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GI > drugs in GI > Flashcards

drugs in GI Flashcards

1
Q

what factors affect absorption in the GI tract? (9 things)

A
  • Gut motility – if quick movement, less time for drug absorption
  • Gastric emptying
  • Surface area – rate greatest in SI
  • Gut pH – some drugs will denature in the acidity
  • Blood flow
  • Presence of food and fluid: eg tetracycline – reduced if diary in gut as it will collate. Rivaroxaban – have with food
  • Antacids- may neutralise other drugs
  • Drug composition and site of administration- IV/ oral/ topical/ nasal/ inhalation
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2
Q

define constipation

A

defection that is unsatisfactory because of infrequent stool, difficulty in passing stools or sensation of incomplete emptying

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3
Q

how many bowel movements weekly define constipation?

A

less than 3

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4
Q

what is faecal impaction?

A

retention of faeces - can vomit it

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5
Q

what are symptoms of constipation?

A

loss of appetite, hard stools, painful bowel movement, possible bleeding, stomach distension/ bloating

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6
Q

name some medications that can cause constipation

A
  • Opioids
  • Iron
  • Antipsychotics including clozapine
  • Diuretics
  • Verapamil – CCB
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7
Q

what medical conditions can pre-dispose to constipation?

A
  • Coeliac – can cause diarrhoea
  • Depression
  • GI obstruction – carcinoma, ilueus, ovarian/ uterine tumours
  • Electrolyte imbalances
  • MS/ parkinsons
  • Damage to pelvic floor – childbirth
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8
Q

what is overflow?

A

diarrhoea can squeeze past blockage

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9
Q

what do bulk forming laxatives do?

A

act by retaining fluid within stool and increasing faecal mass, stimulating peristalsis
eg ispaghula husk – fibre gel

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10
Q

what are side effects of bulk forming laxatives?

A

flatulence and bloating

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11
Q

what is the action of osmotic gel laxative?

A

increase amount of fluid in large bowel producing distension of peristalsis and stool softener

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12
Q

name some osmotic gel laxatives

A
  • Macrogol, lactulose (takes a few days to work), phosphate enema
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13
Q

what are the side effects of osmotic gel laxatives?

A

abdo cramps, bloating, flatulence, nausea, vomiting

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14
Q

what is the action of stimulant laxatives - senna?

A

cause peristalsis by stimulation of colonic nerves

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15
Q

what is the action of stimulant laxatives like bisacodyl or sodium picosulphate?

A

stimulating colonic pr rectal nerves

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16
Q

what are side effects of senna laxatives?

A

: abdo cramps, diarrhoea, nausea/ vomiting, senna may cause yellow- brown colour urine

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17
Q

name some bowel cleansing agents?

A

citamag moviprep

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18
Q

what is the action of prucalopride laxative?

A

prokinetic laxative, stimulating intestinal motility

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19
Q

when would prucalopride laxatives be used?

A

end stage - specialist

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20
Q

how do you manage constipation (3 mths >)

A

: lifestyle – fruit/ veg increase, aim for 30g daily of fibre, increase fluid, exercise. Bulk forming, osmotic (hard stool hard to pass), stimulant (soft stool but difficult to pass)

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21
Q

how do you manage opioid induced constipation?

A

: lifestyle, NO BULK FORMING, osmotic + stimulant, then gradually reduce laxative

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22
Q

how can palliative care cause constipation?

A

medications may contribute (antimuscarinics, opioid analgesics, antacids), secondary effect of disease, direct effect of malignancy causing bowel obstruction, hypercalcaemia, nerve damage

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23
Q

how is palliative care constipation managed?

A
  • Aim to alleviate contributing factor, stimulant and softener (senna and lactulose), titrate and add macrogol
  • If faecal impaction/ loading enema
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24
Q

what is the issue with macrogol (osmotic gel laxative)

A

sachet that needs mixing into water
may be an issue in those that can not swallow - may need to drink alot

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25
Q

how do manage chronic constipation that induces faecal loading?

A

high dose oral macrogol, enemas, suppositories, disimpaction and oral laxatives in stepwise manner

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26
Q

how do manage constipation in pregnancy?

A

lifestyle and short term laxatives
- Bulk, lactulose and senna

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27
Q

why do you want to quickly resolve constipation in pregnancy?

A

reduce strain on pelvis

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28
Q

how long is acute diarrhoea?

A

< 14 days

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29
Q

what usually causes acute diarrhoea?

A

bacterial, viral, food, anxiety

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30
Q

what is defined as chronic diarrhoea?

A

> 4 weeks

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31
Q

what can cause chronic diarrhoea?

A

IBS, diet, coeliac, bowel cancer

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32
Q

what endocrine conditions can cause diarrhoea?

A

– hyperthyroidism, adrenal insufficiency, carcinoid tumours, medullary thyroid

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33
Q

what GI conditions can cause diarrhoea?

A

IBS, inflame BS, coeliac, ischaemic colitis, microscopic colitis, short bowel syndrome, malabsorption, bowel obstruction/ constipation with overflow, diverticulitis

34
Q

what dietary intolerances can cause diarrhoea?

A

: lactose intolerance, fructose intolerance, gluten intolerance, food allergies

35
Q

what medications can cause diarrhoea?

A
  • Laxatives
  • Antacids with magnesium
  • Antibiotics
  • Chemo
  • PPI
  • Medicines suppressing immune system – mycophenolate
  • NSAIDs – used to treat pain and arthritis eg ibuprofen and naproxen
  • Colchine
36
Q

how do you manage travellers diarrhoea?

A

ciproflaxin

37
Q

what are the SICK day rules in diarrhoea?

A

stop any medications that can contribute to dehydration
– remove NSAIDs, ACEi, diuretics

38
Q

what are symptoms of c.diff?

A

fever, crampy abdo pain, diarrhoea

39
Q

what toxins of c.diff can cause mucosal damage?

A

A and B

40
Q

how do you manage C.diff?

A
  • check AB/ PPIs
  • isolate and barrier nursing – find initial cause
  • fluid loss – replenish
  • vancomycin
41
Q

how can C.diff survice in the stomach?

A

endospores can survivie pH and then hence invade intestines

42
Q

what are risk factors of c.diff?

A

: age, frailty, previous history, underlying co-morbiditiess eg abdo surgery, IBS, immunosuppression

43
Q

what are complications of c. diff?

A

severe and include pseudomonas, colitis, toxic megacolon (invaded whole colon), perforation of colon, sepsis and death

44
Q

describe mild diarrhoea?

A

not associated with elevated WCC
- < 3 episodes of loose stools

45
Q

describe moderate diarrhoea?

A

– increased WCC
- Associated with 3-5 loose stools per day

46
Q

describe severe diarrhoea?

A

WCC> 15 x10^9 or increased creatinine
- Temperature or severe colitis – abdo/ radiological signs

47
Q

describe life threatening diarrhoea

A

hypotension, partial/ complete ileus (lack of normal muscle contractions), toxic megacolon, CT evidence of severe disease

48
Q

what is GORD?

A

: chronic condition where reflux of gastric contents back into oesophagus causing heart burn and acid – endoscopy determined oesophagitis or reflux disease

49
Q

what is oesophagitis?

A

inflammation and mucosal erosion

50
Q

what is dsypepsia?

A

range of symptoms (not a diagnosis) – symptoms usually present > 4weeks including upper abdo pain, discomfort, heart burn, gastric reflux, nausea/ vomiting, NDSAIDs and h.pylori

51
Q

what is barrets oesophagus?

A

lining of stomach damaged by stomach acid – risk of cancer

52
Q

what is zollingers ellison sydrome?

A

condition where gastrin – secreting tumour or hyperplasia of the inslet cells in pancreas causes overproduction of gastric acid, resulting in peptic ulcers

53
Q

what is a hiatus hernia?

A

: part of stomach moves up into the chest

54
Q

what age does hiatus hernia become more common?

A

50+

55
Q

what are the causes of depsia?

A

alcohol gastrisis, biliary disease, food sensivity (spicy food), H.pylori, hepatitis, medications, large hiatal hernia, pancreatic disorders, peptic ulcer disease

56
Q

what is the management pathway of dsypepsia?

A
  • Review medication, lifestyle advice  full dose PPI for a month  test and treat as accordingly (if relapse – low PPI dose as required, if no response use H2 for a month)  review
57
Q

what medications cause dsypepsia?

A

NSAIDs, corticosteroids, CCB, nitrates, theophylline, bisphosphates (alendronate), combination of SRIs, NSAIDs/ aspirin increases persons risk of GI bleed

58
Q

how do you manage dsypepsia in pregnancy?

A
  • Antacids and alginates are first line – symptoms are relatively mild
  • If symptoms are severe or persist with antacid/ alginate then try with acid suppressing drug – omeprazole
59
Q

name some PPIs?

A
  • Eg – lansoprazole, pantaoprazole, omeprazole, esomeprazole, rabeprazole
60
Q

what is the action of PPIs?

A
  • Action: block proton pump in gastric parietal cells
61
Q

how do you dose PPIs?

A
  • Dosing: offer full dose for 8weeks but can be long term in those with severe oesophagitis, if NSAID induced stop NSAID if appropriate – full dose PPI for 8 weeks
62
Q

what are the associated risks with PPIs?

A
  • Increased risk of hip fracture
  • Low magnesium – prolonged use – MHRA warning
  • C.diff infections – inhibit gastric acid production leading to proliferation of spores and ability
  • Long term use associated with parietal cell hyperplasia – potential link to cancer
63
Q

what is the action of H2 receptor antagonists?

A

heal gastric and duodenal ulcers by reducing acid output by blocking H2 receptors

64
Q

how much basal acid secretion and pepsin production is reduced with H2 antagonists?

A

60%

65
Q

name some H2 receptor antgaonists?

A
  • Nitazatidine, famotidine
66
Q

why is cimetidine (H2 receptor antagonists) not used in practice anymore?

A

higher risk of drug interactions due to inhibition of cytochrome P450

67
Q

where does H. pylori?

A

antrum - lower part of stomach
inflammation
- ulcer – gastric inflammation may lead to duodenal or gastric ulcer- severe complications may include bleeding ulcer and perforated ulcer

68
Q

how do you test for h.pylori?

A
  • carbon 13 urea breath test or stool antigen test or lab based serology where its performance has been locally validated
  • redo carbon 13 breath test if stoop sample is inconclusive
  • leave a 2 week wash out period after PPI testing and antibiotics
69
Q

how do you prescribe PPI with GORD?

A

: full dose PPI for 4 weeks to aid healing

70
Q

how do you prescribe PPI with severe oesophagitis ?

A

full dose 8 weeks PPI or long term maintenance PPI

71
Q

how do you treat a peptic ulcer if linked to NSAID?

A

full PPI dose for 8 weeks
post NSAID - full NSAID review for at least 6mths - try lower dose ibuprofen and prescribe with PPI

72
Q

how do you treat peptic ulcer with no NSAID use?

A

first line eradication therapy

73
Q

what is the % hospital mortality with GI bleeding?

A

10

74
Q

how to manage GI bleeding?

A
  • High dose PPI (pantoprazole) to reduce risk of bleeding and need for surgery
  • Criticall ill: H2/ PPI oral/ IV to prevent stress upper GI bleeding
75
Q

what are main causes for GI bleeding?

A
  • Usually caused by peptic ulcer or esophagogastric varices
76
Q

what does metoclopramide do?

A

encourages normal peristalsis in upper GI tract
- Does not heal oesophagitis – acts as a 5HT3 blocker at higher doses
- CNS side effects – blocks dopamine receptors

77
Q

what are the acute dsytonia symptoms from metoclopramide?

A

acute dystonia- common in younger and elderly
- Treat with procyclidine
- Other symptoms: facial grimacing, involuntary upward eye movement, muscle spasms of tongue, face, neck and back, laryngeal spasms

78
Q

what are the tarditive dsykinesia side effects from metoclopamide?

A

Traditive dyskinesia side effects:
- Protrusion and rolling of tongue, sucking and smacking movements of lips, chewing motion, facial dyskinesia – gurning, involuntary movements of body and extremities

79
Q

why does metoclopamide cause so many CNS symptoms?

A

it can cross brain blood barrier

80
Q

what is the action of domperidone and who can use ?

A
  • Action – block dopamine receptors – release more prolactin – lactation and gynecomastia is common
    can be used in 12+
81
Q

what is antispasmodics used for?

A

use as required for abdo pain or spasm in IBS

82
Q

what does meberverine antispasmodics do?

A

– direct acting smooth muscle relaxant

GI (12 decks)

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