Gastrointestinal Medications

Question 1

Name the class and suggest THREE ADRs with the use of drugs such as Ompremazole and Lansoprazole.

Answer 1

PPIs
Short term:
- GI disturbance (loose stools/diarrhoea)
- Headache

Long term:

• Nutritional deficiencies (B12 and magnesium)
• C.diff infection
• Increased # risk

Question 2

What advice will you give to a patient when prescribing a PPI?

Answer 2

• Lifestyle advice (stop smoking, healthy eating, less coffee etc.)
• Take right before food (acid pumps only active after eating)

Question 3

Name the class and suggest THREE ADRs with the use of drugs such as Cimetidine and Ranitidine.

Answer 3

H2-receptor antagonists:

• Diarrhoea
• Headache
• Dizziness
• Gynecomastia/impotence

Question 4

Name THREE medications that can cause dyspepsia.

Answer 4

- Non-steroidal anti-inflammatory drugs
(NSAIDs)
- Corticosteroids
- Calcium channel blockers (CCBs)
- Nitrates
- Theophyllines
- Bisphosphonates

Question 5

Describe the treatment for peptic ulcer disease with associated H.pylori infection in as much detail as possible.

Answer 5

• Lifestyle advice
• Triple therapy (one week, everything twice daily):
  + PPI (20/30mg)
  + Abx - Metronidazole (or amoxicillin) 400mg
  + Abx - Clarithromycin 250mg

Say you would refer to BNF and NICE guidance!

Question 6

Explain what is meant by proctitis/proctosigmoiditis in Ulcerative colitis and suggest how remission should be induced.

Answer 6

Proctitis/proctosigmoiditis refers to inflammation that is limited to just the rectum or just the rectum and sigmoid colon in UC.

Induction or remission in this presentation is most commonly achieved by:

• Topical ASAs (as it is limited to rectum), oral ASAs or combined therapy in mild to moderate disease
• Topical corticosteroids in those who ASAs are contraindicated
• Oral corticosteroids in subacute or in ASA failure