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Alimentary System: Pathology SA > Alimentary Pharmacology > Flashcards

Alimentary Pharmacology Flashcards

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1
Q

What drugs affect acid suppression in the GI tract

A

Antacids
H2 receptor antagonists
Proton Pump inhibitors

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2
Q

What drugs affect GI motility

A

Anti-emetics
Anti-muscarinics/spasmodics
Anti-motility

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3
Q

What drugs help in bowel movement in the GI tract

A

Laxatives

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4
Q

What drugs are usedin the treatment of Inflammatory bowel disease

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

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5
Q

What drugs affect intestinal secretion

A

Bile acid sequestrate
- Cholestyramine

Urosodeoxycholic acid

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6
Q

What is an example of an antacid drug, what is it composed of

A

Maalox

containing magnesium and aluminium

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7
Q

What is the mechanisms of antacids

A

Neutralising gastric acid

to relieve symptoms

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8
Q

What is an example of an Alginates and its mechanism in the treatment of acid suppression

A

Gaviscon

Forms a vicious gel that floats on the stomach contents and reduces reflux

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9
Q

Name three additional muscosal protectors in acid suppression

A

Bismuth
Sucralfate
Misoprostol

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10
Q

What is an example of a H2 receptor antagonist and its mechanism

A

Ranitidine

Blocks histamine receptor thereby reducing acid secretion (controlling acid production)

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11
Q

When is H2 receptor antagonist used

A

Indicated in GORD

Peptic ulcer disease

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12
Q

What is the administration of H2 receptor antagonist and proton pump inhibitors

A

Orally

IV

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13
Q

What is an example of a Proton Pump Inhibitor and it mechanism

A

Omeprazole

Blocks proton pump inhibitory thereby reducing acid secretion

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14
Q

What is the indication for the use of Proton pump inhibitor

A

Used in GORD
Peptic ulcer disease

Tripple therapy treatment for PU/DU associated with H.Pylori

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15
Q

What are the GI upset and predisposition that can occur due to Proton pump inhibitor s

A

C. Diff Infections
Hypomaganesaemia
B12 deficiency

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16
Q

What is the mechanism of pro kinetic agents

A

Increase gut motility and gastric emptying

by having parasympathetic nervous system control of smooth muscle and sphincter tone via ACh

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17
Q

What are examples of Prokinetic agents

A

Metoclopramide

Domperidone/dopamine antagonist

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18
Q

How does Domperidone increase gut motility and gastric emptying time

A

blocking dopamine receptors which inhibit post-synaptic cholinergic neurones

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19
Q

What is Pro-kinetics used in the treatment of

A

GORD

Gastroparesis - allows to empty quicker

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20
Q

What is anti emetics, give two examples

A

Prevent vomiting

5- HT3 antagonists

Anti Histamines

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21
Q

Where do 5-HT3 antagonist work to prevent vomiting

A

Chemoreceptor Trigger zone (drugs/toxin)

Vomiting centre/medulla

Pharynx and GIT
(gastroenteritis, radiotherapy, some drugs)

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22
Q

Where do antihistamine work in the prevention of vomiting

A

Vestibular nuceli (motion)

Vomiting centre/medulla

Chemoreceptor trigger zone

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23
Q

Where does dopamine antagonist work for increasing gut motility and gastric emptying

A

Chemoreceptor trigger zone

Pharynx and GIT (gastroenteritis, radiotherapy, some drugs)

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24
Q

What is examples of anti-motlity drugs

A

Loperamide (immodium)

Opiods

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25
What is the mechanism of anti-motility drugs
antagonise optiate receptors in GI tract decreasing ACh release, thereby decreasing smooth muscle contraction and increasing anal spinchter tone
26
What is the clinical benefit of drugs which decrease GI motility
are anti-diarrhoea
27
Why does loperamide have few central opiate effects
Not well absorbed across the blood brain barrier
28
What doe antispasmodics reduce the symptoms of
IBS | Renal colic
29
What is the three mechanism od anti-spasmodics
anti-cholingeric muscarinic antagonists Direct smooth muscle relaxants Calcium channel blockers
30
What is examples if anti-cholinergic muscarinic antagonists | and there mechanisms
- Hyoscine Buscopan - Meberverine Inhibit smooth muscle constrictions in the gut wall, producing muscle relaxation and reduction in spasm
31
What is an example of a CCB and its mechanism
Peppermint oil Reduce calcium required for smooth muscle contractions
32
What is the 4 types of laxatives, and examples
Bulk (e.g. Isphagula) Osmotic (e.g. Lactulose) Stimulant (e.g. Senna) Softeners (e.g. Arachis oil)
33
What is the overall mechanism of laxatives
Work by increasing bulk or drawing fluid into the gut making it easier for stool to pass
34
What is potentially issues of laxatives
Can cause obstruction Osmotic laxatives will not work without adequate fluid intake Misuse Route of administration: oral or rectal
35
What is the problems of anti-motility drugs
Can cause constipation Cannot take it there is an obstruction Prevent diarrhoea - infection isn't "flushed out"
36
What drugs are used in treating inflammatory bowel disease
Aminosalicylates Cortiscosteroids Immunosuppressants (azathioprine) Biologics (Anti-TNFα antibodies)
37
What is examples of aminosalicylates that treat IBD and how are they administrated
Mesalazine Olsalazine (Sulfasalazine original drug but side effect problems) Administrated either Orally or IV
38
What is the mechanism of aminosalicylates in treating IBD
Unclear but has anti-infammatory properties
39
What cautions should be taken when taking aminosalicylates for the treatment of IBD
Chemically related to salicylates so avoid if allergic Be careful if have renal impairment
40
What is the adverse effect of aminosalicylates
GI upset Blood dyscrasias Renal impairment
41
What is the administration and mechanism of cortiscosterioids
Given: Orally, IV, Rectal Anti-inflmammatory effects
42
What is the concerns of taking corticosteroids in IBD
Can cause: -Osteoporosis -Cushingoid features (weight gain, diabetes mellitus, HT) Have an increased susceptibility to infection If abrupt withdrawal causes addisonian crisis
43
Define addisonian crisis
Medical emergency as symptoms that indicate severe adrenal insufficiency caused by insufficient levels of the hormone cortisol
44
How does the immunosuppressant azathioprine work in the treatment of IBD
Prevents the formation of purines required for DNA synthesis so reduces immune cell proliferation
45
What is the adverse effects of azathioprine that means it requires close monitoring
Bone marrow suppression azathioprine hypersensitivity and organ damage to lung,liver, pancreatitis Drug interaction
46
What is an example of a Biologic that treats IBD, and its mechanism
Infliximab - mouse human chimeric antibody to TNFα Prevents the actions of TNFα preventing cytokine occurring in an inflammatory response
47
What is infliximab also used in the treatment of
Psoriasus | Rheumatoid arthritis
48
What are the cautions and contradictions of Infliximab treatment in IBD
Current TB/serious infection Multiple sclerosis Pregnancy/ breast feeding
49
What is the adverse effect of Infliximab
Risk of infection, Infusion reaction (fever, itch) Anaemia, thrombocytopenia, neutropenia Demyelination Malignancy
50
What should all patients taking Infliximab be screened for
TB
51
What are 5 examples of other biologics that can be used in the treatment of IBD
Certolizumab Adalimumab Natalizumab Golimumab Vedolizumab
52
What is the mechanism of Bile acid sequestrate's | Cholestyramine
Reduces bile salts by binding with them in the gut and then excreting as insoluble complex - preventing reabsorption
53
What should be considered when taking Cholestyramine
May affect the absorption of other drugs - take separately May affect fat soluble vitamin absorption so may decrease vitamin K levels (affecting clotting and warfarin)
54
What does chlestyramine treat
Pruitits from biliary cause
55
What does Ursodeoxycholic Acid treat
Gall stones Primary Biliary cirrhosis
56
What is the mechanism of Ursodeoxycholic Acid
Inhibits an enzyme involved in the formation of cholesterol, altering amount in bile and slowly dissolving non-calcified stones
57
Gastrointestinal or liver disease can effect what process of drugs
Absorption Distribution Metabolism Excretion
58
What might change the route of administration of drugs
GI symptoms
59
What facts affect the absorption of drugs in the GI
Change in pH Gut length: - extra stomach time - slow time to small intestine Transit time - dependant on bacteria - diarrhoea, increases transit time, decreases absorption
60
What factor affect distribution of drug in the GI tract
Low albumin (decreased binding and increased free drug concentration)
61
What factor affect the metabolism of drugs in the GI tract
Liver enzymes (decrease in disease, drugs toxicity increase) Increased gut bacteria (metabolise drugs so increased dose needed) Gut wall metabolism (disease may reduce first pass metabolism) Liver blood flow (Blockage in flow means drugs will have a high extraction ratio)
62
What factor affects the excretion of drugs in the GI tract
Biliary excretion due to an increased toxicity if hepatobilliary disease
63
What are the pharmacodynamic effects with drug examples In Liver disease
Exaggerated response e.g. sedation with benzdiaepines Reduced response e.g. reduced dieresis with loop diuretics Increased toxicity e.g. nephrotoxicity with amino-glycosides
64
What is the GI adverse effects of drug treatment
GI upset Diarrhoea/constipation GI bleeding/ulceration Changes to gut bacteria Drug induced liver injury
65
What drugs causes the adverse reaction of diarrhoea/constipation
Cholinergics, NSAIDs, Antimicrobials | Opioids, Anticholinergics
66
What are the mechanism of the drug treatment that cause diarrhoea
osmotic, secretory, shorted transit time, | protein losing, malabsorption,
67
What is the main aetiology of drug induced diarrhoea
antimicrobials
68
What are two example of drug induced GI bleeding/ulceration
Low dose aspirin/NSAIDS Warfarin
69
What is the mechanism of drug induced GI ulcers
Ulcer causation and increases bleeding tendency due to impaired platelet aggregation Implication of other drugs e.g. SSRI and Platelet function
70
What is NSAID pathology to GI Bleeding
Affect COX1 (Impairing the defence) and COX 2 (impairing the healing) and causes epithelial damage (impairing platelet aggregation) resulting in local and systemic effect through prostaglandins
71
Changes to the gut bacteria is mainly due to what drugs
Antibiotics
72
What is the affect of changes to gut bacteria
Loss of oral contraceptive pill activity Reduced Vitamin K absorption (increased prothrombin time) Overgrowth pathogenic bacteria (eg C.diff infection)
73
What is the two forms drug induced liver injury
``` Intrinsic hepatoxocity (predictable, dose dependant) ``` ``` Idiosyncratic hepatotoxicity (unpredictable, not dose dependant) ```
74
What causes drug induced liver injury
The drug itself | or its active metabolite
75
What is the diverse affect of the drug induced liver injury
From asymptomatic increase in LFTS to liver failure and death Generally causes - Acute/chronic hepatitis - cholestasis (gall stone in bile duct)
76
What is the risk factors for drug induced liver disease
Age (elderly at risk) Sex (female at risk) Alcohol consumption Genetic factors Malnourishment
77
What are examples of drugs causing drug induced liver disease (hepatotoxicity)
Paracetamol, isoniazid = acute Diclofenac, methyldopa = chronic ACE inhibitors, co-amociclav = acute cholestasis Methotextrate = fibrosis/cirrhosis
78
What is assessed for child-pugs classification scoring the severity of liver disease
``` High Bilirubin Low albumin PTs Encephalopathy Ascites ```
79
When prescribing in Liver disease what drug properties should be avoided
Drugs which can be toxic due to changes in pharmokinetics Drugs which are hepatotoxic Drugs which may worsen with non liver aspects of liver disease e.g. encephalopathy
80
What are the pharmokinetics that change that can cause toxicity of drugs
Liver metabolism Therapeutic index Bilary excretion
81
What is examples of drugs that are hepatotoxic
Methotrexate | Azathioprine
82
What is an example of a drug which can worsen encephalopathy in liver disease
Benzodiazepine
83
What particular drugs should be avoided when prescribing in liver disease and why
Warfarin/anti-coagulants - clotting factors already low Aspirin/NSAIDS - Increase bleeding time - worsen ascites due to fluid retention Opiates/benzodiazepines - precipitate encephalopathy by increasing sedation

Alimentary System: Pathology SA (27 decks)

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