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Flashcards in GI Deck (23):
1

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

2

What 2 antiemetics should be avoided in parkinson's?

Levomapromazine
Metoclopramide
Give extrapyramidal SE

3

Management of C.diff?

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

4

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

Celecoxib (COX-2) (but thrombosis risk)
Ibuprofen

5

Cutaneous SE of sulfasalazine

Yellow-orange skin discolouration

6

H pylori eradication?

PPI + clarithromycin + amox/metronidazole
(not clari if recent macrolide use)

7

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

8

What drugs are most affected in obstructive jaundice?

Drugs that are excreted in bile
Rifampicin and fusidic acid

9

Which 2 drugs are most affected by hypoproteinaemia?

Highly protein bound drugs, less protein, increased toxicity
Prednisolone, phenytoin

10

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

11

Which drugs should be avoided in ascites?

NSAIDs and corticosteroids (they cause fluid retention)

12

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

13

Should propranolol be prescribed in severe liver disease?

Yes, prophylaxis of variceal bleeding

14

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

15

Should thiamine be prescribed in severe liver failure?

Yes, crucial
Prevents Wernicke's encephalopathy and Korsakoff's psychosis

16

Which tests show liver function?

Prothrombin time
Albumin
Bilirubin

17

Which antibiotics can cause hepatitis and cholestatic jaundice?

Flucloxicillin
Co-amoxiclav

18

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

PPIs

19

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

20

Management of flatulence

Simeticone
Added to antacid
Also used for hiccups in palliative care

21

Name 3 antispasmodics

Peppermint oil
Alverine citrate
Meberverine hydrochloride

22

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

23

List some common drugs that can cause constipation

Ferrous fumerate
Codeine
Hyoscine butylbromide