Pharmacology and Enema Solutions Quiz

Antacids

• Antacids are basic compounds that neutralize hydrochloric acid in gastric secretions.

• They are used to manage gastrointestinal disorders with gastric hyperacidity, such as dyspepsia, gastroesophageal reflux disease, and peptic ulcer disease.

• Antacids are best administered when symptoms occur or are expected, typically between meals and at bedtime.

• Suspensions are more effective and faster-acting than tablets.

• Patients should be instructed to chew tablets thoroughly and follow with a full glass of water.

• Antacids can affect the absorption of other drugs. Leaving a 1-2 hour gap between doses of different medications can usually overcome this interaction.

• Antacids increase stomach pH, potentially releasing enteric-coated tablets or granules prematurely.

• Aluminum-containing antacids can cause constipation, while magnesium-containing antacids can cause diarrhea (though they may be useful in slightly constipated individuals).

• Combination products containing aluminum and magnesium salts minimize bowel disturbance.

• Antacids containing sodium bicarbonate should be avoided in patients with CHF or hypertension, where sodium intake needs restriction.

• Other combined drugs with antacids may include simethicone (reduces gas) and alginates (impeding reflux and protecting esophageal mucosa).

Proton Pump Inhibitors (PPIs)

• PPIs are strong inhibitors of gastric acid secretion.
• They include omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole.
• PPIs treat gastric and duodenal ulcers and are often combined with antibiotics to eradicate Helicobacter pylori.
• They are also used for treating dyspepsia and gastroesophageal reflux disease, plus NSAID-associated ulcers.
• A common regimen for Helicobacter pylori eradication involves a PPI, clarithromycin, and either amoxicillin or metronidazole for 10-14 days (triple therapy).
• PPIs are most effective when taken 30-60 minutes before meals; once-daily doses are usually given in the morning.
• Enteric-coated formulations (granules, capsules, delayed-release tablets) are available. These protect the drug from stomach acid degradation.

Histamine-2 Receptor Antagonists (H2RAs)

• H2RAs include cimetidine, ranitidine, famotidine, and nizatidine.
• These drugs treat gastric and duodenal ulcers, dyspepsia, and gastroesophageal reflux disease.
• Cimetidine inhibits several CYP450 isoenzymes, causing drug interactions with theophylline, warfarin, and clopidogrel.
• Ranitidine has less interaction with hepatic CYP450 drugs.
• Famotidine and nizatidine don't interact with CYP450 drugs.
• Cimetidine has potential anti-androgenic effects, potentially causing gynecomastia and impotence (but these effects are usually reversible).

Laxatives

• Laxatives promote bowel evacuation, used before medical procedures like endoscopy.
• Types include stimulant, bulk-forming, lubricant (fecal softeners), and osmotic.
• Examples: Senna, Bisacodyl, Methylcellulose, Bran, Sterculia, Ispaghula (Metamucil), Liquid paraffin, and Lactulose.
• Stimulant laxatives should be used for short periods to prevent loss of colonic smooth muscle tone.
• Bulk-forming laxatives may take several days to show effect and should be administered before bed to avoid esophageal blockage.
• Oral mesalamine formulations (coated tablets or granules) should not be chewed or crushed.
• Enemas or suppositories may be used in cases of sigmoid colon and rectum involvement.

Antidiarrheals

• The primary goal of acute diarrhea management is fluid and electrolyte rehydration, especially in infants and young children.
• Antidiarrheals are generally not recommended for young children.
• Examples include the drugs loperamide, diphenoxylate with atropine, and adsorbents (like pectin and kaolin).

Antispasmodics

• Antispasmodics (like hyoscine butylbromide) manage gastrointestinal disorders with smooth muscle spasms, and should not be administered to patients with prostate enlargement.
• Other antispasmodics (like mebeverine) are for irritable bowel syndrome pain relief.

Antiemetics

• Antiemetics (prochlorperazine, metoclopramide, and domperidone) treat or prevent nausea and vomiting.
• Cinnarizine is used for motion sickness prevention, administered 2 hours prior to travel.
• Domperidone has less interaction with the central nervous system.

Antiplatelet Drugs

• Antiplatelet drugs like aspirin (low dose) and clopidogrel are used to prevent further thromboembolic events, typically after myocardial infarction or similar conditions.

Anticoagulants

• Anticoagulants primarily treat or prevent blood clot formation.
• Oral anticoagulants (e.g., warfarin) are commonly used, along with injectable anticoagulants (e.g., heparin, enoxaparin, dalteparin).
• Monitoring of anticoagulation (e.g., INR, APTT) is critical to avoid excessive bleeding.

Miscellaneous Cardiovascular Drugs

• Digoxin is used for certain types of arrhythmia, such as atrial fibrillation, and for heart failure.
• Methyldopa is often used for hypertension during pregnancy.

Diuretics

• Diuretics promote water and electrolyte excretion, treating conditions where salt and fluid retention cause edema, often in heart failure or hypertension.
• Common diuretics include thiazide/related diuretics, loop diuretics, potassium sparing diuretics, and carbonic anhydrase inhibitors, along with examples of each drug type.
• Diuretics can be administered in the morning to avoid nighttime diuresis and often require potassium supplementation.

Lipid-regulating drugs

• Drugs that modify blood lipid levels (e.g. statins), used for hyperlipidemia, to lower risks of cardiovascular disease
• Statins and fibrates; important considerations such as timing of administration, and avoiding grapefruit juice.

Nitrates

• Nitrates, particularly glyceryl trinitrate, are used for angina (including transdermal patches and sublingual formulations
• Important considerations include potential for adverse effects, like headache or tolerance, and avoid concurrent use with certain other drugs to prevent dangerously low blood pressure.

Bronchodilators/Anti-asthma drugs

• These medications, inhaled or in other forms, are used to relax or open airways and treat conditions like asthma.
• Examples: SABAs (short-acting beta2 agonists like salbutamol), LABAs (long-acting agents like formoterol or salmeterol), inhaled corticosteroids (e.g., beclomethasone), anti-leukotrienes (e.g., montelukast), anticholinergics (e.g., ipratropium), and theophylline.
• Different techniques are needed to administer inhaled treatments correctly (like inhalers and nebulizers).

Oral Nasal Decongestants

• These drugs, often combinations of sympathomimetics (e.g., pseudoephedrine) and antihistamines (e.g., triprolidine), are used for nasal congestion, and should be used with caution in specific conditions.

Cough Preparations

• Cough preparations are frequently combinations (e.g., suppressants with expectorants), often targeting dry or wet coughs.
• Examples include codeine, dextromethorphan, glyceryl guaiacolate (guaifenesin), and bromohexine.

Test your knowledge on enema solutions and their proper usage. This quiz covers recommended volumes for adults and children, as well as information on antiemetics like Domperidone and Glyceryl trinitrate. Enhance your understanding of pharmacology essentials with these key questions.