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07. Year 2: Alimentary System > Alimentary Pharmacology > Flashcards

Alimentary Pharmacology Flashcards

1
Q

What are different categories of drugs for alimentary disease?

A

Acid suppression

Drugs affecting GI motility

Laxatives

Drugs for inflammatory bowel disease

Drugs affecting intestinal secretions

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2
Q

What are examples of drugs for acid suppression?

A

Antacids

Alginates

H2 receptor antagonists

Proton pump inhibitors

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3
Q

What are examples of drugs affecting GI motility?

A

Anti-emetics

Anti-muscurinics/anti-spasmodics

Anti-motility

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4
Q

What are examples of drugs for IBD?

A

Aminosalicylates

Corticosteroids

Immunosteroids

Biologics

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5
Q

What are examples of drugs affecting intestinal secretions?

A

Bile acid sequestrants

Ursadeoxycholic acid

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6
Q

What do antacids contain?

A

Magnesium or aluminium

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7
Q

What do antacids do?

A

Neutralise gastric acid

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8
Q

When are antacids taken?

A

When symptoms occur

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9
Q

What is an example of an alginate?

A

Gaviscon

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10
Q

What is an alginate?

A

Form of viscous gel that floats on stomach contents and reduces influx

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11
Q

How do H2 receptor antagonists work?

A

Block histamine receptor therby reducing acid secretion

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12
Q

How are H2 receptor antagonists administered?

A

Orally or IV

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13
Q

What is an example of a H2 receptor antagonist?

A

Ranitidine

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14
Q

What is an example of a proton pump inhibitor?

A

Omeprazole

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15
Q

When are H2 receptor antagonists indicated?

A

GORD

Peptic ulcer disease

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16
Q

How do proton pump inhibitors work?

A

Block proton pump and therby reduce acid secretion

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17
Q

When are proton pump inhibitors indicated?

A

GORD

Peptic ulcer disease

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18
Q

How are proton pump inhibitors administered?

A

Oral or IV

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19
Q

What are side effects of proton pump inhibitors?

A

GI upset

Predisposition to C. Difficile infection

Hypomagnesaemia

B12 deficiency

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20
Q

What do prokinetic agents do?

A

Increase gut motility and gastric emptying

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21
Q

What are examples of prokinetics?

A

Anti-emetics such as Metoclopramide and Domperidone

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22
Q

What is the mechanism of action of prokinetic agents?

A

Not clear but involves parasympathetic nervous sytem control of smooth muscle and sphincter tone (via acetylcholine)

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23
Q

What is the mechanism of action for Domperidone?

A

Blocks dopamine receptors which inhibit post-synaptic cholinergic neurones

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24
Q

What is the physiology behind vomiting?

A
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25
Q

What different things can be targeted to prevent vomiting?

A

Chemoreceptor trigger zone

Pharynx and GIT

Vestibular neclei

Cerebral cortex

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26
Q

What is a possible side effect of drugs that decrease motility?

A

Constipation

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27
Q

What are examples of drugs that decrease motility?

A

Loperamide

Opiods

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28
Q

What is the clinical benefit of drugs that reduce motility?

A

Anti-diarrhoea

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29
Q

What is the mechanism of action of drugs that decrease motility?

A

Decrease smooth muscle contraction, increase anal sphincter tone

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30
Q

What are anti-spasmodics used for?

A

Reduce symptoms due to IBS or renal colic

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31
Q

What are the 3 mechanisms of anti-spasmodics?

A

Anti-cholinergic muscurinic antagonists (inhibit smooth muscle contraction in the gut wall)

Direct smooth muscle relaxants

Calcium channel blockers reduce calcium required for smooth muscle contraction

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32
Q

Why does Loperamide have few central opiate effects?

A

Not well absorbed across the blood brain barrier

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33
Q

What are the 4 types of laxitives?

A

Bulk

Osmotic

Stimulant

Softeners

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34
Q

What is an example of a bulk laxative?

A

Isphagula

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35
Q

What is an example of an osmotic laxative?

A

Lactulose

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36
Q

What is an example of a stimulant laxative?

A

Senna

37
Q

What is an example of a softener laxative?

A

Arachis oil

38
Q

How do laxatives work?

A

By increasing bulk or drawing fluid into the gut

39
Q

What are some issues with laxatives?

A

Obstruction

Route of administration (oral or rectal)

Need for other measures (osmotoc laxatives will not work without adequate fluid intake)

Misuse

40
Q

What are examples of aminosalicylates?

A

Mesalazine

Olsalazine

41
Q

What is the mechanism of action of aminosalicylates?

A

Unclear but is anti-inflammatory

42
Q

What is the administration of aminosalicylates?

A

Oral or rectal

43
Q

When should you be cautious towards the use of aminosalicylates?

A

In renal impairment

44
Q

What are some adverse effects of aminosalicylates?

A

GI upset

Blood dyscrasias

Renal impairment

45
Q

What effect do corticosteroids have?

A

Anti-inflammatory

46
Q

What is the administration of corticosteroids?

A

Orally

IV

Rectal

47
Q

What are contraindications for corticosteroids?

A

Osteoporosis

Cushingoid features including weight gain, DM, HT

Increased susceptability to infection

48
Q

What is the mechanism of Azathioprine (immunosuppressent)?

A

Prevents the formation of purines required for DNA synthesis so reduces immune cell proliferation

49
Q

What are adverse effects of Azathioprine?

A

Bone marrow suppresion

Azathioprine hypersensitivity

Organ damage (lung, liver, pancreas)

50
Q

What are biologics?

A

Anti-TNFa antibodies

51
Q

What are examples of biologics?

A

Infliximab

Certolizumab

Adalimumab

Natalizumab

Golimumab

Vedolizumab

52
Q

What are contraindications to Infliximab?

A

Current TB or other serious infection

MS

Pregnancy/breast feeding

53
Q

What are adverse effects of Infliximab?

A

Risk of infection, particular TB

Infusion reaction (fever, itch)

Anaemia, thrombocytopenia, neutropenia

Malignancy

54
Q

What is TNFa?

A

Key cytokine in inflammatory response

55
Q

What is the mechanism of Cholestyramine?

A

Reduces bile salts by binding with them in the gut and then excreting as insoluble complex

56
Q

What are side effects of Cholestyramine?

A

May affect fat soluble vitamin absorption so may decrease vitamin K levels (affecting clotting and warfarin)

57
Q

What are indications for Ursodeoxycholic acid?

A

Gallstones and primary biliary cirrhosis (PBC)

58
Q

What is the mechanism of action of Ursodeoxycholic acid?

A

Inhibits an enzyme involved in the formation of cholesterol, altering amount in bile and slowly dissolving non-calcified stones

59
Q

What does ADME stand for?

A

Absorption

Distribution

Metabolism

Excretion

60
Q

Diseases of what systems can affect the processes of a drug?

A

GI or liver diseases

61
Q

How can GI diseases impact administration of a drug?

A

May require the route of administration to be changed

62
Q

What is absorption of a drug impacted by?

A

pH

Gut length

Transit time

63
Q

What is distribution of a drug impacted by?

A

Low albumin (decreased binding and increased free drug concentration)

64
Q

What is metabolism of a drug impacted by?

A

Liver enzymes

Increased gut bacteria

Gut wall absorption

Liver blood flow

65
Q

What is excretion of drugs impacted by?

A

Biliary excretion (increased toxicity if hepatobiliary disease)

66
Q

What impact does liver disease have on pharmacodynamic effects?

A

Exaggerated or reduced response

Increased toxocity

67
Q

What are examples of adverse GI effects caused by drugs?

A

GI upset

Diarrhoea

Constipation

GI bleeding/ulceration

Changes to gut bacteria

Drug induced liver injury

68
Q

How common is GI upset with medication?

A

Very common, 20-40% of all adverse drug reactions (ADRs)

69
Q

What are examples of drugs that can cause diarrhoea or constipation as an adverse effect?

A

Cholinergics

NSAIDs

Antimicrobials

Opiates

Anticholinergics

70
Q

What are different mechanisms of drugs cause diarrhoea/constipation as an adverse effect?

A

Osmotic

Secretory

Shortened transit time

Protein losing

Malabsorption

71
Q

What are examples of drugs that cause GI bleeding/ulceration as a side effect?

A

1) Low dose aspirin/NSAIDs
3) Warfarin

72
Q

How do NSAIDs lead to bleeding?

A

Cause mucosal injury and bleeding through COX-1 and COX-2 receptors, and epithelial damage

73
Q

What drugs can cause changes to gut bacteria as a side effect?

A

Mainly antibiotics

74
Q

What does changes to gut bacteria as a side effect cause?

A

Loss of OCP activity

Reduced vitamin K absorption (increased prothrombin time)

Overgrowth of pathogenic bacteria (such as C. Difficile)

75
Q

What are the different categories of drug induced liver injury?

A

Intrinsic hepatotoxicity

Idiosyncratic hepatotoxicity

76
Q

What kind of adverse drug reaction is intrinsic hepatotoxicity?

A

Type A ADR

77
Q

What can be said about dose and predictability of intrinsic hepatotoxicity ADRs?

A

Predictable, dose dependent

78
Q

What can be said about the dose and predictability of idiosyncratic hepatotoxicity?

A

Unpredictable, not dose dependent

79
Q

What kind of adverse drug reaction is idiosyncratic hepatotoxicity?

A

Type B ADR

80
Q

What are examples of diseases that can be caused by drugs?

A

Acute hepatitis

Chronic hepatitis

Acute cholestasis

Mixed pattern or atypical hepatitis

Nonalcoholic steatohepatitis

Fibrosis/cirrhosis

Microvesicular steatosis

Veno-occlusive disease

81
Q

What are risk factors for adverse drug reactions?

A

Age (elderly at risk)

Sex (female at risk)

Alcohol consumption

Genetic factors

Malnourishment

82
Q

What is the most common reason for medicinial products being withdrawn from the market?

A

Hepatotoxicity

83
Q

What classification is used to measure the severity of liver disease?

A

Child-Pugh classification

84
Q

Explain Child-Pugh classification?

A

Individual scores are summed and then groups as A, B or C

85
Q

What things does Child-Pugh classification consider?

A

Bilirubin (umol/L)

Albumin (g/L)

PT (s prolonged)

Encephalopathy

Ascites

86
Q

Whilst prescribing in liver disease, care must be taken with what?

A

Drugs which can be toxic due to changes in pharmacokinetics

Drugs which are hepatotoxic

Drugs which may worsen the non-liver aspects of liver disease (such as encephalopathy)

87
Q

What are particular drugs that are known to cause problems with liver disease?

A

Warfarin/anti-coagulant (clotting factors are already low)

Aspirin/NSAIDs (increase bleeding time in combination with deficiency in clotting factors)

Opiates/benzodiazepines (may precipitate encephalopathy by increasing sedation)

88
Q

Where can patients find more drug information?

A

BNF guidance on drugs in liver disease

07. Year 2: Alimentary System (41 decks)

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