Gastrointestinal

Question 1

1. What is the standard (first line) regimen to treat H.pylori?
2. What treatment is used in penicillin allergy?

Answer 1

1. Standard dose PPI bd
   Clarithromycin 500mg bd
   Amoxicillin 1000mg bd
2. Replace amoxicillin with metronidazole 400mg bd

Question 2

Give three metoclopramide contraindications

Answer 2

1. Parkinson’s disease
2. Age <20 (increased EPSE risk)
3. GI obstruction/perforation

Question 3

1. Can aminosalicylates be used in pregnancy? What precaution should be considered?
2. Give 2 counselling points for sulfasalazine

Answer 3

1. Yes - safe in pregnancy. Aminosalicylates can impair folate absorption - provide folic acid supplementation (2-5mg daily).
2. Swallow CR tablets whole, allergic reaction, may cause discolouration (orange/yellow) to body fluids/skin, take with food, have regular blood tests (renal, hepatic)

Question 4

Describe the MOA and list the indication(s) for ursodeoxycholic acid

Answer 4

• Increases bile acid output and bile flow
• Used for chronic liver diseases e.g. Primary Biliary Cirrhosis, gallstones, obstetric cholestasis
• urso = bear, ursodeoxycholic acid = bear bile*

Question 5

Mercaptopurine
Class?
Indication?
Dose = 75mg od (70kg patient) - safe/appropriate?
Counselling - 2 points
Monitoring - 2 points

Answer 5

Class = (purine) antimetabolite/immunosuppressant
Indication = inflammatory bowel disease (also leukaemia, lymphoma… etc)
Dose = SAFE (range is 1.0-1.5mg/kg od, rounded to nearest 25mg)
Counselling - refer any signs of myelosuppression e.g. fever, infection, bleeding, bruising. Best taken on an empty stomach, cytotoxic (handling, disposal etc), photosensitivity, regular blood tests
Monitoring - TPMT (lol) when starting, hepatic, FBC, efficacy