Lower GI Flashcards
Drugs that may commonly cause Diarrhoea
Antibiotics
Orlistat: Pacreatic lipase inhibitor
Misoprolol via cAMP
PPIs via infection
Digoxin toxicity, acarbose, metformin, iron
Ciprofloxacin used emprically for travellers diarrhoes
Opioids as antimotility agents
- Codeine and loperamide
- For sympotmatic relief
- May reduce clearance of infective organism
- Reduce tone and peristaltic movements by pre-synaptic mu-opioir receptors w/Ach
Loperamide: no BBB penetration. has enterohepatic recycling, stays in gut
Codeine: analgesic
Alpha2-adrenoceptors agonists e.g. clondine can also constipate
Antimuscarinics as antiotility
- Dicycloverine - antimuscarinic
- TCAs are constipating my muscarinic antagonism
Define constipatino
Less than 3 motions a week
Treating constipation
- Diet with roughage
- Drug induced?
If this fails:
- OSmotic laxatives e.g lactulose
- Magnesium; release of CCK increasing motility
- Bulking agents
- Stimulant laxatives:
IBS treatment
- Lactulose or loperamide for respective symptoms
- Antispasmodics
- Antimuscarniscs
- Mebeverine: GI relaxant
- Amitriptyline (TCA)
Treating Inflammatory bowel Disease
-
5-aminosalicylates
- Mainstay for UC
- %-ASA inhibit leukotrionoe and prostanoid formation, scavenge free radicals, decrease neutrophil chemotaxis
-
Corticosteroids
- Induce remission of IBD
- Prednisolone; anti-inflammatory
- Budesonide; less systemic side-effects
- Bowel rest? Probiotics? Fish Ooil?
- Immunosurpressants: cycloospoorine MTX, infliximan(TNF-a)
MTX is effective in chrons but not in UC. But serious NSAID interaction
Once weekly dose. Monitor renal LFT, and FBC
Report fever/cough, may indicate infection due to neutropenia
Report Cough/dyspnooa-may indicate pulmonary toxicity
Ciclosporin in IBD
Induces remissionon
INCREASED RISK OF Pneumocystis carinii, so give prophylactic co-trimox
Antibiotics in IBD
Metronidazole+ciproflox may be used for up to 3 months
Infliximab in IBD
MAB that neutralises proinflammatory TNF-a
Been identides as RF for tuberculosis
