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GIT BLOCK 2Nd Year, 2Nd Block King Saud University College of Medicine GIT BLOCK 2nd Year, 2nd Block Revision This work includes lectures from 3 to 10 and it is a summery of the important notes on each lecture + the uses and side effect for each drug +MCQs L3:antiamebic drugs Drugs Clinical Uses Adverse Effects Metronidazole -Giardiasis -Neurotoxicological effect= Notes &tinidazole -Trichomoniasis Peripheral neuropathy& 1-if the Pateint came with symptoms we -Broad spectrum of Encephalopathy use tissue amebicides while if he came anaerobic bacterial -Disulfiram-like effect with asymptoms we use luminal infections -Dysuria. amebicides -Neutropenia. Emetine -Amoebic liver abscess. Serious toxicities: cardiotoxicity, 2-if we have to start the treatment with &Dehydroemetine -Severe forms of Hypotension, cardiac tissue amebicides we have to follow with amebiasis acute amoebic arrhythmias, heart failure. dysentery luminal amebicides to get rid of the cycts Chloroquine In combination -pruritus 3-metronidazole is for amebic liver diseases. -Hemolysis in G6PD deficient the drug of choice in all tissue patients. Amebiasis And it is similar to tinidazole but tinidazole is better Diloxanide furoate -Drug of choice GIT disorder for asymptomatic intestinal 4-Emetine &Dehydroemetine both are infection toxic and have been replaced by metronidazole + they never given I.V Iodoquinol asymptomatic amebiasis -Peripheral neuropathy including optic neuritis. 5- luminal amebicides drugs should be -Enlargement of the thyroid gland. poorly absorbed to do the action which is -Iodine sensitivity. -interference with thyroid function eradicate cysts tests 6-Ciprofloxacin is the drug of choice in Paromomycin chronic amebiasis to -Gastrointestinal distress eliminate cysts bacillary dysentery. Ciprofloxacin Bacterial diarrhea -Arthropathy 7-In children and pregnancy, ceftriaxone (caused by shigella, -Phototoxicity. or cefixime is the choice salmonella and E coli). -Liver toxicity GIT -CNS -CVS disorder L3:antiamebic drugs Q1: Old age patient who is live lonely come to you with extra luminal amoebiasis, he has lots of drugs to use for different diseases, which one of the following drugs is the best drug of choice in this case ? A) Metronidazole *Ans: B ( Because it has better toxicity profile and potency than B) Tinidazole metronidazole, so he will take small dose and may be once daily rather C) Diloxanide furoate than high dose and frequent time daily ) 1 - B Q2: Alcoholic patient come to you with abdominal distress, nausea, vomiting, flushing, headache, * tachycardia, hyperventilation ,after he take metronidazole for liver abscess . How you explain his symptom ? 2 A) Disulfiram-like effect - B) Effects of high dose metronidazole A C) alcohol dehydrogenase deficiency 3 - Q3: Which drug we should be avoid in case of patient with thyroid enlargement: A A) Iodoquinol B) Diloxanide 4 C) Chloroquine - C Q4: Child present with bacillary dysentery which of the following should be given to treat him ? A) Metronidazole 5 - B) Ciprofloxacin A C) Cefixime Q5: which of the following has direct and indirect pathways to kill luminal forms of ameba ? A) Paromomycin Sulphate B) Metronidazole C) Cefixime L4:Drugs used in Drugs Clinical Uses Adverse Effects treating constipation 1-Dietary fibers: 1. Delayed onset of action (1-3 Indigestible parts of days). and IBS vegetables & fruits,Bran 2. Intestinal obstruction (should powder. Notes 2-Hydrophilic colloids: Acute & chronic be taken with enough water). 1- Osmotic Laxatives include lactulose, Saline Psyllium seed, Methyl constipation 3. Bloating, flatulence, distension. laxatives , Polyethylene glycol (PEG) cellulose, 4. Interfere with other drug Carboxymethyl absorption e.g. iron, cardiac 2-Saline laxatives include(Magnesium cellulose (CMC) glycosides sulphate or hydroxide Sodium or potassium phosphate) has a rapid effect and many 3-Fecal Softeners Treat constipation in Paraffin oil: adverese effects so it modified to (Docusate, Glycerin, patients with hard stool impairs absorption of fat soluble Polyethylene glycol (PEG) Paraffin oil) or specific conditions vitamins. and for people who -not palatable 3-Stimulant Laxatives is the most powerful should avoid straining group and it is not used in chronic ( as in after surgery or constipation because the patient won’t be acute perianal disease) able to pass stool without it 4-Stimulant Laxatives act via direct stimulation 1. Abdominal cramps may occur. (Bisacodyl, Castor oil, of enteric nervous 4-Castor Oil degraded into ricinoleic acid and 2. Prolonged use dependence senna, cascara, aloes) system →increased it is very irritating to mucosa & destruction of myenteric plexus peristalsis & purgation leading to atonic colon. 5-senna also degraded into emodin which has direct stimulant action 5-Osmotic Laxatives 1.Prevention of chronic 1. Delayed onset of action (2-3 (Lactulose) constipation. days) 6- Senna is contraindicated in lactation & 2.Hepatic 2. Abdominal cramps and Castor oil in pregnancy encephalopathy flatulence. (Hyperammonemia) as 3. Electrolyte disturbances. in liver cirhhosis. 7-for IBS we give Alosetron&Tegaserod both 3. Hemorrhoids . of them derivative from serotonin one is 4. opioid constipation agonist and the other is antagonist 6-Osmotic Laxatives Treatment of acute 1. Disturbance of fluid and (Saline laxatives) constipation . electrolyte balance 2. May have systemic effects. L4:Drugs used in treating constipation and IBS Drugs Clinical Adverse Uses Effects Q1: Patient suffering from constipation for 3 month then he develops Hemorrhoids after taking the history you found that he has liver cirrhosis, 7-Osmotic Used for No Adverse congestive heart failure and CNS depression . what is the drug of choice for Laxatives whole bowel Effects = constipation in this case ? (Polyethyle irrigation advantage A) lactulose ne glycol prior to B) Magnesium sulphate (PEG)) colonoscopy 1. Limited fluid C) Sodium phosphate or surgery or electrolyte imbalance 2. less Q2: Patient are going to do colonoscopy, which one of these drug should we flatulence and give him for bowel irrigation ? cramps A) Magnesium sulphate 8- Used in B) lactulose Alosetron severe IBS- D C) Balanced Polyethylene Glycol in women Constipation (5HT3 who have and ischemic Q3: Patient suffering from constipation and he decide to use senna to antagonist) not had colitis relieve it, he use it for long time until he become dependent . What do you success with expect to see as a complication of prolong use of senna ? any other treatment. A) atonic colon B) intestinal obstruction 9- Short term C) ischemic colitis Tegaserod treatment of IBS-C in (5HT4 women <55 CVS side effects Q4: patient come to you suffering from constipation and she is agonist) years old breastfeeding which drug should we avoid ? with no A) castor oil history of B) senna heart C) Bisacodyl problems L4:Drugs used in treating constipation and IBS Q5: Pregnant women come to you suffering from constipation which drug may cause abortion so we should avoid it ? A) castor oil 1 - B) senna A C) Bisacodyl 2 - C C Q6: patient with IBS was treated by a drug and after a while he developedischemic colitis . What was the drug he took ? 3 - A) Tegaserod A B) Anthraquinone glycosides 4 C) Alosetron - B B Q7: Patient suffering from abdominal discomfort associated with constipation , he diagnosed 5 - that he have Irritable Bowel Syndrome with constipation . What is the drug of choice? A A) Tegaserod 6 B) Anthraquinone glycosides - C C C) Alosetron 7 - Q8: Patient undergo surgery, after that the doctor prescript one of the drugs that use for A constipation becouse the patient should avoid straining to prevent any effort during 8 defecation . Which of drug from the following do you think the doctor prescript ? - C A) luminal amebicides B) polyethylene glycol C) lubricants L5:Drugs used in Drugs Clinical Uses Adverse Effects inflammatory bowel 1-Sulfasalazine -Rheumatoid arthritis -Side effects of sulfasalazine: (Azulfidine) (Crystalluria, Bone marrow disease (IBD) depression, Megaloblastic anemia, Folic acid deficiency (should be Notes provided), Impairment of male 1-All aminosalicylates are used for fertility (Oligospermia)). -in ulcerative proctitis induction (acute) and maintenance Side effect of 5-ASA: Interstitial and proctosigmoiditis nephritis. (prophylaxis) of remission 2-Asacol ,Pentasa (oral) -well tolerated = have less side 2-there are different formulation because Canasa(suppositories) effects compared to sulfasalazine -we can give it to sulaf allergic we want to delay the absorption of Rowasa(enema) patients aminosalicylates from the small intestine to act on the site of inflammation . 3-prednisone(oral) -acute flares of -prednisolone(oral) disease (moderate & -Budesonide(oral) severe active 3-Glucocorticoids As enema or IBD) suppository have Less absorption rate 4-hydrocortisone(IV or -Asthma. than oral that means they have Minimal IM) -Rheumatoid arthritis. side effects & maximum tissue effects. -methyl -immunosuppressive drug for organ prednisolone(IV or IM) 4-Budesonide treat active mild to transplants. -Hydrocortisone(Rectal) -Antiemetic during moderate Crohn’s disease involving ileum cancer and proximal colon while,Hydrocortisone -chemotherapy. give to treat Crohn’s disease involving Induction and rectum or sigmoid colon 5-azathioprine & 6- -leucopenia+thrombocytopenia maintenance mercaptopurine -Hepatic dysfunction*Routine remission in IBD ,Complete blood count & liver 5- Immunomodulators function tests are required in all Are used to induce remission in IBD in patients*
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