BNPH700 > GI Medications > Flashcards

GI Medications Flashcards

(63 cards)

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1
Q

What medication areas are included within the GI area?

A
  • Stomach Acid Controlling Medications
  • Antiemetics
  • Laxatives and 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

Given 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, H. 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 ADR’s 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 or crush or chew the capsules
  • Not for long term use
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10
Q

What is GORD (Gastro-oesophageal reflex 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 cid is able to pass back up into the oesophagus

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11
Q

What are some symptoms of GORD?

A
  • Heartburn
  • Acid reflux
  • A sore, inflamed oesophagus
  • Bad breath
  • Bloating and belching
  • Nausea
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12
Q

3 classes of antiemetics and give an example for each?

A

Serotonin Antagonist - Ondansetron
Dopamine Antagonist - Metoclopramide
H1 receptor antagonist (antihistamine) - Cyclinzine

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13
Q

What is the indication of use for Ondansteron?

A

Chemotherapy induced nausea & vomiting
Radiotherapy induced nausea & vomiting
Post operative nausea & vomiting

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14
Q

What is the MOA for Ondansetron?

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

ADR’s of 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 and 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 ADR’s & 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 neaurotrasmitters 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 Metocloproamide?

A

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

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24
Q

What is the MOA for Metoclopramide?

A

Block D2 receptors in CTZ & vomiting centre this reducing vomiting reflex

Enhances gastric motility resulting in accelerated gastric emptying

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25
What are some adverse drug reactions associated with Metoclopramide?
Diarrhoea, drowsiness, restlessness, headaches, hypotension
26
What are some cautions/contraindications associated with metoclopramide?
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
When can Metoclopramide be used for people under 20 years old?
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
What patient education would you provide to someone on Metoclopramide?
- Avoid concurrent use of alcohol and other CNS depressants - Inform patients signs and 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 experience drowsiness/ dizziness
29
What is the indicator of use for cyclizine?
Used for motion sickness, vertigo, palliative care
30
What is the MOA for Cyclizine?
blocks H1 receptors and has anticholinergic effect
31
What are some Anticholinergic effects?
Dry moth, constipation, urinary retention, bowel obstruction, blurred vision, dilated pupils
32
What are some adverse drug reactions associated with Cyclizine?
Drowsiness, GI upset, some anticholinergic effects
33
What are some contraindications of cyclinzine?
Bowel obstruction & Parkinson's disease
34
What patient information would you provide to someone on Cyclizine?
Limit drinking alcohol whole you are taking cyclizine. Alcohol can increase the risk of side effects such as drowsiness For motion sickness take 1-2 hours before departure Inform ADRs and advise patients to notify Dr immediately if having fast, irregular heartbeat, trouble urination, change in vision Avoid driving or other activities requiring alertness if experiencing drowsiness/dizziness
35
How many classes of laxatives are there?
- Bulk-forming - Faecal softening agents - Osmotic - Stimulant laxatives
36
What are some examples of Bulk-forming laxatives?
Psyllium, Metamucil
37
What is the indication of use for Bulk-forming laxatives?
Constipation, they have also been found to improve stool consistency in diarrhoea and for colosomy and ileostomy patients
38
MOA for Bulk-forming laxatives?
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
What are some ADR's associated with Bulk-forming laxatives?
Bloating Flatulence Abdominal cramps Nausea Dehydration
40
Why are bulk-forming laxatives the least harmful?
They do not interfere with food absorption and are high in fibre, encouraging an easier bowel movement
41
What patient education would you provide to someone on bulk-forming laxatives?
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 hrs
42
What are some contraindication for bulk-forming laxatives?
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
What are some examples of stool/faecal softeners?
Docusate, liquid paraffin, poloxamer
44
What is the indication of use for Stool/Faecal softeners
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
MOA for stool/faecal softeners?
Wetting agent. Facilitate mixture of water and fatty substances with faecal mass, producing soft faeces
46
What are some ADR's associated with stool/faecal softeners?
Stomach or intestinal pain or cramps Nausea Diarrhoea Throat irritation
47
What patient education would you provide to someone on stool/faecal softeners?
Maintain hydration as can cause dehydration Softened stool may be excreted 1-3 days after oral administration
48
What are some contraindications associated with stool/faecal softeners?
Dependence (excessive/prolonged use) Allergic to docusate sodium Nausea, vomiting or severe stomach pain A blockage in your intestines
49
What are some examples of Stimulant laxatives?
Bisacodyl, Senna
50
What is the indication of use for stimulant laxatives?
Preparation for diagnostic and surgical bowel procedures. (constipation associated with slow transit time, constipating drugs, neurologic constipation i.e spinal patients). Opioid related constipation
51
MOA for stimulant laxatives?
Promote accumulation of water and increase peristalsis in the colon by irritating intramural sensory nerve ending in the mucosa. Encourage bowel movements by acting on the intestinal wall. They increase the muscle contractions that move along the stool mass
52
What are some ADR's associated with stimulant laxatives?
Abdominal cramping, fluid and electrolyte imbalance, bloating, nausea
53
What patient education would you provide to someone on stimulant laxatives?
- 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
What contraindications are associated with stimulant laxatives?
- Caution in prolonged use - may develop dependance - Appendicitis - Blockage of the stomach or intestine - The inability to control a bowel movement
55
What are some examples of osmotic laxatives?
Lactulose, Microlax, Sorbitol
56
What is the indication of use for Osmotic Laxatives?
Constipation
57
MOA for osmotic laxatives?
Normal colonic bacteria metabolise lactulose to acids therefore produce osmotic effect, increase fluid accumulation in lumen, distension, peristalsis and bowel movement. Draw water into the lumen of the intestines increasing stool volume and triggering motility
58
What are some ADR's associated with Osmotic Laxatives?
Bloating, Flatulence, Nausea, Vomiting, Cramping, Electrolyte disturbance
59
What patient education would you provide for someone on osmotic laxatives?
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 thrust and dehydration Effects after 6-8 hours
60
What are some contraindications associated with osmotic laxatives?
Bowel obstruction Renal impairment Dependence with overuse of laxative
61
Why should bisacodyl not be crushed or chewed?
Destroy the coating on the tablet and may increase the risk of stomach upset and nausea
62
What are the names of the cells that secrete HCL into the stomach?
Parietal cells are responsible for gastric acid secretion, which aids in the digestion of food, absorption of minerals, and control of harmful bacteria
63
What are the protective mechanisms that protect the lining of the stomach from HCL?
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
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