GI

Question 1

Name 13 drugs that can cause hepatotoxicity

Answer 1

Diabetic (pioglitazone, sulfonylureas)
Immunosuppressants (ciclosporin, methotrexate)
Anti epileptics (sodium valproate, phenytoin, sodium valproate)
TB meds (rifampicin, isoniazid, pyrazinamide)
Anaesthetic (halothane)
Cardiac (statins, amiodarone)
isotretinoin

Question 2

What 2 antiemetics should be avoided in parkinson’s?

Answer 2

Levomapromazine
Metoclopramide
Give extrapyramidal SE

Question 3

Management of C.diff?

Answer 3

1st line: oral metronidazole
2nd line: oral vancomycin
3rd line: IV metronidazole + oral vanc

Question 4

In pain management for someone with peptic ulcer disease, which NSAIDs are best?

Answer 4

Celecoxib (COX-2) (but thrombosis risk)

Ibuprofen

Question 5

Cutaneous SE of sulfasalazine

Answer 5

Yellow-orange skin discolouration

Question 6

H pylori eradication?

Answer 6

PPI + clarithromycin + amox/metronidazole

not clari if recent macrolide use

Question 7

What advise would you give to someone taking creon?

Answer 7

Take with food
Avoid hot food and drink
Mix with food and take immediately
Any food with creon mixed in must be discarded after 1hr

Question 8

What drugs are most affected in obstructive jaundice?

Answer 8

Drugs that are excreted in bile

Rifampicin and fusidic acid

Question 9

Which 2 drugs are most affected by hypoproteinaemia?

Answer 9

Highly protein bound drugs, less protein, increased toxicity

Prednisolone, phenytoin

Question 10

What are the main issues in pts with hepatic impairment to be aware of when prescribing?

Answer 10

Bile excretion (obstruction?)
Protein binding (low albumin)
Clotting (lack of clotting factors)
Fluid retention
Hepatotoxicity

Question 11

Which drugs should be avoided in ascites?

Answer 11

NSAIDs and corticosteroids (they cause fluid retention)

Question 12

Should NSAIDs be prescribed in severe liver disease?

Answer 12

No, contraindicated
Can worsen liver and renal function
Prostacyclins are needed for renal blood flow, NSAIDs reduce prostacyclins, reducing renal blood flow and leading to AKI
Hepatotoxicity & cholestatic hepatitis

Question 13

Should propranolol be prescribed in severe liver disease?

Answer 13

Yes, prophylaxis of variceal bleeding

Question 14

Should ACEi be prescribed in severe liver failure?

Answer 14

No, contraindicated
Need RAAS system activation to maintain peripheral vasc resistance
Hypotension-> renal failure
Also leads to hyperkalaemia

Question 15

Should thiamine be prescribed in severe liver failure?

Answer 15

Yes, crucial

Prevents Wernicke’s encephalopathy and Korsakoff’s psychosis

Question 16

Which tests show liver function?

Answer 16

Prothrombin time
Albumin
Bilirubin

Question 17

Which antibiotics can cause hepatitis and cholestatic jaundice?

Answer 17

Flucloxicillin

Co-amoxiclav

Question 18

Which are more effective in GORD: PPIs or H2 antagonists?

Answer 18

PPIs

Question 19

What should happen with GORD in pregnancy?

Answer 19

1st line: diet and lifestyle
2nd line: antacid or alginate
3rd line: ranitidine
4th line: omeprazole if severe

Question 20

Management of flatulence

Answer 20

Simeticone
Added to antacid
Also used for hiccups in palliative care

Question 21

Name 3 antispasmodics

Answer 21

Peppermint oil
Alverine citrate
Meberverine hydrochloride

Question 22

Describe IBS management

Answer 22

Diet (reduce fizzy and caffeinated drinks, increase water and oats, avoid sorbitol)
Probiotics? 4 weeks
Antispasmodics (alverine)
Laxatives if constipation, loperamide if diarrhoea
Low dose amitriptyline for abdo pain or SSRI
CBT

Question 23

List some common drugs that can cause constipation

Answer 23

Ferrous fumerate
Codeine
Hyoscine butylbromide