Gastroenterology
Drug-Induced GI Disease
Gastroenterology

Drug-Induced GI Disease

Constipation, ulcer/perf, hepatitis, pancreatitis, esophagitis.

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◆Motility changes

  • •Opioids → constipation. Tx: osmotic laxatives (PEG), cathartics (Mg citrate), softeners (docusate)
  • •Anticholinergics (diphenhydramine, oxybutynin, amitriptyline) → constipation, fecal impaction
  • •Chronic laxative abuse (eating disorders) → hypoK + arrhythmias

◆NSAID/aspirin GI injury

  • •Inhibit prostaglandin → loss of mucosal barrier
  • •Gastritis, PUD, perforation
  • •Painless diverticular hemorrhage in elderly

◆Drug-induced hepatitis

  • •Acetaminophen overdose → centrilobular necrosis → N-acetylcysteine
  • •Isoniazid → ↑AST/ALT without ↑bilirubin; also B6 deficiency
  • •Valproic acid → hyperammonemia + hepatotoxicity

◆Drug-induced pancreatitis (I GET SMASHED)

  • •Thiazides, loop diuretics, sulfa, valproate, azathioprine, didanosine

◆Pill esophagitis culprits

  • •NSAIDs, tetracyclines, bisphosphonates, KCl, iron
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