Level 2

Semester 4

Module : Gastrointestinal system, liver, Nutrition& Metabolism(GLNM411)

Practical Revision of GIT
 Instructor information

▪ Contact: Rehab M. Elshahat

▪ Department: pharmacology
▪ Official email: rehab@azhar.edu.eg
▪ Mobile: 01006833432
Q1-mention antispasmodic drugs with example?
Antispasmodic drugs are a group (class) of medicines that can
relieve cramps or spasms of the stomach, intestines, and bladder.

There are two main types:

I-Antimuscarinics
➢ Atropine
➢ Propantheline
➢ Dicycloverine
➢ II-Smooth muscle relaxants
➢ Mebeverine
➢ Papaverine
➢ Peppermint oil
Q2-write the mechanism of action of antimuscarinics

Mechanism of action:
➢ Antimuscarinics act by attaching to the receptors and prevent binding
of Ach to Muscarinic (M) receptors.
➢ Which resulting in inhibition of smooth muscle contractions.
Q1-Write the pharmacological action of dicycloverine

pharmacological action of dicycloverine

1-GIT : smooth muscle relaxation (antispasmodic effect)

decrease salivary secretion
2-CVS : blocking M2 receptors
increase heart rat and may leads to tachyarrhythmia
3- Other secretion: decrease lacrimal and sweat secretion
Q2-Mention two precautions of dicycloverine?

Precautions:
1- It decrease sweat secretions so it may ppt fever and heat stork.
2- drowsiness hallucination and alteration of mental status and blurred
of vision
All of these can decrease the working performance of the patient.

N.B : On long use should be close monitoring to CNS &CVS side effects
Q3-list 2 adverse effects of dicycloverine ?

Side effects:
A-common side effects
1-CNS: drowsiness, dizziness, and hallucination
2-Eye: blurred vision & dry eyes
3-GIT: dry mouth, nausea, vomiting, constipation,
& abdominal bloating

B-Serious side effects :

1-Decreased Sweating
2-Irregular heartbeat
3-Slurred speech
4-Agitation
Q4- Enumerate two contraindications of dicycloverine?
1. Obstructive uropathy
2. Obstructive disease of the gastrointestinal tract
3. Severe ulcerative colitis
4. Reflux esophagitis
5. Cardiovascular disease
6. Glaucoma
7. Myasthenia gravis
8. Hypersensitivity to dicyclomine
Q1-Write the mechanism of action of mebeverine?
Directly relaxes intestinal smooth muscle without anticholinergic effects.

Mechanism of action:
➢ Is a muscolotropic spasmolytic with a strong and selective action
on the smooth muscle spasm of the gastrointestinal tract,
particularly of the colon.
N.B: It does not have the acetyl choline side effect commonly
seen in an
anticholinergic antispasmodic drugs.
Q2-Enumerate 3 side effects of mebeverine?

Side effects
➢ Skin rash
➢ Facial Swelling
➢ Angioedema
➢ Dizziness
➢ Drowsiness
➢ Headache
 Instructor information
• Contact: Doaa Abdel Fatah Hellal
• Department: Clinical Pharmacology
• Official email: doaahellal@gmail.com
• Mobile (optional): 01068381663
An elderly woman with a recent history of myocardial infarction is seeking a
medication to help treat her occasional heartburn. She is currently taking several
medications, including aspirin, clopidogrel, simvastatin, metoprolol, and lisinopril.

Q-Which of the following choices should be avoided in this patient and why?
A. Calcium citrate.
B. Famotidine.
C. Omeprazole.
D. Ranitidine.
E. Calcium carbonate.
Correct answer = C. Omeprazole may possibly decrease
the efficacy of clopidogrel because it inhibits the conversion
of clopidogrel to its active form.
Patient aged 64 years, suffers from heartburn and has a past medical
history of hypertension, angina and heart failure.
His medication history includes amlodipine (Ca channel blocker) 5,
isosorbide mononitrate MR 30 mg each morning, GTN spray 1–2 sprays
when required.
Q1:What recommendations could you make regarding patient drug
therapy?
Answer question

Calcium channel blockers and nitrates can lower esophageal

sphincter pressure and could, therefore, be contributing to his
heartburn. Alternatives, such as a β-blocker, for his angina could be
explored.
MR Jack 65 years old obese patient complaining of heartburn,
regurgitation, dysphagia, reflux and nocturnal cough. and was
prescribed ranitidine & Gaviscon and domperidone

Q1:Mention the composition and the mechanism of action of

Gaviscon?
Q2 :Mention the mechanism of action, two uses & adverse effects of
domperidone?
Q3: Mention mechanism of action , 2 uses and 2 adverse effects of
ranitidine?
Q1:Mention the composition and the mechanism of action of
Gaviscon?
Gaviscon: antacid-alginic acid products

(alginic acid + Mg-trisilicate + Al-hydroxide + NaHCO3):

Alginic acid in presence of saliva and NaHCO3 forms a highly viscous

foamy solution of Na-alginate that floats on the gastric contents as a
raft and prevents gastric reflux.
Q2 :Mention the mechanism of action, two uses & adverse effects of
domperidone?
Mechanism It blocks peripheral D2 receptors (because it does NOT cross BBB)
leading to: Decrease the inhibitory action of dopamine on the GIT motility. No
CNS side effects

Uses:
1-Gastroesophageal reflux
2-Disorders of gastric emptying: e.g. diabetic gastroparesis and postoperative
gastric retention.
Adverse effect:
There is growing evidence that domperidone may ↑ QT interval and predispose to
serious arrhythmia and sudden death.
Q3: Mention mechanism of action , two uses and two adverse effects of
ranitidine?
Mechanism of action: competitive inhibitors of H2-receptors on parietal cell with a
marked ↓ in histamine-stimulated HCl secretion.
Uses
1-Duodenal and gastric ulcers.
2-Prophylaxis & treatment of stress ulcers (e.g. after burn or major trauma).
3-GERD.
Adverse effects
1-Anti-androgenic effects (due to block of androgen receptors) leading to ↓ sperm
count, impotence and gynecomastia.
2-Reversible hepatotoxicity and Reversible anemia.
3-CNS symptoms: headache, slurred speech, delirium, coma occurs mainly in
elderly
Overweight 66 years old woman complaining of epigastric pain was diagnosed as
GERD

Q1: Mention lines of treatment of GERD?

Q2: Mention two types of prokinetic drugs?

Q3:Mention mechanism of action

Q4-Enumerate two adverse effects of metoclopramide?

Q1: Mention lines of treatment of GERD?

Non- Drug Therapy

1-Sleeping on a high pillow
2-Avoid: Large meals and eating before sleeping.
Alcohol, smoking, spicy foods and coffee.
Aspirin and NSAIDs.
Tight clothes around the abdomen.
3-Weight reduction
Drug therapy
1-Decreasing HCl secretion: (H2 blockers and proton pump inhibitors).
2-Prokinetic drugs.
3-Antacids and antacid combinations(Gaviscon).
4-Surgical treatment: if medical therapy failed.
Q2: Mention two types of prokinetic drugs?
1-Dopamine antagonists: Metoclopramide and Domperidone.

2-Serotonin (5-HT4) agonists: e.g. Mosapride

3-Cholinomimetic (M3 agonists): e.g. Bethanechol.

4-Macrolide antibiotics: e.g. Erythromycin

Q3:Mention mechanism of action metoclopramide?

Mechanism of action
↑ lower esophageal tone and enhances gastric emptying and upper GIT
motility through:
Blocking of dopamine (D) receptors (central & peripheral) leading to
decrease the inhibitory action of dopamine on the GIT motility.
Enhances cholinergic transmission in the GIT.
Q4-Enumerate two adverse effects of metoclopramide?

Adverse effects
1-Sedation (the most common).
2-Extrapyramidal effects (dystonia and dyskinesia): due to
blockade of D2 in the basal ganglia.
3-Hyperprolactinemia due to blockade of D2 in the pituitary
 Instructor information
• Contact: Sameh Ahmad Abdelghany
• Department: Clinical Pharmacology
• Official email: dr.samghany@gmail.com
• Mobile (optional): 01003798288
• Academic hours:
➢ Saturday: 10:00 AM-12:00 PM
 ‹#›

Review Q.1
A 36-year-old woman presents with a 2-day history of
diarrhea and abdominal pain following a weekend camping
trip. She appears acutely ill and is dehydrated. Physician
suspects may be giardiasis (Protozoal infection) from
contaminated water in camp and send stool sample for
analysis.
Q1:What are initial lines of treatment?

Q2:Write mechanism of action of Adsorbents ?

 ‹#›

Answer Q.1
A 36-year-old woman presents with a 2-day history of diarrhea and
abdominal pain following a weekend camping trip. She appears
acutely ill and is dehydrated. Physician suspects may be giardiasis
(Protozoal infection) from contaminated water in camp and send stool
sample for analysis.
Q1:What are initial lines of treatment?
▪ As the patient is dehydrated she needs ORS or if the case is severe IV fluids
can be given
▪ Also Antimicrobials like Metronidazole can be given till final diagnosis is
made
Q2:Write mechanism of action of Adsorbents ?
▪ They adsorb water, microoganisms and toxins.
▪ They coat the mucosa and protect it.
 ‹#›

Review Q.2
A 42-year-old man with ulcerative colitis is having a are in
symptoms with severe abdominal pain and bloody diarrhea
or the past 24 hours. He is being treated with sulfasalazine
but has not been compliant because of a persistent
annoying rash.
Q1:Write mechanism of action of sulfasalazine?

Q2:Write 2 side effects of synthetic opioids?

 ‹#›

Answer Review Q.2

A 42-year-old man with ulcerative colitis is having a are in symptoms with
severe abdominal pain and bloody diarrhea or the past 24 hours. He is being
treated with sulfasalazine but has not been compliant because of a persistent
annoying rash.
Q1:Write mechanism of action of sulfasalazine?
In the colon, the “azo” bond is broken by intestinal bacteria to release 5-ASA
and sulfapyridine: 5-ASA has anti-inflammatory and immunosuppressive,
while sulfapyridine is poorly absorbed sulfonamide with antibacterial action.
Q2:Write 2 side effects of synthetic opioids?
Anti-cholinergic side effects e.g. dry mouth.
Addiction: if used for prolonged duration.
 ‹#›

Review Q.3
A 32-year-old woman with the diagnosis o Crohn’s disease
initially had a good response to glucocorticoid therapy
with a one-year remission. However, despite
glucocorticoid therapy, she is now having frequent flares o
abdominal pain and bloody diarrhea.
Q1:What options are available for her treatment of this
relapse?

Q2:Write mechanism of action of Cholestyramine?

 ‹#›

Answer Review Q.3

A 32-year-old woman with the diagnosis o Crohn’s disease initially
had a good response to glucocorticoid therapy with a one-year
remission. However, despite glucocorticoid therapy, she is now
having frequent flares of abdominal pain and bloody diarrhea.
Q1:What options are available for her treatment of this relapse?
▪ Patients who relapse frequently may be treated with
immunosuppressive agents such as azathioprine-mercaptopurine.
▪ Infliximab is can be used in Crohn’s disease to ↓ TNFα.
Q2:Write mechanism of action of Cholestyramine?
it binds bile acids in the intestine preventing their absorption and
decreasing their irritation.
 ‹#›

Review Q.4
A 27-year-old woman with ulcerative colitis is being
treated with sulfasalazine
Q1:She should be closely monitored for which of the
following common adverse effects with this drug?
A. Hearing loss
B. Blood in her urine
C. Heart arrhythmia
D. Skin rash
E. Onset o seizures
Q2:Write mechanism of action of Bismuth
subsalicylate and Corticosteroids?
 ‹#›

Answer Review Q.4

A 27-year-old woman with ulcerative colitis is being treated with sulfasalazine
Q1:She should be closely monitored for which of the following common
adverse effects with this drug?
A. Hearing loss
B. Blood in her urine
C. Heart arrhythmia
D. Skin rash
E. Onset o seizures
 ‹#›

Q2:Write mechanism of action of Bismuth subsalicylate

and Corticosteroids?
▪ Bismuth: provides a protective coat for the mucosa
and binds toxins produced by pathogenic bacteria.
▪ Subsalicylate: hydrolyzed by intestinal bacteria into
salicylic acid →↓ intestinal inflammation,
hypermotility and secretions.
2. Corticosteroids
➢ Mechanism:
▪ Stimulation of Na+ absorption from the intestine.
▪ Anti-inflammatory action (see endocrine).
 ‹#›

Review Q.5
Caucasian male who presents to his primary care physician with
complaints of diarrhea approximately 5 times per day, abdominal
pain, and nausea for the past 4 days. Case diagnosed as traveler's
diarrhea
Q1:What is the most appropriate management of moderate
dehydration for this case?

Q2:Which empiric antibiotic regimen would you recommend

for this patient?
 ‹#›

Answer Review Q.5

Caucasian male who presents to his primary care physician with complaints of
diarrhea approximately 5 times per day, abdominal pain, and nausea for the past
4 days. Case diagnosed as traveler's diarrhea
Q1:What is the most appropriate management of moderate dehydration for
this case?
▪ Oral rehydration solution (ORS)
▪ first-line management of mild to moderate dehydration caused by diarrhea.
Q2:Which empiric antibiotic regimen would you recommend for this
patient?
Azithromycin or fluoroquinolone antibiotics are recommended empirically in
cases of travelers' diarrhea