GI Flashcards
Name 13 drugs that can cause hepatotoxicity
Diabetic (pioglitazone, sulfonylureas)
Immunosuppressants (ciclosporin, methotrexate)
Anti epileptics (sodium valproate, phenytoin, sodium valproate)
TB meds (rifampicin, isoniazid, pyrazinamide)
Anaesthetic (halothane)
Cardiac (statins, amiodarone)
isotretinoin
What 2 antiemetics should be avoided in parkinson’s?
Levomapromazine
Metoclopramide
Give extrapyramidal SE
Management of C.diff?
1st line: oral metronidazole
2nd line: oral vancomycin
3rd line: IV metronidazole + oral vanc
In pain management for someone with peptic ulcer disease, which NSAIDs are best?
Celecoxib (COX-2) (but thrombosis risk)
Ibuprofen
Cutaneous SE of sulfasalazine
Yellow-orange skin discolouration
H pylori eradication?
PPI + clarithromycin + amox/metronidazole
not clari if recent macrolide use
What advise would you give to someone taking creon?
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
What drugs are most affected in obstructive jaundice?
Drugs that are excreted in bile
Rifampicin and fusidic acid
Which 2 drugs are most affected by hypoproteinaemia?
Highly protein bound drugs, less protein, increased toxicity
Prednisolone, phenytoin
What are the main issues in pts with hepatic impairment to be aware of when prescribing?
Bile excretion (obstruction?) Protein binding (low albumin) Clotting (lack of clotting factors) Fluid retention Hepatotoxicity
Which drugs should be avoided in ascites?
NSAIDs and corticosteroids (they cause fluid retention)
Should NSAIDs be prescribed in severe liver disease?
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
Should propranolol be prescribed in severe liver disease?
Yes, prophylaxis of variceal bleeding
Should ACEi be prescribed in severe liver failure?
No, contraindicated
Need RAAS system activation to maintain peripheral vasc resistance
Hypotension-> renal failure
Also leads to hyperkalaemia
Should thiamine be prescribed in severe liver failure?
Yes, crucial
Prevents Wernicke’s encephalopathy and Korsakoff’s psychosis
Which tests show liver function?
Prothrombin time
Albumin
Bilirubin
Which antibiotics can cause hepatitis and cholestatic jaundice?
Flucloxicillin
Co-amoxiclav
Which are more effective in GORD: PPIs or H2 antagonists?
PPIs
What should happen with GORD in pregnancy?
1st line: diet and lifestyle
2nd line: antacid or alginate
3rd line: ranitidine
4th line: omeprazole if severe
Management of flatulence
Simeticone
Added to antacid
Also used for hiccups in palliative care
Name 3 antispasmodics
Peppermint oil
Alverine citrate
Meberverine hydrochloride
Describe IBS management
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
List some common drugs that can cause constipation
Ferrous fumerate
Codeine
Hyoscine butylbromide
