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Old 01-25-2013
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Default Primary Biliary Cirrhosis

A 32-year-old woman presents with fatigue, pruritus, and yellowing of white of eyes. Investigations reveal anti-mitochondrial antibodies and elevated alkaline phosphatase (ALP), γ -glutamyl transpeptidase (GGTP) levels. Primary biliary cirrhosis is diagnosed, and she is treated with ursodeoxycholic acid, corticosteroids, and cholestyramine. One month later, she returns, complaining of abdominal discomfort and constipation, which resolves when she stops cholestyramine. However, the itching is severe when the drug is stopped. What drug may be used as an alternative to cholestyramine to relieve this patientís itching?

A) INH
2) Ethambutol
3)
Pyrazinamide
4)
Streptomycin
5) Rifampin

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Old 01-25-2013
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Originally Posted by SarahM View Post
A 32-year-old woman presents with fatigue, pruritus, and yellowing of white of eyes. Investigations reveal anti-mitochondrial antibodies and elevated alkaline phosphatase (ALP), γ -glutamyl transpeptidase (GGTP) levels. Primary biliary cirrhosis is diagnosed, and she is treated with ursodeoxycholic acid, corticosteroids, and cholestyramine. One month later, she returns, complaining of abdominal discomfort and constipation, which resolves when she stops cholestyramine. However, the itching is severe when the drug is stopped. What drug may be used as an alternative to cholestyramine to relieve this patientís itching?

A) INH
2) Ethambutol
3)
Pyrazinamide
4)
Streptomycin
5) Rifampin

rifampin ( exact moa is unclear
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Old 01-25-2013
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???.. Read those drugs in list never noticed used in itching.. Waiting for answer..
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Old 01-25-2013
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Default Rifampin

The correct answer is Rifampin.
as far as the MOA, i think it just induces P450 so you end metabolizing whatever caused the pruritis.
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Old 01-25-2013
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Originally Posted by SarahM View Post
The correct answer is Rifampin.
as far as the MOA, i think it just induces P450 so you end metabolizing whatever caused the pruritis.
pruritis in PBC is unrelated to bile acid deposition in skin;

inc. opiodergic tone contributes to itching; bilirubin levels is prop. related to endogenous opiod peptide production;

dronabinol can be used;

as for rifampin the current hypothesis is that it inhibits bile salt uptake by liver
favouring its excretion;

(SOURCE: MEDSCAPE)
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