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Yr3 Pharmacology > GI Drugs > Flashcards

GI Drugs Flashcards

1
Q

Name an OTC example of an Antacid

A

Gaviscon, Rennie

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2
Q

How do Antacids work?

A

They act as buffers to stomach acids, resist pH changes

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3
Q

Name 2 indications of antacids

A

GI reflux, dyspepsia (indigestion)

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4
Q

What effect would VTE treatment have on gaviscon?

A

Anticoagulants increase gaviscon’s effect.

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5
Q

Name 6 drug types that antacids can affect serum concentrations of:

A 
Increases serum concentrations of:
ACE inhibitors eg ramipril
Certain antibiotics: Cephalosporins, ciprofloxacin and tetracyclines
Bisphosphonates 
Digoxin
PPIs eg Omeprazole
Levothyroxine
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6
Q

What are antacids contraindicated with?

A

Nothing significant

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7
Q

What will antacids do to urine?

A

Turn it slightly acidic

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8
Q

How are antacids eliminated?

A

In the urine

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9
Q

What would you tell a patient before starting them on an antacid?

A

Taking them for reflux / indigestion
Only a temporary measure
Do not take at the same time as other medicines, because of how many it reacts with (leave 2 hours in between)
Lifestyle adjustments to help: smaller, less fatty meals, stop smoking and drinking, raise bed head

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10
Q

What do H2 Receptor antagonists such as ranitidine do?

A

Reduce acidity of stomach
By blocking H2 receptors (where usually histamine binds)
Histamine binding to receptor causes H+ to be released into stomach lumen in exchange for K+, thus increasing acidity.
H2 receptor antagonists stop this.

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11
Q

why would someone need a H2 receptor antagonist?

A

GORD or peptic ulcer disease (PPIs usually prefered)

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12
Q

Name some interactions and contraindications of Rantidine?

A

No significant.

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13
Q

What major and minor side effects of H2 antagonists are there?

A

No Major

Minor: occasional diarrhoea, headache, dizziness

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14
Q

How is ranitidine eliminated?

A

renally

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15
Q

What would you tell a patient who is about to start on a H2 antagonist?

A

Take around mealtimes for most effectiveness
Side effects rare
Report red flags for Gastric malignancies that this may be hiding

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16
Q

Name some red flags for GI malignancies

A

Difficulty swallowing, feel like something stuck in throat, meleina

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17
Q

How would you know a drug is a PPI?

A

Ends in -OLE, e.g. Omeprazole, Lansoprazole

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18
Q

How do PPIs and H2 receptor antagonists differ?

A

PPIs irreversibly inhibit H+/K+ ATPase, H2 receptor antagonists reversibly inhibit.

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19
Q

How do PPIs work?

A

Irreversibly inhibit H+/K+ ATPase in gastric parietal cells., completely suppressing gastric acid secretion.
More effective that PPIs.

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20
Q

Name some indications of PPIs

A

Prevent and treat gastric ulcers
Symptomatic relief of GORD and dyspepsia
Eradication of H.pylori along with antibiotics

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21
Q

Which PPI would someone be prescribled if they were being treated to prevent occlusions when they have coronary artery stent?

A

Lansoprazole or pantoprazole, as some (especially omeprazole) reduce the anti platelet effects of clopidogrel by decreasing its activation by cytochrome p450 enzymes.

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22
Q

What are some contraindications and side effects of PPIs?

A

Contraindications: none
Side effects: can disguise symptoms of GI cancer and some evidence of increased risk of fractures - consider lower dose in those with osteroporosis

23
Q

How is omeprazole eliminated?

A

80% as metabolites in urine

20% in faeces from bile secretions

24
Q

What would you tell a patient before starting them on a PPI?

A

It’s to reduce stomach acid
Check they’re not on clopidogrel
Report any signs of gastric cancer (meleina, weight loss, swallowing difficulty)

25
Q

What kind of drug is Loperamide, what is it used for and what’s its trade name? OTC or prescription?

A

Opioid
Antimotility drug in diarrhoea
Imodium
OTC

26
Q

How does imodium work?

A

Opioid that doesn’t enter CNS so no analgesic effects
Agonist of opioid u-receptors in GI tract, which increases non-propulsive contractions of the gut, and reduces peristaltic contractions.
Leaves more time for water to be absorbed in the colon so stools are hardened as well as gastric motility reduced.

27
Q

What is imodium indicated and contraindicated for?

A

Indications: Diarrhoea
Contraindications: Acute IBD and C.diff: peristalsis stopping increases risk of megacolon and perforation. Also acute bloody diarrhoea as it can signify bacterial infection. stops the infection leaving the body.

28
Q

Side effects of loperimide / imodium are uncommon but name a few:

A

Dizziness, drowsiness, dry mouth, vomiting, constipation (too high dose), fatigue, stomach discomfort.

29
Q

How is loperamide eliminated?

A

Unchanged in faeces- it never leaves GI tract, so none if it found systemically.

30
Q

Patient info for loperimide?

A

Only to relieve diarrhoea, It doesn’t stop the underlying cause
Stop if constipated, abdo pain or need it for 5+ days

31
Q

name 3 types of laxatives and examples of each

A

bulk forming eg methylcellulose, isphagula husk
osmotic eg lactulose, macrogol, phosphate enema
Stimulant eg senna

32
Q

How do bulk forming laxatives work

A

contain hydrophilic substance which isn’t absorbed or broken down by the gut, attracting water into the gut and stool.

33
Q

How do osmotic laxatives work

A

contain osmotically active substances which aren’t absorbed, attreactine water into the gut and the stool

34
Q

How do stimulant laxatives work

A

These increase the water and electrolyte secretion into the gut lumen, increasing the volume of colonic content, thus stimulating the peristalsis.
They also have a direct peristaltic action.

35
Q

Which kind of laxative interacts with other drug(s), and which ones(?)

A

Osmotic, warfarins effects may be slightly elevated

36
Q

What are the contraindications of bulk forming laxatives?

A

Intestinal obstruction, , fecal impactation, ileus.

37
Q

What are the contraindications of osmotic laxatives?

A

Intestinal obstruction as perforation possible. Phospate enemas can cause large fluid shift so be careful in heart failure, ascites and electrolyte disturbances

38
Q

What are the contraindications of stimulant laxatives?

A

Intestinal obstruction, avoid anal preparations in haemorrhoids and anal fissure

39
Q

How is each type of laxative eliminated?

A

Osmotic and bulk forming: not absorbed systemically so excreted in faeces.
Stimulant: metabolised in liver, eliminated by biliary excretion in faeces

40
Q

What would you tell a patient before starting a bulk forming laxative?

A

Its a fibre suppliment
adjust dose to symptoms
take with a meal

41
Q

What would you tell a patient before starting an osmotic laxative

A

Drink lots of water! 6-8 cups /day
Side effects: discomfort and cramps
Adjust dose according to symptoms
Stop once doing 2-3 soft stools / day.

42
Q

What would you tell a patient before starting taking senna

A

Drink 6-8 cups of water / day
Beware they don’t work immediately
Abdo cramps and flatulence can occur, go with time
Adjust dose to symptopms

43
Q

What is the first line drug treatment for mild to moderate ulcerative colitis?

A

Aminosalicylates eg mesalazine

44
Q

What is the method of action of Mesalazine

A

Its broken down into 5-aminosalicylic acid, which works topically on the gut (not absorbed systemically)
Exact MOA unknown, but has inmunosupressive and antiinflammatory effects.

45
Q

What are mesalazines interactions?

A

Other salicylates eg aspirin. (Don’t take if sensative to aspirin)

46
Q

Name 5 side effects of aminosalicylates

A 
GI upset eg nausea, dyspepsia
Headache
Rare blood disorders eg leukopenia, thrombocytopenia
(reverseable) sperm decrease
Serious hypersensitivity reaction
47
Q

What would you tell a patient who is starting on mesalazine?

A

To help control UC

Report any unexplained bleeding, bruising (blood disorders) or infection.

48
Q

Whats an example of an anti-emetic, and what do they do?

A

Metoclopramide, dopamine d2 receptor antagonists

Anti-sickness

49
Q

how do anti-emetics work? (2 ways)

A

Dopamine works via D2 receptor in the chemoreceptor trigger zone in medulla in brain, D2 senses substances which make us feel sick. Dopamine is also a gut neurotransmitter, where is slows it down.
By blocking dopamine D2 receptors, it blocks the feeling of wanting to be sick, as well as promoting gastric emptying which also helps.

50
Q

When is the risk of extrapyramidal side effects increased in prescribing metaclopramide? What are extrapyramidal side effects? Why shouldn’t it be prescribed with parkinsons meds?

A

When prescribed with antipsychotics.
Akathisia, dystonia, psuedoparkinsonism, and dyskinesia.
Antagonises parkinsons meds effects.

51
Q

When is metaclopramide contraindicated?

A

Children: extrapyramidal side effects

GI obstruction and perforation: increases gut motility.

52
Q

What are the side effects of metroclopramide!

A

Diarrhoea, extrapyramidal movement disorders

53
Q

How is metroclopramide eliminated

A

In urine

54
Q

What would you tell a patient starting on metroclopramide

A

Anti sickness medication

Side effects

Yr3 Pharmacology (6 decks)

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