Drug of Choice Cheatsheet — Gastro Focus (MRCP Part 1)

TL;DR

This drug of choice cheatsheet — gastroenterology focus (MRCP Part 1) condenses the essential pharmacotherapy questions that appear in the MRCP Part 1 exam. It highlights the first-line treatments for high-yield GI, hepatic, and biliary conditions with updated NICE and BNF guidance, mini-cases, and practical recall tips to boost your exam efficiency.

Why this matters

In MRCP Part 1, gastroenterology contributes a significant portion of clinical pharmacology questions. Examiners frequently ask for the single best drug for a given presentation rather than its mechanism or side effects. Mastering these “drug of choice” questions is a fast way to gain marks in scenarios that otherwise feel ambiguous.

This post is your quick-access, evidence-aligned reference, curated from MRCP(UK) patterns, NICE Clinical Knowledge Summaries, and the British National Formulary.

High-Yield “Drug of Choice” Table for MRCP Part 1

Clinical Scenario	Drug of Choice	Key MRCP Note
Helicobacter pylori eradication	PPI + Clarithromycin + Amoxicillin (or Metronidazole if penicillin-allergic)	7-day triple therapy; confirm eradication with urea breath test
Acute variceal bleed	IV Terlipressin	Combine with ceftriaxone and urgent endoscopic band ligation
Hepatic encephalopathy	Lactulose (± Rifaximin for recurrence)	Aim for 2–3 soft stools/day; avoid protein restriction
Wilson’s disease	Penicillamine	Monitor for cytopenia; zinc acetate for maintenance
Primary biliary cholangitis	Ursodeoxycholic acid	Improves survival; obeticholic acid if inadequate response
Ulcerative colitis (mild–moderate)	Mesalazine (5-ASA)	Use oral + rectal route for distal disease
Crohn’s flare	Oral Prednisolone	Budesonide for ileocaecal disease; azathioprine for maintenance
Severe alcoholic hepatitis	Prednisolone (if no infection)	Continue 4 weeks if Lille score < 0.45
Spontaneous bacterial peritonitis	Cefotaxime (or Ceftriaxone)	Treat ≥ 5 days; add albumin on day 1 & 3
Clostridioides difficile infection	Oral Vancomycin	Fidaxomicin second-line; avoid loperamide
Ascites (control)	Spironolactone (± Furosemide)	Maintain sodium < 2 g/day; monitor K⁺

Mnemonic clusters for rapid recall

1. “Liver – TLC” → Terlipressin, Lactulose, Cefotaxime.

2. “IBD – MAPS” → Mesalazine, Azathioprine, Prednisolone, Surgery.

3. “Infection – CAPS” → Clarithromycin, Amoxicillin, Penicillamine, Spironolactone.

Cluster-based mnemonics organise recall by system rather than by alphabet, a technique that enhances memory during timed MRCP questions.

Practical mini-case

Case: A 45-year-old woman with alcoholic liver disease presents with confusion and flapping tremor. Serum ammonia is raised, and she has mild ascites.

Question: What is the drug of choice for her confusion?

Answer:  Lactulose.

it acidifies the colon, reducing ammonia absorption. Rifaximin is adjunctive after recurrent episodes. Exam tip: MRCP distractors often include neomycin—historically used but now outdated.

Study-Tip Checklist

1. Group drugs by organ system — revise hepatic, intestinal, and biliary conditions separately.

2. Use repetition over time, not in one sitting. Space gastro recall every 3 days.

3. Prioritise therapeutic logic over memorising doses; MRCP tests “which drug”, not “how much”.

4. Integrate QBank practice: attempt at least 20 pharmacotherapy MCQs daily in the Free MRCP MCQs.

5. Use exam-time triggers: link symptoms (e.g., confusion → lactulose; variceal bleed → terlipressin).

6. Review current NICE antimicrobial updates to avoid outdated antibiotic regimens.

7. Test under time pressure: use the mock test simulator to rehearse rapid recognition.

   
   

Common pitfalls

• Confusing prophylaxis vs. treatment: propranolol prevents varices but doesn’t stop active bleeding — terlipressin does.

• Mixing Crohn’s and UC therapies: 5-ASA for UC induction; not effective for Crohn’s.

• Omitting dual antibiotics in H. pylori therapy: always triple therapy with a PPI.

• Choosing metronidazole alone for SBP: MRCP expects cefotaxime.

• Neglecting adjuncts: variceal bleed = drug + banding + antibiotic, not one alone.

  
  

FAQs

1. How can I memorise gastro “drug of choice” topics effectively for MRCP Part 1?

Use pattern recognition — group drugs by organ and pair each with a key symptom. Reinforce through spaced QBank drills.

2. Does MRCP Part 1 follow NICE or BNF drug guidance?

Predominantly BNF and NICE UK guidance, prioritising mainstream first-line therapy.

3. Is rifaximin first-line for hepatic encephalopathy?

No. Lactulose is first-line; rifaximin prevents recurrence after ≥ 2 episodes.

4. Should I memorise drug doses?

Only general awareness is required — the exam tests choice and mechanism, not exact dosing.

5. How many “drug of choice” questions appear in MRCP Part 1?

Roughly 10–12 % of questions assess pharmacotherapeutic judgement, often embedded in gastro and infectious cases.

Ready to start?

Consolidate these facts within your structured revision plan. Explore:

• The full MRCP Part 1 overview for subject-wise weightage and strategies.

• Hundreds of practice questions in the Free MRCP MCQs QBank.

• Exam-style simulations on the Mock Tests portal to sharpen recall speed.

Each minute spent mastering these high-yield “drug of choice” topics translates to real marks in the exam hall.

Sources

• MRCP(UK) Examination Blueprint

• British National Formulary – Gastrointestinal System

• NICE Clinical Knowledge Summaries – Gastroenterology Topics

• Liver disease management: NICE NG50