Q

what drugs act on the vomiting centre in the medulla to stop vomiting?

A

> anti-muscarinics

> anti-histamines

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22
Q

what is the mechanism of action of loperamide?

A

it acts on the opiate receptors in the GI tract to decrease ACh release. this decreases smooth muscle contraction and increases anal sphincter tone causing a decrease in motility.

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23
Q

why does loperamide have few central opiate effects?

A

it is not well absorbed across the blood-brain barrier

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24
Q

by what three mechanisms do antispasmoids reduce symptoms of IBS and renal colic?

A

> anti-cholinergic muscarinic antagonists (inhibit smooth muscle contraction in gut wall)
direct smooth muscle relaxants
calcium-channel blockers reduce calcium required for smooth muscle contraction

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25
Q

what are the 4 types of laxatives?

A

> bulk
osmotic
stimulant
softeners

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26
Q

what issues can there be with laxatives?

A

> obstruction (lead to perforation)
route of administration (oral or rectal)
other measures as oral laxative will not work without adequate fluid intake
misuse

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27
Q

what is the action of aminosalicylates?

A

anti-inflammatory

28
Q

how are aminosalicylates administered?

A

orally or rectally

29
Q

when should you avoid prescribing aminosalicylates?

A

> in patients allergic to salicylates (as they are chemically related)

30
Q

when should you use caution in using aminosalicylates?

A

in renal impairment

31
Q

what are the adverse effects associated with aminosalicylates?

A

> GI upset
blood dyscrasias
renal impairment

32
Q

how are corticosteroids administered?

A

orally, IV or rectally

33
Q

what are contraindications for use of corticosteroids for IBD?

A

> osteoporosis

> cushingoid features including weight gain, DM, HT

34
Q

what concerns are there with using corticosteroids for IBD?

A

> there is increased susceptibility to infection

> addisonian crisis, with abrupt withdrawal (hypertensive, dehydrated)

35
Q

what is the action of immunosuppressants in IBD?

A

they prevent to formation of purines required for DNA synthesis so reduces immune cell proliferation

36
Q

what are the adverse effects associated with use of immunosupressants in IBD?

A

> bone marrow suppression
azathioprine hypersensitivity
organ damage
numerous drug interactions

37
Q

what is required when using immunosuppressant’s in IBD?

A

specialist use and close monitoring

38
Q

what is infliximab?

A

a biologic, antiTNF(alpha)antibody.

mouse human chimeric antibody to TNF-alpha

39
Q

what do biologics prevent?

A

action of TNF alpha, key cytokine in inflammatory response

40
Q

what are the cautions/contraindications of infliximab?

A

> current TB (or other serious infection)
multiple sclerosis
pregnancy/breast feeding

41
Q

what are the adverse effects associated with infliximab?

A 
> risk of infection (TB)
> infusion reaction (fever, itch)
> anaemia, thrombocytopenia, neutropenia
> demyelination
> malignancy
42
Q

name some biologics other than infliximab

A

> certolizumab
adalimumab
golimumab
vedolizumab

43
Q

what is certolizumab?

A

fab fragment of humanized anti-TNF alpha monoclonal antibody

44
Q

what is adalimumab?

A

humanized recombinant antibody to TNF

45
Q

what is natalizumab?

A

ant-integrin monoclonal antibody

46
Q

what is the action vedolizumab?

A

it binds to integrin alpha4beta7 (peyers patch adhesion molecule)

47
Q

what is the action of cholestyramine?

A

it reduces bile salts by binding with them in the gut so they are excreted as insoluble complex

48
Q

what may cholestyramine affect?

A

> absorption of other drugs

> fat soluble vitamin absorption (may decrease vitamin k levels affecting warfarin and clotting)

49
Q

what is ursodeoxycholic acid used to treat?

A

> gallstones

> primary biliary chirrhosis

50
Q

what is the action of ursodeoxycholic acid?

A

it inhibits enzymes involved in the formation of cholesterol altering the amount in bile and slowly dissolving non-calcifies stones

51
Q

what problems may there be with the ADME of GI pharmacology?

A

> GI/liver diseases can affect the processes of the drug ADME
GI symptoms also necessitate a change in route of administration

52
Q

what may affect the absorption of a drug?

A

> pH
gut length
transit time

53
Q

what may affect the distribution of a drug?

A

> low albumin (decreased binding leads to increased free drug concentration)

54
Q

what may effect the metabolism of a drug?

A

> liver enzymes
increased gut bacteria
gut wall metabolism
liver blood flow

55
Q

what may effect the excretion of a drug?

A

> biliary excretion

56
Q

what GI adverse effects can there be with medication?

A

> diarrhoea/constipation
GI bleeding/ulceration
changes to gut bacteria
drug induced liver injury

57
Q

what is 25% of all drug induced diarrhoea due to?

A

antimicrobials

58
Q

what are the effects of changes to gut bacteria?

A

> loss of OCP activity
reduced vitamin K absorption (increased prothrombin time)
overgrowth of pathogenic bacteria

59
Q

what type of ADR is intrinsic hepatotoxicity?

A

type a as it is predictable, dose dependent and acute

60
Q

what type of ADR is idiosyncratic hepatotoxicity?

A

type b as it is unpredictable, not dose dependent and can occur at anytime

61
Q

what are the effects of idiosyncratic hepatotoxicity?

A

they can range from asymptomatic increase in LFTs to fulminant liver failure and death

62
Q

what are the risk factors of hepatotoxicity?

A 
> elderly
> female
> alcohol
> genetic factors
> malnourishment
63
Q

what classification is used when judging the severity of liver disease?

A

child-pugh classification

64
Q

what are the groups in the child-pugh classification?

A 
A= <7
B= 7-9
C= >9
65
Q

what things are scored in the child-pugh classification of liver disease?

A 
> bilirubin
> albumin
> PT (prolonged)
> encephalopathy
> ascites
66
Q

when prescribing for liver disease what should you take care of/avoid?

A

> drugs that can be toxic due to changes in pharmacokinetics
drugs which are hepatotoxic
drugs which may worsen the non-liver aspects of liver disease

67
Q

what specific drugs should you avoid in liver disease?

A

> warfarin (clotting factors already low)
aspirin/NSAIDs (increases bleeding time, can worsen ascites)
opiates/ benzodiazepines (may precipitate encephalopathy)

Alimentary System (33 decks)

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