Pharmacotherapy of Respiratory, Gastrointestinal, and Hepatic Disorders
What the exam tests
Respiratory, gastrointestinal and hepatic questions test stepwise therapy, inhaler technique, acid suppression, eradication regimens and cirrhosis complications. The examiner wants the next best step and the monitoring that goes with it.
Core rules
- Asthma: ICS-containing therapy is mandatory. Use ICS–formoterol as maintenance and reliever in selected patients; never use a LABA alone. Assess adherence, inhaler technique and triggers before stepping up.
- COPD: bronchodilators are the base; add inhaled corticosteroid only for frequent exacerbations or eosinophilia. Smoking cessation is the only intervention that changes disease course.
- GERD: a PPI taken 30–60 minutes before the first meal; a trial of eight weeks is standard. Avoid long-term PPI without indication.
- H. pylori: quadruple therapy with a PPI, bismuth, tetracycline and metronidazole for 14 days where resistance is high; confirm eradication at least four weeks after antibiotics.
- Cirrhosis: spironolactone plus furosemide for ascites; lactulose titrated to two or three soft stools daily for encephalopathy; rifaximin for recurrent episodes.
Worked example
A 58-year-old with cirrhosis and ascites gains 4 kg and has a tense abdomen. Start spironolactone 100 mg and furosemide 40 mg daily, restrict sodium and monitor weight, renal function and potassium. Avoid NSAIDs. If ascites is refractory, refer for paracentesis and consider a TIPS assessment.
Traps
Prescribing a PPI at bedtime; using LABA monotherapy in asthma; continuing H. pylori therapy without confirming eradication; giving NSAIDs in cirrhosis; titrating lactulose until diarrhea; forgetting to check inhaler technique.