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Alimentary System > Clinical Pharmacology of the Alimentary System > Flashcards

Clinical Pharmacology of the Alimentary System Flashcards

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1
Q

What is the most common symptom of malignancy in terms of altered bowel habit?

A

Diarrhoea

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2
Q

What are the main drug classes used in treatment of alimentary disease?

A 
Acid suppressing 
Drugs affecting GI motility 
Laxatives
Drugs for IBD 
Drugs affecting intestinal secretions
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3
Q

Give an example of a drug used for acid suppression in alimentary disease

A

Antacids
H2 receptor antagonists
Proton pump inhibitors

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4
Q

give an example of a drug used to affect GI motility in alimentary disease

A

Anti-emetics
Anti-muscarinics/anti-spasmodics
Anti-motility drugs

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5
Q

Give an example of a drug type used for IBD

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

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6
Q

What do antacids contain that neutralises gastric acid?

A

Magnesium or aluminium

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7
Q

How do alginates help acid reflux?

A

They form a viscous gel which floats on the stomach contents and reduces reflux

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8
Q

What do H2 receptor antagonists block?

A

Histamine receptors

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9
Q

In what diseases are H2 receptor antagonists indicated?

A

GORD

Peptic ulcer disease

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10
Q

How can H2 receptor antagonists be administered?

A

Orally or intravenously

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11
Q

In what diseases are proton pump inhibitors indicated?

A

GORD

Peptic ulcer disease

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12
Q

How can proton pump inhibitors be administered?

A

Orally or intravenously

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13
Q

When would triple therapy including a proton pump inhibitor be indicated?

A

For treatment of peptic or duodenal ulcers associated with H. pylori

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14
Q

Proton pump inhibitors can cause a predisposition to what?

A

Clostridium difficile infection
Hypomagenesaemia
B12 deficiency

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15
Q

What do prokinetic agents increase?

A

Gut motility and gastric emptying

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16
Q

When would prokinetic agents be indicated?

A

GORD
Gastroparesis
(constipation)

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17
Q

Give an example of a prokinetic agent

A

Anti-emetics
Laxatives
e.g Metoclopramide, Domperidone

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18
Q

Give an example of a drug which can be used to treat diarrhoea i.e. which decrease motility

A

Loperamide

Opiates

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19
Q

What is the mechanism of action of drugs which decrease gut motility?

A

Via opiate receptors in the GI tract to decrease ACh release and smooth muscle contraction and increase anal sphincter tone

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20
Q

What are the mechanisms of action of anti-spasmodics?

A

Anti-cholinergic muscarinic antagonists
Direct smooth muscle relaxants
Calcium channel blockers

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21
Q

How do anti-cholinergic muscarinic antagonists work?

A

Inhibit smooth muscle contraction in the gut wall, producing muscle relaxation and reducing spasm

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22
Q

Give the different types of laxative and an example of each

A

Bulk - Isphagula
Osmotic - Lactulose
Stimulant - Senna
Softeners - Arachis oil

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23
Q

How do laxatives work?

A

By increasing the bulk of fluid drawn into the gut

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24
Q

What cause of constipation do you need to rule out before prescribing laxatives?

A

Obstruction - giving laxatives when constipation is due to obstruction could cause rupture, megacolon etc.

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25
Give an example of an aminosalicylate
Mesalazine Olzalazine Sulfasalazine
26
Aminosalicylates are first line treatment in
inflammatory bowel disease
27
Where are aminosalicylates metabolised?
In the liver
28
When should aminosalicylates be avoided?
If the patient is allergic to salicylates
29
How can corticosteroids be administered?
Orally Intravenously Rectally
30
Give an adverse effect of corticosteroids
``` Diabetes Osteoporosis Hypertension Cushing's disease Increased risk of infection ```
31
If a patient on corticosteroids becomes acutely unwell, should you withdraw or increase their corticosteroid dose?
Increase (double)
32
How do immunosuppressants work?
Prevent formation of purines which are required for DNA synthesis, so reduces immune cell proliferation
33
Adverse effects of immunosuppressants mainly relate to
bone marrow suppression
34
How to biologics work?
Prevent action of TNF-alpha which is a key cytokine in inflammatory response
35
What are the contra-indications for immunosuppressant use?
Current TB, or other serious infection Multiple sclerosis Pregnancy or breast feeding
36
Give an adverse effect of immunosuppressants
Increased risk of infection, particularly TB Infusion reaction causing fever and itch Anaemia Thrombocytopenia Neutropenia Malignancy
37
Give an example of a drug affecting biliary secretion
Cholestyramine | Ursodeoxycholic acid
38
How does cholestyramine work?
Reduces bile salts by binding with them in the gut and then excreting them as an insoluble complex
39
Other than bile salts, what might cholestyramine affect?
Absorption of other drugs (should be taken separately) | Fat soluble vitamin absorption
40
Ursodeoxycholic acid is used to treat
gallstones and primary biliary cirrhosis
41
Gastrointestinal or liver disease can affect the processes of drug;
Absorption Distribution Metabolism Excretion
42
Drug absorption is affected by
pH gut length transit time
43
The rate of drug absorption in GI/liver disease is more affected than
the total drug absorption
44
Drug distribution can be affected by
low albumin levels
45
Drug metabolism is affected by;
liver enzyme concentration | gut wall metabolism
46
What percentage of adverse drug reactions does GI upset account for?
20-40%
47
What drugs are commonly responsible for diarrhoea/constipation?
``` Cholinergics NSAIDs Antimicrobials Opiates Anticholinergics Opiates ```
48
Give an example of a mechanism affected by drugs causing diarrhoea/constipation
Osmotic Secretory Transit time Protein absorption
49
25% of drug induced diarrhoea is due to
antimicrobials
50
GI bleeding/ulceration accounts for what percentage of hospital admissions due to adverse drug reactions?
6.5%
51
What drugs, taken by a high percentage of the elderly population, are common causes of GI bleeding/ulceration?
Low dose aspirin NSAIDs Warfarin
52
Changes to gut bacteria is mainly due to
antibiotics
53
Give an adverse effect of changes in gut bacteria due to antibiotics
Loss of OCP activity Reduced vitamin K absorption Overgrowth of pathogenic bacteria
54
What are the features of intrinsic hepatotoxicity (type A ADR)?
Predictable Dose dependent Acute e.g. paracetamol overdose
55
What are the features of idiosyncratic hepatotoxicity (type B ADR)?
Unpredictable Not dose dependent Can occur at any time May be part of a hypersensitivity reaction Can be due to the drug itself or an active metabolite
56
What are the most common types of drug induced liver injury?
Hepatitis | Cholestasis
57
What are the risk factors for drug induced liver injury?
``` Age Female Alcohol consumption Genetic Malnourishment ```
58
When prescribing for a patient with liver disease, what needs to be considered?
Risk factors of drug induced liver injury | Severity of liver disease
59
What classification can be used to assess the severity of liver disease in a patient?
Child-Pugh classification
60
The Child-Pugh score separates liver disease into what three classifications, and which has the worst prognosis?
A - score < 7 B - score 7-9 C - score > 9 C has the worst prognosis
61
In prescribing for a patient with liver disease, care should be taken to avoid drugs which;
Can be toxic due to changes in pharmacokinetics Are hepatotoxic May worsen non-liver aspects of disease e.g. ascites
62
Drugs prescribed to patients with liver disease should have what kind of therapeutic index?
Wide therapeutic index
63
Give an example of a drug which should be avoided in patients with liver disease
Methotrexate Azathioprine Bensodiazepines
64
Caution should be taken when prescribing what kind of drugs to patients with liver disease?
``` Warfarin/anticoagulants Aspirin NSAIDs Opiates Benzodiazepines ```
65
When can you find information about risks with specific drugs in liver disease?
British National Formulary (BNF)

Alimentary System (29 decks)

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