All are drugs causing cholestasis with inflammation of bile ducts: , EXCEPT:
**Core Concept**
Cholestasis refers to the reduction or stoppage of bile flow from the liver to the duodenum, often resulting in inflammation of the bile ducts. Certain drugs can cause cholestasis by damaging the bile duct epithelium or affecting bile secretion and transport.
**Why the Correct Answer is Right**
Cholestasis with inflammation of bile ducts is a known side effect of certain drugs, particularly those that affect the liver or biliary system. Drugs like rifampicin (A) and amiodarone (C) can cause cholestasis through direct toxicity to the bile duct epithelium or by affecting bile secretion. The mechanism involves the inhibition of bile salt export pumps (BSEP) and other transporters in the bile ducts, leading to accumulation of bile salts and subsequent inflammation.
**Why Each Wrong Option is Incorrect**
**Option B:** This option is incorrect because ursodeoxycholic acid (UDCA) is actually used to treat cholestasis, not cause it. UDCA works by reducing the toxicity of bile salts and improving bile flow.
**Option A:** Rifampicin can cause cholestasis, particularly in patients with underlying liver disease. It inhibits the bile salt export pump (BSEP) and other transporters, leading to the accumulation of bile salts and inflammation of the bile ducts.
**Option C:** Amiodarone can also cause cholestasis, particularly in patients with underlying liver disease. The mechanism involves direct toxicity to the bile duct epithelium and inhibition of bile secretion.
**Clinical Pearl / High-Yield Fact**
When prescribing medications, it's essential to consider their potential side effects on the liver and biliary system, particularly in patients with underlying liver disease. Ursodeoxycholic acid (UDCA) is a useful medication for treating cholestasis, but it's not a cause of it.
**Correct Answer: B. Ursodeoxycholic acid (UDCA)**