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BNPH700 > GI Medications > Flashcards

GI Medications Flashcards

1
Q

What medication areas are included within the GI area?

A
  • STOMACH ACID CONTROLLING MEDICATIONS
  • ANTIEMETICS
  • LAXATIVES & ANTIDIARRHOEAL DRUGS
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2
Q

What are the 2 main types of medications used to control stomach acid?

A

Proton Pump Inhibitors
Antacids

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3
Q

Give an example of a proton pump inhibitor

A

Omeprazole

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4
Q

What suffix do proton pump inhibitors use?

A

“-prazole”

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5
Q

What is the indication of use for proton pump inhibitors?

A

Peptic ulcer disease, Gastritis, GORD (Gastro-oesophageal reflux disease) H.Pylori (Helicobacter pylori)

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6
Q

What is the MOA for proton pump inhibitors (Omeprazole)?

A

Bind irreversibly to the gastric proton pump in the parietal cells to prevent the release of gastric acid resulting in an increase in gastric pH

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7
Q

What are some adverse drug reactions associated with proton pump inhibitors?

A

Minor ADR’s of – GI upset, headache, dizziness, skin rash

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8
Q

What are some cautions/contraindications associated with proton pump inhibitors?

A

Caution with concurrent administration of with diazepam, phenytoin, warfarin

Can decrease absorption of medications that require an acid environment

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9
Q

What patient education would you provide the patient on proton pump inhibitors (Omeprazole) ?

A

Do not open, crush or chew the capsules

Not for long term use

Should follow guidelines for step down therapy and not stop abruptly as can cause rebound acidity

Administer once-daily dose 1 hour before meals, preferably in the morning.

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10
Q

What is GORD (Gastro-oesophageal reflux disease)?

A

Acid from the stomach leaks up into the oesophagus (gullet). Usually caused by the ring of muscle at the bottom of the oesophagus becoming weakened. Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus. But for people with GORD, stomach acid is able to pass back up into the oesophagus.

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11
Q

What are some symptoms of GORD?

A

Symptoms include:
- Heartburn (an uncomfortable burning sensation in the chest that often occurs after eating)

  • Acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
  • A sore, inflamed oesophagus
  • Bad breath
  • Bloating and belching
  • Nausea
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12
Q

What are 3 classes of antiemetics and give an example for each

A

Serotonin Antagonist - Ondansetron

Dopamine Antagonist - Metoclopramide

H1 receptor antagonist (antihistamine) – Cyclizine

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13
Q

What is the indication of use for Ondansteron?

A

Chemotherapy induced nausea & vomiting
Post op nausea & vomiting

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14
Q

What is the MOA for Ondansteron?

A

Binds to 5HT receptors in the GI tract, CTZ & vomiting centre
Inhibits stimulation of these receptors therefore preventing the vomiting reflex

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15
Q

What are some adverse drug reactions associated with Ondansetron?

A

Constipation, headache, anxiety, dizziness

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16
Q

What are some drug interactions and cautions associated with Ondansetron?

A

Tramadol – opposing effects of both ondansetron & tramadol, the analgesic effect is lessened.

Caution with opioids due to the increased risk of constipation with both opioids & ondansetron

Caution with other CNS depressants e.g. benzodiazepines, opioids & some antipsychotics = increased risk of serotonin syndrome

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17
Q

What patient education would you provide to someone who is taking ondansetron?

A
  • Inform ADRs & advise patients to notify DR immediately if irregular heartbeat or involuntary movement of eyes, face, or limbs occur.
  • Avoid driving or other activities requiring alertness if experiencing drowsiness/dizziness
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18
Q

What is the site of action of antiemetic drugs on the CTZ (chemoreceptor trigger zone)?

A
  • Dopamine & serotonin receptors.
  • Receptor antagonists include:
    ** Serotonin – Ondansetron.
    **Dopamine – Metoclopramide
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19
Q

What is the site of action of antiemetic drugs on the Vestibular Apparatus?

A
  • Cholinergic muscarinic receptors
  • Anticholinergic e.g., Hyoscine
  • Antihistamines e.g., Cyclizine.
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20
Q

What is the site of action of antiemetic drugs within the Gastric area?

A
  • Dopamine & serotonin receptors.
  • Receptor antagonists include:
    ** Serotonin – Ondansetron.
    ** Dopamine – Metoclopramide.
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21
Q

What are the Neurotransmitters involved in the physiology of vomiting?

A

Histamine, Acetylcholine, Serotonin, Dopamine

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22
Q

What is involved in vomiting? Where is the vomiting centre located?

A
  • Vomiting involves sensory nerve cells (the chemoreceptor trigger zone) and the vomiting centre (medulla oblongata).
  • The vomiting centre receives input from the CTZ, the vestibular apparatus and higher brain centre organs e.g. heart, part of GIT
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23
Q

What is the indication of use for Metoclopramide?

A

Nausea and vomiting in patients with gastroesophageal reflux disease (GORD) or diabetic gastroparesis by increasing gastric motility. It is also used to control nausea and vomiting in chemotherapy patients.

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24
Q

What is the MOA for Metoclopramide?

A

Blocks D2 receptors in CTZ & vomiting centre thus reducing vomiting reflex

Enhances gastric motility resulting in accelerated gastric emptying

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25
Q

What are some adverse drug reactions associated with Metoclopramide?

A

Diarrhoea, drowsiness, restlessness, headaches, extrapyramidal effects (tardive dyskinesia / parkinsonian), hypotension

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26
Q

What are some cautions/contraindications associated with metoclopramide?

A

Cautions elderly (increased risk of tardive dyskinesia)

Young adults (15–19 years old) and children (increased risk of dystonic reactions)

Contraindicated with bowel obstruction and GI bleeding

Contraindicated for persons with Parkinson’s Disease (acute dystonic reactions )

27
Q

When can Metoclopramide be used for people under 20 years old?

A

when other medication is unsuitable and only for the following indications:

  • severe intractable vomiting of known cause
  • vomiting due to radiotherapy or cytotoxic drugs
  • aid to gastro-intestinal intubation
  • premedication prior to surgical procedures.
28
Q

What patient education would you provide to someone on Metoclopramide?

A
  • Avoid concurrent use of alcohol and other CNS depressants
  • Inform patients Signs & Symptoms of ADRs, especially Extra Pyramidal Symptoms, and notify Dr immediately if involuntary or repetitive movements of eyes, face, or limbs occur.
  • Avoid driving or other activities requiring alertness if experiencing drowsiness/dizziness
29
Q

What is the indicator of use for Cyclizine?

A

Used for motion sickness, vertigo, palliative care

30
Q

What is the MOA for Cyclizine?

A

Blocks H1 receptors and has anticholinergic effect

31
Q

What are some Anticholinergic effects?

A

dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating

32
Q

What are some adverse drug reactions associated with Cyclizine?

A

Drowsiness, GI upset, some anticholinergic effects

33
Q

What are some Contraindications of Cyclizine?

A

Bowel obstruction & Parkinson’s disease.

34
Q

What patient information would you provide to someone on Cyclizine?

A

Limit drinking alcohol while you are taking cyclizine. Alcohol can increase the risk of side effects such as drowsiness.

For motion sickness take 1-2 hrs before departure

Inform ADRs & advise patients to notify DR immediately if having fast, irregular heartbeat; trouble urination, change in vision, constipation

Avoid driving or other activities requiring alertness if experiencing drowsiness/dizziness

35
Q

How many different classes of laxatives are there?

A

Bulk-forming
Faecal softening agents
Osmotic
Stimulant laxatives

36
Q

What are some examples of Bulk-forming laxatives?

A

Psyllium, Metamucil

37
Q

What is the indication of use for Bulk-forming laxatives?

A

Constipation, they have also been found to Improve stool consistency in diarrhoea & for colostomy and ileostomy patients

38
Q

What is the MOA for Bulk-forming laxatives?

A

Stimulate peristalsis by increasing the bulk of the stool through absorption of water in the colon. Softens the stool. Absorb water and increase the volume, bulk and moisture of non-absorbable intestinal contents

39
Q

What are some adverse drug reactions associated with Bulk-forming laxatives?

A

bloating
Flatulence
Abdominal cramps
Nausea
dehydration
Skin Rash

40
Q

Why are bulk-forming laxatives the least harmful?

A

They do not interfere with food absorption and are high in fibre, encouraging an easier bowel movement

41
Q

What patient education would you provide to someone on bulk-forming laxatives?

A

Ensure adequate fluid intake – risk of dehydration

Encourage natural foods that aid this process e.g. high fibre foods

Effect may not be apparent for 12-24 hours

42
Q

What are some contraindication for bulk-forming laxatives?

A

Known hypersensitivity to bulk-forming laxatives or any ingredient in the formulation

Partial obstruction of the bowel

Oesophageal obstruction, dysphagia, or problems of the throat.

43
Q

What are some examples of Stool/faecal softeners?

A

Docusate, liquid paraffin, poloxamer

44
Q

What is the indication of use for Stool/Faecal softeners?

A

To treat acute constipation and to prevent straining (e.g. after bowel surgery). Softened stool may be excreted 1-3 days after oral administration

45
Q

What is the MOA for stool/faecal softeners?

A

Wetting agent. Facilitate mixture of water & fatty substances with faecal mass, producing soft faeces.

46
Q

What are some adverse drug reactions associated with stool/faecal softeners?

A

Stomach or intestinal pain or cramps
Nausea
Diarrhoea
Throat irritation (from oral stool softeners)

47
Q

What patient education would you provide to someone on stool/faecal softeners?

A

Maintain hydration as can cause dehydration

Softened stool may be excreted 1-3 days after oral administration

48
Q

What are some contraindications associated with stool/faecal softeners?

A

Dependence (excessive/prolonged use)

Allergic to docusate sodium

Nausea, vomiting, or severe stomach pain

A blockage in your intestines

49
Q

What are some examples of Stimulant laxatives?

A

Bisacodyl, senna

50
Q

What is the indication of use for Stimulant laxatives?

A

Preparation for diagnostic & surgical bowel procedures. (constipation associated with slow transit time, constipating drugs, neurologic constipation i.e. spinal patients). Opioid related constipation

51
Q

What is the MOA for stimulant laxatives?

A

Promote accumulation of water and increase peristalsis in the colon by irritating intramural sensory nerve endings in the mucosa. Encourage bowel movements by acting on the intestinal wall. They increase the muscle contractions that move along the stool mass

52
Q

What are some adverse drug reactions associated with stimulant laxatives?

A

Abdominal cramping, fluid & electrolyte imbalance, bloating, nausea

53
Q

What patient education would you provide to someone on stimulant laxatives?

A
  • Usually work within 6-12 hours
  • Do not take regularly
  • Results are slowed if taken with food
  • Take at night for results in the morning
54
Q

What contraindications are associated with stimulant laxatives?

A
  • Caution in prolonged use—may develop dependence (exception for patients with spinal damage or neuromuscular disease)
  • Appendicitis.
  • Blockage of the stomach or intestine.
  • The inability to control a bowel movement
55
Q

What are some examples of Osmotic laxatives?

A

Lactulose, Microlax, sorbitol

56
Q

What is the indication of use for Osmotic Laxatives?

A

Constipation

57
Q

What is the MOA for Osmotic Laxatives?

A

Normal colonic bacteria metabolise lactulose to acids therefore produce osmotic effect, increase fluid accumulation in lumen, distension, peristalsis & Bowel movement. Draw water into the lumen of the intestines increasing stool volume & triggering motility.

58
Q

What are some adverse drug reactions associated with Osmotic Laxatives?

A

Bloating, Flatulence, Nausea, Vomiting, Cramping, Electrolyte disturbance

59
Q

What patient education would you provide for someone on osmotic laxatives?

A

Ensure adequate fluid intake to maintain hydration and regular blood to monitor electrolyte levels. Some of these laxatives can cause electrolyte imbalances as they draw out nutrients and other contents with the water, which increases thirst and dehydration

Effects after 6-8 hours

60
Q

What are some contraindications associated with osmotic laxatives?

A

Bowel Obstruction
Renal Impairment
Dependence with overuse of laxative

61
Q

Why should Bisacodyl (Stimulant laxatives) not be crushed or chewed?

A

Destroy the coating on the tablet and may increase the risk of stomach upset and nausea.

62
Q

What are the names of the cells that secrete HCL into the stomach?

A

Parietal cells are responsible for gastric acid secretion, which aids in the digestion of food, absorption of minerals, and control of harmful bacteria.

63
Q

What are the protective mechanisms that protect the lining of the stomach from HCL?

A

The mucus covers the stomach wall with a protective coating. Together with the bicarbonate, this ensures that the stomach wall itself is not damaged by the hydrochloric acid

BNPH700 (8 decks)

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