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Case12: Inflammatory Bowel > Drugs > Flashcards

Drugs Flashcards

(59 cards)

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1
Q

Name 3 disorders of inappropriate motility.

A
  1. Diarrhoea
  2. Constipation
  3. Irritable bowel syndrome, IBS
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2
Q

3 approaches to treat severe diarrhoea

A
  1. Rehydration to maintain fluid & electrolyte balance (priority) !
  2. Use of antibiotics
  3. Use of spasmolytic or other anti-diarrhoeal drugs
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3
Q

Priority in managing diarrhoea

A

Maintain fluid & electrolyte balance

rehydrate

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4
Q

3 classes of anti-diarrhoeal drugs

A
  1. Antimotility / Antisecretory drugs
  2. Antibiotics
  3. Adsorbents
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5
Q

5 types of antimotility / antisecretory drugs

A
  1. Opioid receptor agonists
  2. Enkephalinase inhibitors
  3. Muscarinic receptor antagonists
  4. 5-HT3 antagonists
  5. Bismuth compounds

antimotility = slow down intestinal movement

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6
Q

Examples of opioid receptor agonists

A
  • Loperamide
  • Codeine
  • Diphenoxylate
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7
Q

Mechanism of action: Opioids receptor agonist

A
  • acts on μ opioid receptor in myenteric plexus to inhibit ACh release, and reduce motility
  • reduces frequency of abdominal cramps
  • decreases passage of faeces
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8
Q

Clinical use: Opioids receptor agonist

A

Treat acute non-infectious diarrhoea

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9
Q

Mechanism of action: Enkephalinase inhibitors

A

1. inhibits enzyme enkephalinase, preventing breakdown of enkephalins

  • enkephalins bind to delta-opioid receptors

2. also reduces excessive intestinal secretion

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10
Q

Clinical use: Enkephalinase inhibitors

A

Acute diarrhoea

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11
Q

Example of Enkephalinase inhibitors

A

Racecadotril

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12
Q

Mechanism of action: Antimuscarinics

A

Block muscarinic receptors

hence, reducing GI motility & spasms

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13
Q

Clinical use: Antimuscarinics

A

Irritable bowel syndrome

Cramping diarrhoea

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14
Q

Examples of Antimuscarinics

A
  • Atropine
  • Hyoscine
  • Dicycloverine
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15
Q

Mechanism of action: 5-HT3 receptor antagonist

(serotonin receptor antagonist)

A

Inhibits serotonin in GI tract

hence blocking gut motility and secretion

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16
Q

Clinical use: 5-HT3 receptor antagonist

A

Women who exhibit severe diarrhoea-predominant IBS

  • who failed conventional therapy
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17
Q

Example of 5-HT3 receptor antagonist

A

Alosetron

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18
Q

Why use antibiotics in diarrhoea?

A

Kill infectious bacteria causing diarrhoea

underlying cause

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19
Q

Example of antibiotic for diarrhoea treatment

A
  • Ciprofloxacin
  • Cotrimoxazole
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20
Q

Most common bacterial organisms causing diarrhoea

A

E.coli

Salmonella

Shigella

Campylobacter

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21
Q

Mechanism of action: Adsorbents in diarrhoea

A
  • absorb water and increase stool bulk
  • binds to intestinal toxins, and remove them
  • protect intestinal mucosa
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22
Q

Example of adsorbent for diarrhoea treatment

A

Charcoal

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23
Q

First-line management of constipation

A

Non-pharmacological measures

  • high fibre diet
  • drink plenty of fluids
  • avoid caffeine/alcohol
  • manage stress
  • habit training
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24
Q

Second-line management for constipation

Study These Flashcards
A

Pharmacological (laxatives)

25
Types of laxatives
1. Bulk-forming laxatives 2. Osmotic laxatives 3. Faecal softeners 4. Stimulant laxatives
26
Mechanism of action: **bulk-forming** laxatives
absorb water → increasing stool bulk → promoting peristalsis - forms a bulky hydrated mass *#no side effects* *but takes long*
27
Examples of bulk-forming laxatives
- methylcellulose - ispaghula husk - bran
28
Clinical use: **bulk-forming** laxatives
Chronic constipation Irritable Bowel Syndrome
29
Mechanism of action: **osmotic** laxatives
draws water into bowel
30
Examples of **osmotic** laxatives
- lactulose - macrogol
31
Clinical use: **osmotic** laxatives
Chronic constipation Drug-induced constipation
32
Mechanism of action: **faecal softeners**
lower surface tension → allow water to soften stool
33
Example of faecal softeners
Docusate sodium
34
Clinical use: faecal softeners
patients who should avoid straining (e.g. post-surgery)
35
Mechanism of action: **stimulant** laxatives
- stimulate myenteric nerves → stimulates peristalsis → intestinal muscles contract to push out stool - also promotes accumulation of water & electrolytes
36
Examples of **stimulant** laxatives
- senna - bisacodyl
37
Clinical use: **stimulant** laxatives
- relief constipation when other laxatives haven't worked - to clear bowel before procedures (e.g. colonoscopy, surgery)
38
When should laxatives be **avoided**?
In bowel obstruction
39
**NICE** guidelines for oral laxatives
**Start** with *bulk-forming* laxative - if patient can drink adequate fluids Consider **switching** to *osmotic* laxative - if patient cannot drink / if stools remain hard Consider **adding** stimulant laxative - if stools soft, but difficult to pass
40
Drugs used to treat Irritable bowel syndrome (IBS)
Target individual symptoms: - for abdominal spasm → **Antispasmodics** - for diarrhoea → **Anti-diarrhoeals** - for bloating / constipation → **Laxatives** - for pain → **Antidepressants** - for infection → **Antibiotics**
41
**2** main types of **Antispasmodics**
1. Antimuscarinics (also called Anticholinergics) 2. Direct smooth muscle relaxants
42
Examples of **Antimuscarinics**
- hyoscine - butylbromide - dicycloverine
43
Mechanism of action: **Antimuscarinics**
Block action of *Acetylcholine*, a neurotransmitter that stimulates muscle contractions (in enteric plexus) - hence, reducing intestinal motility
44
Clinical use: **Antispasmodics**
Help prevent cramping in *Irritable bowel syndrome* (IBS)
45
Mechanism of action: Direct smooth muscle relaxants
Act directly on smooth muscle to relax, without affecting nerve transmission
46
Examples of direct smooth muscle relaxants
- peppermint oil - mebeverine
47
How to treat *Inflammatory bowel disease*?
1. Medications → Anti-inflammatory drugs → Immunosuppressants → Antibiotics 2. Nutrition 3. Surgery
48
3 types of **Anti-inflammatory** drugs
1. Aminosalicylates 2. Corticosteroids 3. Biologics
49
Mechanism of action: **Aminosalicylates**
Reduce inflammation by: - inhibiting prostaglandins and cytokines in the gut - decreasing neutrophil chemotaxis & superoxide generation
50
Clinical use: Aminosalicylates
Mild to moderate ulcerative colitis
51
Examples of **Aminosalicylates**
- mesalazine - sulfasalazine
52
Mechanism of action: **Corticosteroids**
Inhibits synthesis of inflammatory mediators → Reduce inflammation - also act as Immunosuppressant
53
Clinical use: **Corticosteroids**
Moderate to severe attacks of *Ulcerative colitis* & *Crohn's disease*
54
Examples of **corticosteroids** in IBD
Prednisolone
55
Mechanism of action: **Biologics**
Target specific immune pathways: example: (1) TNF - αlpha inhibitors (2) Anti-integrin antibodies (3) Anti-interleukin antibodies *→ inhibit IL-12 / IL-23*
56
Examples of **Biologics** * (anti-inflammatory drugs)
(1) TNF - αlpha inhibitors → Adalimu**mab** , Inflixi**mab** (2) Anti-integrin antibodies → Vedolizumab (3) Anti-interleukin antibodies → Ustekinumab , Mirikizumab
57
Mechanism of action: **Immunosuppressants**
Suppress immune system → Reduce inflammation
58
Clinical use: **Immunosuppressants**
- **severe** Inflammatory bowel disease - patients who relapse when they come off with steroids
59
Examples of **Immunosuppressants** used in IBD
- methotrexate - ciclosporin - azathioprine

Case12: Inflammatory Bowel (7 decks)

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