GI drugs

Question 1

Drugs which can cause dyspepsia

Answer 1

• NSAIDs – (Aspirin)
• Corticosteroids
• Calcium blockers (relax LOS -> regurgitation)
• Bisphosphonates (chemical)
• Nitrates (relax LOS -> regurgitation)
• Theophyllines

Question 2

Main stimuli for gastric acid secretion by parietal cells are:

Answer 2

– Gastrin
– Acetylcholine
– Histamine

Question 3

3 drug options for mucosal protection in PUD?

Answer 3

Prostaglandin analogue: eg misoprostol
Alginate: eg gaviscon
Chelates: eg Sucralfate

Question 4

Drugs to reduce acid secretion?

Answer 4

ranitidine and lansoprazole/omeprazole



Question 5

2 antacids:

Answer 5

aluminium and magnesium hydroxide

Question 6

SEs of H2 blockers (eg ranitidine):

Answer 6

nausea, rash, headache, diarrhoea, constipation

Question 7

SEs of PPIs:

Answer 7

headaches, abdo pains & diarrhoea (c.diff/infection in cirrhosis)

Question 8

Antimuscarinic drugs used as antispasmodics?

Answer 8

hyoscine bromide or propantheline bromide in IBS

Question 9

Drugs used in IBS and Diverticular disease?

Answer 9

mebeverine and peppermint oil

Question 10

Motility stimulants?

Answer 10

metoclopramide and domperidone (DA antagonist) in NUD

Question 11

Options for H. pylori testing?

Answer 11

– Endoscopic; CLO test, or biopsy
– Serology
– Radiolabeled Carbon13 Breath Test; confirm eradication

Question 12

Triple therapy (first line when +ve test):

Answer 12

– proton pump inhibitor (standard dose) twice daily + clarithromycin 500 mg twice daily + metronidazole 500 mg twice daily or amoxicillin 1000 mg twice daily, for seven, 10, or 14 days

Question 13

• Quadruple therapy: ( in areas with high clarithromycin resistance)

Answer 13

– proton pump inhibitor (standard dose) twice daily + metronidazole 500 mg three times daily + tetracycline 500 mg four times daily + bismuth subcitrate 120 mg four times daily, for seven, 10, or 14 days

Question 14

Third line treatment (when several attempts have failed)

Answer 14

– PPI (standard dose) twice daily + amoxicillin 1000 mg twice daily + levofloxacin 500 mg twice daily for 10 days

Question 15

Who to refer?

Answer 15

Patients of any age with dyspepsia when presenting with any of the following:
• Chronic gastrointestinal bleeding / iron deficiency anaemia
• Unintentional weight loss
• Dysphagia
• Persistent vomiting
• Epigastric mass
• Family history of gastric Ca
• Previous GI surgery

Question 16

Summary of dyspepsia management?

Answer 16

1st line Rx: PPI full dose
2nd line Rx: H2 antagonist or prokinetics
At any stage Rx positive Helicobacter pylori PPI and antibiotics Review after each Rx

Question 17

Categories of anti-emetics?

Answer 17

• Dopamine antagonists
• 5-HT3 antagonist
• H1 Receptor Blockers
• Anticholinergics
• Others

Question 18

When re dopamine antagonists used?

Answer 18

Used in neoplastic disease, radiation sickness, drug induced vomiting, general anaesthetics and cytotoxics
• Not effective for motion sickness

Question 19

Examples of dopamine antagonists?

Answer 19

Metoclopramide, Domperidone, Prochlorperazine

Question 20

D2 agonist SEs?

Answer 20

extrapyramidal specially in the young, elevate prolactin levels

Question 21

When is prochlorperazine used?

Answer 21

severe vertigo, labyrinthine disorders

Question 22

Which antiemetic helps increase gastric emptying, and is good for migraine?

Answer 22

metoclopramide

Question 23

Which anti-emetic class has:
• Gastric prokinetic activity
• Very effective but expensive
• Used in cytotoxic chemotherapy or radiotherapy
• Is well tolerated

Answer 23

5-HT3 Antagonists eg Ondansetron, Granisetron

Question 24

When is ondansetron used?

Answer 24

In gastroparesis assoc’d with nausea/vomiting

Question 25

SEs of 5HT3 antagonists?

Answer 25

constipation , rash, flushing, headache, hypersensitivity reaction

Question 26

Which drugs are useful for any cause of N&V mainly in vestibular disorders e.g vertigo, tinnitus, Meniere’s disease, motion sickness?

Answer 26

Antihistamines (eg. cinnarizine, cyclizine)

Question 27

SEs of cyclizine/antihistamine anti-emetics

Answer 27

drowsiness, dry mouth, sometimes blurred vision

Question 28

Which anti-emetics are used in motion sickness, premedication, pallative care?

Answer 28

Anti cholinergics

Question 29

Which drug is an e.g. of an anti-cholinergic anti-emetic?

Answer 29

Hyoscine bromide

Question 30

SEs of hyoscine?

Answer 30

– Drowsiness, blurred vision, difficulty with micturition, dry mouth

Question 31

Which anti-emetic is used to enhance other agents in Chemotherapy?

Answer 31

Corticosteriods eg dexamethasone.

Nabilone sometimes used in chemo (specialist)

Question 32

Which drug used in an anxious patient with nausea/vomiting?

Answer 32

Benzodiazepines (anxiolytic and hypnotic)

Question 33

Management of a GI bleed?

Answer 33

• Protect airway, give 100%O2
• 2 large-bore cannulae for IVI access
• Bloods for FBC,U&E,LFT, glucose, clotting, cross-match 6 units
• IV colloid whilst waiting for blood, (O Rh-ve)
• CVP, urinary catheter,
Contact HCU/ITU
• 15 mins vital obs, including pulse, BP, CVP, UO
• Urgent endoscopy
• If risk of rebleed then iv PPI infusion
• Surgical intervention

Question 34

Management of a variceal haemorrhage?

Answer 34

Resuscitate as before
• Correct clotting Vit K, FFP, platelets
• Antibiotics
• Terlipressin bolus or (Octreotide infusion) (no evidence that one is better than the other)
• Urgent endoscopy and band ligation
• Intubate (grade III-IV encephalopathy)
• Balloon Tamponade

Question 35

Other interventions and drugs used post oesoph. variceal bleeding (sec. prevention)?

Answer 35

TIPS (transjugular intraheptic portal shunting)
• Propranolol
• Isosorbide mononitrate