DR.

JIGGAR’S SECTION (10-14 questions)

Pancreatic disorders in GIT (1 question): exocrine functions (lack of enzymes from pancreas).
“patient presents with pancreatic damage, what do you supply?” – pancrelipase: contains mix
of amylase, lipase and proteases.
“after taking the enzyme, what is the most common complaint?” – OROPHARYNGEAL
MUCOSITIS
“if person has taken enzyme for long time what do you check for?” – do endoscopy for COLONIC
STRICTURES.
(Pancrealipase also increases GOUT symptoms).

Pancrealipase is given along with ACID SUPPRESSION THERAPY: omeprazole or something. A drug that is
NOT GIVEN is sulcralfate (because it requires activation with stomach acid so you don’t give with acid
suppressant therapy.).
The pancrealipase must be given with acid suppressant to prevent damage in the stomach.

Most common drugs for acute pancreatitis: THIAZIDES, DIDANOSINE, STVUDINE, AZATHIOPRINE.

Obesity drugs: (4 questions)

“what is the site that drugs target for obesity?” – GIT or CNS (hypothalamus has satiety center).
Or you could increase oral expenditure by increasing SYMPATHETICOMIMETIC ACTION.
The drugs that work in GIT:
ORLISTAT: blocks the enzyme LIPASE. Most common complaint is STAINING (Because they come
with urgency). Adult person taking orlistat for long time you should supply VITAMINS (fat soluble vitamin
lacking: ADEK). Also if person is on WARFARIN for any reason, there is an increasing chance of BLEEDING
(Both against vitamin K). Orlistat is administered THREE TIMES a day (with meals). Drug is also useful for
hyperlipidemic patient, diabetic patient, and elderly!
Drugs that work in CNS:
5HT-2c drug, LORCASERIN. Also good for diabetics. It is a serotonin drug, so if you combine with
SSRIs, SNRIs or MAO inhibitors you have increasing chance of SEROTONIN SYNDROME. Lorcaserin mainly
increases signal in SATIETY CENTRE = less hunger, less intake of food.
Sympatheticomimentic drug:
PHENTERMINE: increasing the release of NE in the CNS. Also targets the reuptake channel.
Sympathetic activity is increased (basal tone increased) = INCREASES ENERGY EXPENDITURE. This drug is
absolutely contraindicated in anyone with cardiovascular disease (because major side effect is
HYPERTENSION and TACHYCARDIA).
Phentermine is combined with TOPERAMIDE (anti-seizure). Toperamide has side effect of
weight loss, so it potentiates (synergistic) when added with phentermine.
Other combo drug is Natrexone and bupropione
Liraglutide: GLP-1 AGONIST. So diabetic person you can combine this drug instead of
sulfonylurea.
Dronabinol: is an appetite STIMULANT – used for weight GAIN. Acts on the cannabinoid
receptors. Specifically used in people with HIV.
 Megestrol: also an appetite stimulant. Increased appetite is a SIDE EFFECT for this drug, so it is
sometimes used if person is underweight.

LIVER disease section (7 questions)

Dose dependant liver injury = methotrexate, amphetamine etc.
For gallbladder:
Orsodeoxycholic acid (Orsodiol): replaces the total cholesterol pool in the liver. Inhibits
cholesterol synthesis and secretion in intestine. SOLUBLIZES The GALLSTONES (but the stones must be
less than 20). LITHOPOLIC ACID is the toxic metabolite of this drug which can harm the liver.

For liver
Felabumate, acetaminophen, rifampin, terbinafine valproic acid, zafirlukast: these are drugs
known to cause LIVER INJURY. So must be careful when prescribing these drugs.

INTRINSIC HEPATOTOXIC INJURY: mainly hepatocellular, means increases the APL? Enzyme.
In idiosyncratic it is either METABOLIC (effects secretion of bilirubin) and HYPERSENSITIVITY.

Dircetly hepatotoxic drugs: acetaminophen, salicylates, statins, amiodarone, methotrexate, OCP and
alcohol (the drugs in the INTRINSIC HEPATOTOXIC (Type A) section.

TYPE B IDIOSYNCRATIOC = erythromycin etc. (just memorize this section).

Acetaminophen: txic metabolite TREATED with N-acetyl-Cysteine. Noramlly our liver has glutathione so
there is no production of metabolite. In OVERDOSE glutathione is limited and production of n-acetyl-p-
benzo-quinionne (NAPQIO (The toxic metabolite) is formed.
INH: does idiosyncratic damage becase of polymorphism in the enzyme. Produces hepatotoxins
Acetylsomethig. This is idiosyncratic type B drug.
Halothane: combined toxic, direct and allergic (both type A and type B because it is dose-dependant
AND there is hypersensitivity due to hapten). Halothane produces MALIGNANT HYPERTHERMIA
(halothane + SUCCINYLCHOLINE are the ones that cause malignant hyperthermia).
Asprin: REYE’S SYNDROME in children. Try to avoid children suffering from influenza to give asprin.
Instead you should give acetaminophen. It increases acidity so treat with ALKALZATION>
Alcohol: chronic alcohol and person wants to give it up, you can give de-addiction DISULFRAM which
inhibits aldehyde dehydrogenase. Aldehyde accumulates and gives syndromes. Naloxone also can be
used or acamprostate

PORTAL HYPERTENSION: give octreotide, vasopressin (less used), propranolol.

HEPATITIS: lamivudine and interferon.
WILSON DISEASE: antidote is penicillamine

Small bowel disorder (1-2 questions). [look at the list in the large bowel section].
Any kind of vomiting for any reason, the best drug is ondansetron. Ondansetron common side
effect is headache and dizziness. Can increase QTprolongation rarely.
In a psychological case you can use a dopamine kind of the drug – metoclopramide (D2 blocker)
is a PROKINETIC DRUG because it increase the peristaltic movement. Metoclopramide indicated in
chemo induced nausea/vomiting and GASTROPARESTIC (like in diabetes melitus). The metoclopramide
give extrapyramidal type symptoms. (sub domperidone to get less EPS). The increasing peristaltic
movement through ach by acting on the dopamine receptor. By increasing the movement, the content is
moving into intestine and reducing nausea/vomiting.
[ERYTHROMYCIN acts on MOTILIN receptor and this can also be helpful in gastroparesis patient.]
For motion sickness = scopolaamide. Person who also has allergy can use an antihistamine
(diphenhydrinate). H blocker for VERTIGO = meclizine.
Aprepitant: is specifically for NEUROKININ RECEPTOR – drug is for chemo-induced nausea and
vomiting as well.
In PREGNANCY (For morning sickness) you want to give doxylamine + B6.