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Pharmacology > GI > Flashcards

GI Flashcards

1
Q

What type of drug is aluminium hydroxide (Maalox)?

A

Antacid

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2
Q

What are the indications for aluminium hydroxide?

A

Heartburn, stomach ulcers, dyspepsia

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3
Q

What is the mechanism of action of antacids?

A

Neutralise excess stomach acid to prevent it from damaging tissue

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4
Q

What is the indication of an alginate?

A

Heartburn, stomach ulcers, dyspepsia

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5
Q

What is the mechanism of action of an alginate?

A

Act to increase the viscosity of the stomach contents, which reduces reflux. After reacting with stomach acid, they then form a floating ‘raft’ which separates the gastric contents from the gastro oesophageal junction, to prevent mucosal damage.

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6
Q

What type of medication are hyoscine and mebeverine?

A

Anti-spasmotics

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7
Q

What is the mechanism of action of hyoscine butylbromide?

A

Antimuscarinic (antispasmodic) drug, binds to muscarinic receptor and acts as competitive inhibitor of ACh

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8
Q

What are the indications for hyoscine butylbromide?

A

1st line treatment of IBS

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9
Q

What counter indications are there for hyoscine butylbromide?

A

Arrhythmias

Decreases parasympathetic drive so may cause tachycardia

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10
Q

What might mebeverine be used for?

A

IBS and related conditions (stomach pain, persistent diarrhoea and flatulence)

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11
Q

What sort of medication is ranitidine?

A

H2-receptor antagonist

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12
Q

What are the possible indications for ranitidine?

A

Poetic ulcer disease (treatment and prevention)
GORD
Dyspepsia
PPIs are generally more effective and therefore preferred

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13
Q

What is the mechanism of ranitidine?

A

H2receptor antagonist
Blocks H2 receptor on parietal cell, which if activated would stimulate proton pump to function.
However pump can be stimulated by other pathways so effect is not complete (PPIs are more effective)

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14
Q

What sort of drug are omeprazole, lansoprazole, pantoprazole, esomeprazole?

A

PPIs

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15
Q

What are PPIs prescribed for?

A

1st line treatment for…
Prevention and treatment of peptic ulcer disease (including NSAID associated)
Symptomatic relief of dyspepsia and GORD
Eradication of Helicobacter Pylori infection (in combination with antibiotic therapy)

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16
Q

What is the mechanism of action of PPIs?

A

Reduce gastric acid secretion by irreversibly inhibiting H+/K+ ATPase in gastric parietal cells.

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17
Q

What are the risks of PPIs?

A

May disguise the symptoms of gastric cancer

Increased risk of osteoporosis

18
Q

What type of drug is loperamide? (Imodium)

A

Anti-motility

19
Q

What is an indication for loperamide?

A

Diarrhoea

Usually as a result of IBS or viral gastroenteritis

20
Q

What is the mechanism of action of loperamide? (Imodium)

A

Opioid, but does not penetrate CNS so no analgesic effects. Agonist of gamma-receptors in GI tract, increases non-propulsive contractions of gut smooth muscle, but reduces propulsive (peristaltic) contractions. This slows movement of bowel contacts (so more water absorption)and anal sphincter tone is increased.

21
Q

What are the contraindications for loperamide? (Imodium)

A

Acute UC (decreasing peristalsis increases risk of toxic megacolon)
Risk of Clostridium difficult colitis
Should not be used for bloody diarrhoea

22
Q

What sort of drugs are ispaghula husk, methylcellulose, sterculia?

A

Bulk forming laxatives

23
Q

What might be an indication for bulk forming laxatives, e.g. ispaghula husk?

A

Constipation an fecal impaction
Milk chronic diarrhoea, associated with diverticula disease and IBD
Particularly in patients unable to increase their dietary fibre intake

24
Q

What is the mechanism of action of bulk forming laxatives, e.g. ispaghula husk?

A

Contain a hydrophilic substance e.g. polysaccharide or cellulose, which is not absorbed or broken down in the gut. This attracts water into the stool increasing its mass (therefore adequate fluid intake is needed alongside it). Increased stool bulk in turn stimulates peristalsis.

25
Q

What sort of medication are lactulose, macrogol, phosphate enema?

A

Osmotic laxatives

26
Q

What is an indication for prescribing osmotic laxatives, e.g. lactulose, macrogol, phosphate enema?

A

Constipation and fecal impaction
Bowel preparation prior to surgery or endoscopy
Hepatic encephalopathy

27
Q

What is the mechanism of action of osmotic laxatives?

A

The drug is not absorbed by the body and is osmotically active. Therefore it increases the water content of stool, maintaining its volume and stimulating peristalsis.

28
Q

Which laxative would you use for hepatic encephalopathy and why?

A

Lactulose
It reduces ammonia absorption by increasing gut transit time and acidifying stool, inhibiting proliferation of ammonia producing bacteria

29
Q

What are contraindications for a phosphate enema?

A

Heart failure
Ascites
Electrolyte disturbances

30
Q

What type of medication are senna, glycerol suppositories, bisacodyl, docusate sodium

A

Stimulant laxatives

31
Q

What are the indications for stimulant laxatives ?

A

Constipation

As suppositories for fecal impaction

32
Q

What is the mechanism of action of stimulant laxatives e.g. senna, glycerol suppositories ?

A

Increase water and electrolyte secretion from the colonic mucosa, thereby increasing the volume of colonic content and stimulating peristalsis. Also have a direct pro-peristaltic action

33
Q

What are some potential side effects of stimulant laxatives?

A 
Abdominal cramping
Diarrhoea
Melanosis coli (reversible pigmentation of intestinal wall) with prolonged use
34
Q

What is a contraindication for laxatives in general?

A

Intestinal obstruction - risk of perforation

35
Q

What type of drug is Mesalazine?

A

Aminosalicylate

36
Q

What is an indication for mesalazine?

A

First line treatment for mild to moderate UC

Sulfasalazine can be used as an alternative but less common

37
Q

What is the mechanism of action of mesalazine (an aminosalicylate)?

A

Releases 5-aminosalicylic acid (5-ASA), which has anti inflammatory and immunosuppressive effects. Appears to act topically on gut -preparations are designed to be delay delivery of the active ingredient until further down the gut.

38
Q

Wha this a contraindication for aminosalicylates e.g. mesalazine, sulfasalazine?

A

Aspirin hypersensitivity, these are salicylates like aspirin

39
Q

What sort of drug is infliximab?

A

Biologic

Anti-TNF alpha

40
Q

What is infliximab used to treat?

A 
Crohn’s disease
Rheumatoid arthritis
Psoriasis
Ankylosing spondylitis 
Psoriatic arthritis
Crohn’s disease with fistulae
41
Q

What is the mechanism of action of infliximab?

A

Anti-TNF alpha

Blocks the effects of this substance and therefore reduces inflammation

Pharmacology (9 decks)

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