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WEEK 3:
Lower GI pharmacology:
| Question | Answer |
|---|---|
| examples of toxins causing nausea and vomiting | bacterial toxins, alcohol, and drugs (Digoxin, SSRIs, opioids, erythromycin, cancer chemotherapy, and levodopa) |
| main causes of nausea and vomiting (4) | toxins, pain related (eg acute coronary syndrome), anxiety or psychogenic vomiting, and endocrine/ metabolic (pregnancy or high urea in CKD or diabetic ketoacidosis) |
| central causes of nausea and vomiting | intracranial (eg migraine or raised intracranial pressure from tumour/ haemorrhage. infection) or labyrinthine disorders (motion sickness or labyrinthitis) |
| PONV meaning | post operative nausea and vomiting |
| what receptors can contribute to PONV (4) | Histamine H₁, Acetylcholine Muscarinic M₁, Dopamine D₂ and Serotonin 5HT₃ |
| antihistamines | work by blocking H1 receptors on vestibular nuclei |
| example of older antihistamines | |
| older antihistamines | promethazine and diphenhydramine have significant anticholinergic activity but more side effects. |
| antimuscarinics | |
| what antihistamine can be given to pregnant women | |
| which antihistamine is less sedating antihistamine | |
| dopamine receptor antagonists | |
| dopamine receptor antagonists like phenothiazines (prochlorperzine) can be given how | bucally |
| 5HT3-receptor antagonists act on | GTT and CTZ |
| 5HT3-receptor antagonists useful in | |
| examples of 5HT3-receptor antagonists (2) | granisetron and ondansetron |
| effect of drugs like cisplatin | disrupt 5HT containing chromafin cells in gastric mucoa |
| issue with 5HT3 receptor antagonists | long QT syndrome |
| acute diarrhoea definition | passing 3 or more per day <14 days |
| chronic diarrhoea associated with (3) | IBS, malabsorption syndrome and colorectal cancer |
| what drugs can cause acute and chronic diarrhoea | Mg²⁺, antibiotics, metformin, cytotoxics, NSAIDs, PPIs, orlistat |
| cause of osmotic diarrhoea | increased solutes in intestinal lumen |
| what causes inflammatory and secretory dirrhoea (Acute) | pathogen disrupting/ destroying epithelium of intestine |
| secretory diarrhoea | water being secreted into intestinal lumen |
| inflammatory and infectious diarrhoea | infection/ inflammation of lining of intestine |
| accelerated transit | too fast to allow absorption of water |
| which bacteria can cause inflammatory and secretory diarrhoea | |
| examples of viral gastroenteritis | |
| which protozoa can cause inflammatory and secretory diarrhoea | |
| oral rehydration therapy (ORS) includes | solution of isotonic electrolytes |
| why is solution of isotonic electrolytes given | replaces isotonic electrolytes lost in diarrhoea (most important in children and elderly) |
| how does glucose help in oral rehydration therapy (ORS) | |
| opiates | |
| first pass metabolism in opiates | extensive first pass metabolism with very little reaching systemic circulation and unlikely to cause opiate side effects (does not pass BBB) |
| antimotility agents | |
| effect of codeine and loperamide | |
| drugs with antimuscarinic actions or side effects | |
| probiotics | reduce duration of diarrhoea as an adjunt to rehydration therapy |
| how do probiotics help reduce antibiotic associated diarrhoea (ALLEGEDLY) | antibiotics kill flora but probiotics can help balance this |
| problem with probiotics | pass stomach so most bacteria will die :( |
| traveller's diarrhoea | |
| what vaccination should be given if endemic | vaccination for salmonella typhi |
| duration of illness for traveller's diarrhoea with antibiotics eg rifaximin | cut from 3-1.5 days |
| why is ciprofloxacin no longer considered appropriate | EMA warning over tendon rupture/ CNS |
| what replaced cirpofloxacin | rifaximin - is poorly absorbed |
| constipation | |
| causes of constipation | |
| examples of drugs causing constipation | Al³⁺, Ca²⁺, antimuscarinics, tricyclics, antipsychotics, verapamil, iron, opioids etc. |
| bulk forming treatment | |
| stimulant drug treatment | |
| osmotic laxatives as drug treatment | |
| lactulose as a drug treatment | |
| Mg2+ osmotic effect | |
| phosphate and citrate enemas work within | 30 minutes |
| faecal softeners | |
| prucalopride 5-HT4 agonist | |
| IBS most often affects which age groups | |
| IBS most often affects which sex | |
| healthcare professionals should consider assessment for IBS if | |
| treatments for IBS | |
| appearance of IBS | |
| IBS can increase risk of | bowel obstruction and carcinoma |
| ulcerative colitis | |
| location of ulcerative colitis | mostly remains localised to rectal area and usually restricted to colorectal mucosa (where location and severity affects type of treatment given) |
| Crohns disease management according to NICE | |
| add on treatments in Crohn's disease | |
| azathioprine monitoring | |
| treatments for Crohn's disease | |
| 5-aminosalicylates and mode of action | |
| biological drugs | |
| what should you not offer for those with Crohn's disease | azathioprine, mercaptopurine or methotrexate as monotherapy to induce remission |
Created by:
22tango
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